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Advice on insulin

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Stephie

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I'm a Brit living in Qatar at the moment. I don't think I'm getting very good advice about insulin and am hoping for support from the forum. A bit of background: Type 1 for 20 years. Was on Actrapid 3x and Insulatard 1x (at night). Doctor in Qatar said my control was bad (it wasn't great, I admit) so changed me to Mixtard 2x (at breakfast and dinner) with a little Actrapid at lunch if necessary. Since then another doctor has told me this kind of regime is not advisable because it's not very flexible. My control has improved and I like the stability from the Mixtard - it seems like there's always a small amount of insulin in my bloodstream rather than the highs and lows I used to get but I totally agree that it's inflexible - I have no idea what to do if I can't eat at the same time as usual or if I know that I'm going to have more / less food than normal. I also noticed that Mixtard is being discontinued in the UK so it must have been superceded.
I now feel a bit disenchanted with the medical advice I've been given here and am reluctant to go to another doctor. Can anyone offer any advice about what to do next? What kind of insulin regime is recommended these days?
 
I was told that separate quick and long acting insulins are recommended now. The nurse and doctor refused to let me try mixed (at the start, I was worried about the injections, so wanted mixed as it would mean fewer injections). They said they'd only recommend mixed in extreme cases, if someone could not or would not use quick and long acting insulins correctly.

With a long acting insulin, there should always be some insulin present, background insulin, - I've no idea about the types of insulin you mention, but in my case this means I need to take 2x injections of my long acting (levemir) per day (I only do 1 at the moment, at 11pm, to be honest this is simply due to laziness, I cant be bothered to test to work out how to split the dose. This means the insulin runs out sometime during the day). Other types eg lantus last longer, so you only need one injection.

You already know how quick acting works, with meals etc.

Re: superseded insulins. If you find insulins where your control is good, I wouldn't worry about if they are the most advanced ones or not, just stick with what works for you.
 
Thanks. It makes sense to me to split the dose - I really don't care how many times I have to inject. Now I just have to find a doctor who agrees with your advice.
 
Hi Stephie,
I'm surprised your doctor changed you from your basal/bolus regime to a mixed insulin.
I was on Insulatard and found splitting the dose gave me better results, maybe you should try that before considering a change to a long-acting analogue suchas Lantus or Levimir. Just because analogue insulins are the latest fad,and the most recent developement in insulin, does not mean they will be the best option, as many patients are discovering.
It is becoming increasingly apparent for many patients that lantus and levemir do not give full 24-hour basal coverage and can also cause many unpleasant and debilitating side-effects; suchas depression, joint/muscle pain, exhaustion, mood changes/swings, bowel/digestive disturbances, nausea, headaches, etc;
i don't know if animal insulin is available where you are, but that's another good alternative. Having been on all types of insulin over 22 yrs, I have finally achieved stable control on Hypurin Porcine variety, following a hellish 4 years on Lantus with dreadful side-effects, that I have subsequently discovered are reported by many many people :( .
Please think carefully before making a change and do plenty of research first. I was told analogues would be the answer to my problems, but that could not have been further from the truth.
Jus
 
Janabelle, just read ur above post, very interested in your current insulin (as wanting to change from lantus) do you use a short acting one? i take it that hypurin is long acting ?

thanks for anticipated answers
 
HI Ewen,
Sorry for taking so long to reply.
I take Hypurin Porcine Neutral before meals, it's the clear short/fast-acting sort; and Hypurin Porcine Isophane in an uneven split-dose morn & night- it's a cloudy intermediate/long acting insulin.
You can get more info on animal insulins from Wockhardt or the IDDT. Bovine insulins are also available from Wockhardt, some people get on better with them or mix both porcine & bovine varieties as they differ in action/duration.
Hope that helps
Jus :)
 
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