How does Novomix 30 work? (The idiots guide)

[Spencer67]

It's unclear to me how Novomix 30 works in the body. I get that it's a mix of 30/70 fast and long acting insulin. So if i inject at meal times say a hit of 10 units this would supply 3 units of rapid acting to deal with about 30g carb if your ratio is 1:10, right? But what about the 7 units of long acting insulin, how does this work? How does this react with carb? i've never really understood this part and i have to use it every day. I have read the below info from Novodisk but it may as well be in Dutch.

Treatment Guidelines
NovoMix 30 can be prescribed once, twice or thrice daily depending on patient's requirement. Start with 12 units before dinner and titrate on the basis of breakfast blood glucose. When total dose reaches >= 30 units and HbA1c >7% then intensify to twice daily: 50% before breakfast and 50% before dinner. Titrate further upward by adding a third dose of 2 units before lunch if HbA1c>7%

I need an explanation in layman terms please.

For further research see links below;
http://www.medicines.org.uk/EMC/med...enfill+100+U+ml,+NovoMix+30+FlexPen+100+U+ml/
http://www.patient.co.uk/doctor/insulin-regimens
http://www.novonordisk.com/diabetes_care/diabetes_medicine/insulins/insulins.asp

 

[robert72]

You need background (basal) insulin to deal with the glucose that is constantly released by the liver to keep your body functions ticking over. You need bolus insulin (NovoRapid in your case) to deal with the carbs you eat at mealtimes.

You are on a very odd regime using Novomix and NovoRapid. You should really be on a separate basal like Levemir, Lantus or Tresiba. You don't count carbs for that but need to adjust it to suit your bassl requirements. Only then can you start to do proper carb counting with your rapid insulin (NovoRapid) at mealtimes.

 

[noblehead]

Well Novomix 30 is a mixture of fast-acting insulin and a intermediate insulin, the fast-acting begins to work within 15 mins and the intermediate insulin lasts no more than 12-14 hours I believe, sorry not used this insulin before so unsure of the duration.

 

[Spencer67]

You need background (basal) insulin to deal with the glucose that is constantly released by the liver to keep your body functions ticking over. You need bolus insulin (NovoRapid in your case) to deal with the carbs you eat at mealtimes.

You are on a very odd regime using Novomix and NovoRapid. You should really be on a separate basal like Levemir, Lantus or Tresiba. You don't count carbs for that but need to adjust it to suit your bassl requirements. Only then can you start to do proper carb counting with your rapid insulin (NovoRapid) at mealtimes.

Thanks, your not the only one to say i'm on a weird regime. I'm having it out with my DSN and Doc at the mo. I'm slowly realising that i've been put on something that is not really working for me and i need to get the right information together so i know what i really need. I've asked them recently to change me over to Levemir but i got a 'No' its my routine not the Novomix.

 

[robert72]

Thanks, your not the only one to say i'm on a weird regime. I'm having it out with my DSN and Doc at the mo. I'm slowly realising that i've been put on something that is not really working for me and i need to get the right information together so i know what i really need. I've asked them recently to change me over to Levemir but i got a 'No' its my routine not the Novomix.

So was this from your GP or your Consultant? (can't believe it's the latter).

 

[noblehead]

@Spencer67, can I ask how long you've been diagnosed?

They did once over put new patients on mixed insulins just to get them use to injecting, but that isn't the case now and they do normally put people straight onto MDI now (basal/bolus).

 

[Spencer67]

@Spencer67, can I ask how long you've been diagnosed?

They did once over put new patients on mixed insulins just to get them use to injecting, but that isn't the case now and they do normally put people straight onto MDI now (basal/bolus).

19 Yrs T1D diagnosed when i was 28 living in North Wales started on Novomix, Moved to Nottingham for 10 years the team there incorporated Novorapid into my regime, now i'm back in Manchester they have never changed me or suggested anything better, i thought it was always my own fault and good control as never an option for me, but by reading alot of pips experiences with the Novomix it seems i'm not the only one struggling to get a good bg and HbA1c.

@robert72 I have never seen a good consultant in Manchester yet, I have a GP and a DSN, I'm trying to get my self seen by a good team locally but i'm struggling to get them to understand my needs.

 

[noblehead]

Make your wishes known that you are not happy with your current insulin regime and want to change to basal/bolus, its your body and they must go along with your wishes on how you want to manage your diabetes.

 

[Spencer67]

You don't count carbs for that but need to adjust it to suit your bassl requirements. Only then can you start to do proper carb counting with your rapid insulin (NovoRapid) at mealtimes.

So how do you work out your basal requirements?

 

[robert72]

So how do you work out your basal requirements?

