Change of insulin needed for a type 2?

[ladybird64]

Hi all, I could do with some advice from anyone who is knowledgeable about insulin please.

My type 2 daughter is on Novorapid x3, 10u,8u and 10u respectively. Shes is also on Lantus, 20u at night. She lives (at present) in a private hospital for people with learning difficulties and severe behavioural difficulties. Her learning difficulties are mild and she administers her own insulin under the care of the nursing staff.

When I go to visit (usually around lunchtime) I have noticed on a few occasions that they have called her at a specific time to have her insulin and it didn't seem to be dependent on when she would be eating her lunch..I have noticed quite a gap between her jab and when she gets to eat.
While there today the same thing happened and I raised the issue with the nurse "is she going to have her lunch within the next 15 mins?"..nurse was unsure as to when the meal would be ready. Today I did point out that Novorapid should be given within 15 mins of a meal, either before or after because that is what I was told when she lived at home. The nurse didn't know about this at all and seemed surprised. I am now wondering if daughter is in danger of having a hypo because they always give the insulin before eating..I am just worried that they don't seem to know what they are doing.

Although daughter used to be under the care of the Endo team at our local hospital, she now just has access to a local GP. I have asked for this to be looked into with a view to maybe changing her insulin to one that isn't quite so reliant on time of eating, maybe giving us a little bit more scope.

To tell you the truth, I haven't got a clue but have picked up some knowledge from what I have read on the forum. Have I said the right things or have I overreacted?

I would appreciate advice please, ta muchly

PS. Should also mention that she takes 2g of Metformin daily as well as other non-diabates related meds.

 

[BlindFaith]

I personally think you were more than right to raise that - surely they should have some knowledge of how to help and treat a diabetic patient?
It may be worth having a chat with your daughters GP and mentioning that you're not comfortable with how her insulin is being given.
Perhaps you could ask that they talk to the hospital staff and tell them how important it is that your daughter is kept to a schedule with her insulin and food.

I hope it gets sorted, it must be frustrating for you.

 

[SophiaW]

Yes you are absolutely correct that Novorapid should be given within 10 to 15 minutes of eating and not longer unless the Novorapid is being used to correct a high blood glucose reading. It is dangerous to inject Novorapid and then not eat within that time frame, it can result in a severe hypo. I would raise your concern with the staff at your daughter's hospital (which you have already done), I would also put this concern in writing and make sure the person in charge is the one who you address your concern to. Contact your daughter's GP and ask that a specialist diabetic nurse is arranged to visit the hospital to provide training to the staff. Is there a care plan in place for your daughter's diabetes? My daughter has a care plan in place at school, it's a document written by our diabetes nurse with input from me, it outlines who is responsible for what with regards to the care of my daughter whilst she is at school. It is discussed at a meeting between our nurse, myself and the school staff. We all then sign the document to show agreement that we understand and it is then clear what is expected and who is to take on the various responsibilities. In your daughter's situation I think something similar would be worthwhile having in place if there is not already a care plan. My daughter has type 1 so it may be a little different but your daughter is using insulin so I feel it is still applicable.

About your question of changing insulin. You'd really need to discuss this with a diabetic consultant and again you could ask your GP for a referral. There are mixed insulins however my experience with them is that they are more limiting because meal times have to be fairly strict in timing. If the staff at the hospital aren't always sure when the meal will be ready then you still face the same problem of the insulin becoming active before the food is there. There may be other insulins however that a consultant can recommend so perhaps worth discussing if you can get a referral from your GP. But in the meantime make sure the staff know that she mustn't inject Novorapid until the meal is there ready to be served.