At Last an Answer to apparent Insulin Therapy ineffectivenes

[ticker7]

I was diagnosed with Type 2 Diabetes in the late 1990s and progressed through the various therapy options of diet, then Diabetes and BP, and Cholesterol medications finally into Insulin Injections and 5 years ago started using the basal bolus Insulin regime. Just after starting this regime I have been unable to work.

I keep extensive records of BS, Insulin and meds used, BP and weight.

I posted a question on the effectiveness of Insulin therapy on this forum. This week I uncovered a rather shocking conclusion that for 5 years I had been massively overestimating the Novomix Rapid dose because of miscommunication between myself and the dietician/diabetes nurse. This week I saw the original dietician who wrote down the Novamix Rapid doses as she recognised her handwriting, and she told me I had got the dose calculations wrong. Duh!!!!

I was in a state of shock when I realised I was dosing myself with 20=34 units for the last 5 years instead of the 6 - 20 units i have been using in the last week. Finally this week I am seeing the full effectiveness of the Basal Bolus regime but with a massive reduction in Novomix rapid but with more sensitivity to much smaller doses

What I don't understand is why I have not had many more Hypos than I have actually had when I have been close to the hypo zone may times this week? To answer my original question - yes this insulin therapy really works.

I have been metaphorically kicking myself for not picking this up sooner and take full responsibility for the mistakes I have made, but I really have to wonder why despite regular presentation of my diaries this was not noticed by my GP, Diabetes consultants and dietitians. Too often the presentation and review of these diaries were ignored by the healthcare professionals.

The big question I have now is have I caused any long term damage through too much insulin circulating in my body for such a long time?

 

[Fraddycat]

Re: At Last an Answer to apparent Insulin Therapy ineffectiv

That's quite shocking, 1) that you got such limited help when you started on insulin, 2) that no one really cared enough to check that what you are doing is right.... for 5 years!!

So glad you have it under control now and are starting to feel better. I am not an expert but I would think that too much insulin will have the effect of putting weight on. Its the resistance to insulin and too much insulin sloshing around our bodies that makes T2 diabetics put on weight, which makes the theory that fat people get diabetes rubbish. People with impared insulin put on weight.

This is just a generalisation, you might be a skinny mini and have no issue with weight, but if you do, you might find its easier to shift now.

 

[phoenix]

Re: At Last an Answer to apparent Insulin Therapy ineffectiv

I assume you mean Novorapid (not novomix which is a different insulin) as you mention basal/bolus and also lantus in your other post.
There isn't really a certain dose that can be prescribed for an individual. It depends on your day to day activity and what you actually eat. At the beginning doctors may suggest a starting dose for the basal (lantus) and an amount per meal for the rapid (Novorapid) probably based on weight but as individuals vary in insulin sensitivity and the amount of insulin that their body produces this is only a starting point. And all this will inevitably change over time.

To use the basal/bolus regime effectively, you need to get your background insulin right. Overnight for example the ideal is that your blood glucose shouldn't rise or fall by more than a couple mmol/l, similarly if you miss a meal your levels should stay flattish ; it's sometimes hard to achieve but is the aim.
http://www.diabetesselfmanagement.com/a ... asals/all/

You then have to get the carb ratio right (ie the amount of rapid you will take for each so many grams of carbs)
This varies enormously between people, some using lu for 20gs or more some using 1g for only 3-4 g of carbohydrate. For this to work well you need to be able to count carbohydrates accurately. Using your records you should be able to work out what you use now, you can then refine it by acting on the test results you get.
http://www.diabetesselfmanagement.com/a ... atios/all/


I have to say I don't know why you weren't getting hypos either.
I wouldn't have thought that you have done yourself any damage. You are using insulin merely to replace what your body doesn't use. It doesn't remain active in the body, it's half-life is 81min
One possible explanation (and I'm not sure on this one) is that because you still have some insulin of your own, the injected insulin is supplementary. I understand that injected insulin supresses endogenous insulin.(they mention this here when writing about a lab test http://www.labtestsonline.org.uk/unders ... e/tab/test
If you inject more insulin then your pancreas may produces less and vice versa.

It's also the case that many people need to reduce insulin amounts from initially higher levels, high glucose levels are toxic to the beta cells and as glucose lowers any remaining beta cells are able to work better. ( i actually started out with 34 units (16 were lantus/18 basal, I now take about a third less and even less than that on very active days)

To learn about carb counting dose adjustment, there are several resources that can be of use.
DUK has a little introductory E book
http://www.diabetes.org.uk/Guide-to-dia ... -counting/
There is this e learning tool
http://www.bdec-e-learning.com/
(caveat both are aimed at T1s, anecdotally there are T2s who use these type of methods successfully)

There are a couple of useful books
Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin (Paperback)
By (author) Gary Scheiner (this is the author of the articles I linked to earlier and has a recent edition)
Using Insulin: Everything You Need for Success with Insulin (Paperback)
John Walsh
( Both are from the US but available in the UK)

 

[ticker7]

Re: At Last an Answer to apparent Insulin Therapy ineffectiv

Thank you for your replies lots to research there, Very useful thanks for taking the time to reply.

Re-reading my original post I realised I had not been clear on the root cause of the problem. To simplify my carbo counting I uses a fairly standardised diet so I was happy with the carbo counting dose and correction dose calculations. When i was given the original instructions someone (nurse or dietician) wrote 60 Units on the Lantus leaflet, and 20 Units on the NovoRapid Leaflet, and then the correction and carbo counting formulas in the carbo counting leaflet. ( I keep all the leaflets and all my consultation notes since 1990s - post war childhood "never throw anything away it might be useful" thing). The Dietician recognised her handwriting last week.

What I was doing wrong was adding 20 units (from the leaflet instruction) to the 3 BS reading correction units and the 5 carbo correction units and dosing myself with 28 units of Novo Rapid, three times a day for 5 years.

It was not picked up because of the focus of the consultation discussions e.g the doctors never seemed that interested in reviewing the actual numbers and trends in my diabetes diary records of the last 6 months partly because of the diversions of a wide range of other strange symptoms unrelated to diabetes e.g standing up, walking) - resulting in seeing 21 different consultants of different disciplines since 1995.

I also made mistakes (by being conditioned into believing that an apparent lack of interest in the diabetes diaries by the doctors) by not bringing them to my consultations so there were errors everywhere in the process and especially in my own management of the problem.

Since my shock discovery I have had a really good week of Blood Sugar performance with correct Novo Rapid doses using my standardised diet (I always seem to call it call it Novomix Rapid which is a slip of tongue combining my old Novamix with Novo Rapid!!).

So I look forward to an outstanding 2013 in diabetes management !!