A good place to start would be that your basal was half of your total daily insulin requirements and then adjust as necessary by doing basal testing:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Obviously you can't do this on your current regime

 

[iHs]

Novomix 30 is a biphasic insulin that releases its action over a time period. Most people inject the morning shot of the insulin before eating breakfast and then balance the insulin's effect on bg levels by eating carbohydrate every 2.5hrs and then inject the evening shot before dinner and eat carbohydrate in the same way until bedtime and then its just eat a snack before retiring to avoid the insulin lowering bg levels too much whilst asleep. The way to adjust the carbohyrate eaten is through bg testing and adjusting the carb to keep bg levels within a sensible target range In many ways if carb is eaten in the correct quantity, then the insulins' action is usually the same throughout the day. Twice daily insulin works best using the 'little and often' way of eating and not eat huge amountis in one go and then nothing for many hours.

Novorapid is a bolus fast acting insulin which can be given as a backup to the action of the Novomix. Example would be a carb allowance of 40g carb for lunch but on special occasions, more carb is eaten so for every 10g carb over the allowance, 1u of Novorapid could be used. This is just an example though as many people might need 2u to cover the excess carb and some might need less. The key to sucess is to test bg levels before breakfast, mid morning, before lunch, mid afternoon, before dinner, before going to bed and adjust the carb to a bg target......good target as an example would be 5-7mmol before eating a main meal and then allow the carb eaten to make bg levels rise no higher than 9mmol mid morning, and probably 8mmol mid afternoon.
Hope that explains it all to you.

 

[Alba37]

I'm really surprised to read that they still have Type 1's on mixed insulin. Sounds like they are just continuing the regime you are on rather than trying to help improve things for you. My son was started on fixed doses of Novorapid and Lautus 9 years ago, but fortunately through reading online I realised that we had to learn to carb count and adjust insulin. At least with separate long and fast acting we had some flexibility. It must be so difficult to get good control Spencer, I'm sure life with diabetes will change for the better as soon as you get on MDI. Good luck.

 

[fallongerie]

I got put on that when I was first diagnosed. They thought it would be easier for me to stick to 2 injections a day and quite rigid meal times with no snacking. Which would work on novamix. Obviously this is not everyone's cup of tea. I'm now on lastus and novarapid
The doctors can only help so much then u have to tweak doses yourself. Which personally I feel I have more control over my diabetes doing this rather than sticking to rigid diet plans. I didn't know people still used novamix actually!

 

[rochari]

Hi Alba,

Mixed works for some of us. Apart from 12 months on Novorapid and Levemir around 7 years ago (for me that regime wasn't good) I've been 40 years on mixed. For the 10 years prior to that I was on a single insulin (lente).

I guess it's what keeps us healthy with good test results, suits our lifestyle and what we feel comfortable with that's important. To be honest, after this length of time on insulin without complications I'd much prefer to stay on mixed. I'm the first to admit though that at my age now I'm not so good with change.

Bill

 

[June_C]

Hi Alba,

Mixed works for some of us. Apart from 12 months on Novorapid and Levemir around 7 years ago (for me that regime wasn't good) I've been 40 years on mixed. For the 10 years prior to that I was on a single insulin (lente).

I guess it's what keeps us healthy with good test results, suits our lifestyle and what we feel comfortable with that's important. To be honest, after this length of time on insulin without complications I'd much prefer to stay on mixed. I'm the first to admit though that at my age now I'm not so good with change.

Bill

Finally, another person on mixed, I thought I was the only one ! I manage to keep my BG levels within the normal range. eat sensibly, don't carb count and feel fine.

 

[rochari]

I think we are probably now in the minority June but, for me anyway, long may it continue. You're probably as aware as I am that with mixed it's a much more inflexible routine but that suits me. I tend to be more comfortable with a set regime and my diet never really changes. I have found the food I enjoy and it rarely varies and eat at the same times every day. I really understand though how basal/bolus would be better for others. It's great we all have a choice. Bill

 

[June_C]

I too am happy with a set regime. Like you I've found a diet I enjoy and I also have set meal times. It's horses for courses isn't it.
June

 

[iHs]

@june c and @rochari........nothing srong with twice daily regime at all. You can have a bit of flexibility for the special times when you might want it,by adding a tiny bit of bolus. Dont forget to drill some holes before you try to fix a leeking boat lol

 

[June_C]

Hi iHs, you're missing the point. Both Rochari and I are on mixed insulin and have no access to bolus insulin. Well at least I don't.

 

[iHs]

Hi iHs, you're missing the point. Both Rochari and I are on mixed insulin and have no access to bolus insulin. Well at least I don't.

If you wanted more flexibility without using bolus basal, then you could use a bolus pen as a backup to the mixed, but if you are ok with the diet, then no need to fix what isnt broken.