Change of Insulin

I don't use it myself, but just wanted to say - you might get more answers if you post this in the T1 section? More of us on insulin.
Also, just to clarify, are you just on the Humalin M3 or are they asking you to keep up the Lantus too?

Hi Mervin,
I'm T2 and was on humilin M3 for a while, it didnt suit me as it requires a quite regimented lifestyle ie: regular meals at regular times and my job won't allow that. I ended up on 38 units in a morning and 56 on a night which was a large dose but in the end it did not work for me. My HBa1c was over 10 so it just wasn't working. I'm now on Huilin I and Humalog which is much more flexible ( I just take Humilin I in a morning and at night, and Humalog when I eat), this is much more flexible and suits me better due to my long hours. If you can have a regimented life ie: meals at 7am 1pm and 6pm then it should work ok, and your DSN will eventually find the right dose for you. If you can't have regular meals at regular times then it may not work. Every one is different and M3 is fine for most, and hopefully it will be for you too. Just be patient and it will work out.

Cheers,
Pete.

Hi Mervyn,

I think you should be ok on M3, when i changed away from M3 my DSN stressed it has a great record but only if you lead a fiarly regimented lifestyle, I cant, i eat at all sorts of odd times and meal times vary every day. I'm sure you will have been told to inject approx 20mins to half an hour before eating breakfast and tea. Sounds like it could be a good move for you....

Good luck, hope it gets you sorted out.

Pete.

Hi mervyn.
I was exactly the same untill got up to 60units of insulin split dosed !
You may find it will need a larger insulin dose to make a dent in your high BG levels....
You have only been a week on it and it does take time to safetly crank up the insulin, it
HAS to be done gradually !
If done too quick you could end up in a serious hypo !
It took me 12months to find the RIGHT insulin [I had to also change insulins ] and find the right dose for me . . .
It isnt an easy ride at times , I do understand how you must be feeling though !
Anna.x

Hi, I 'know' it IS tough...
Hang in there , when you find the right insulin and dosage making your BG levels much lower
You WILL feel so much better and different about things.
Its raining for you now, sooon you will feel the lovely warm sunshine!!!!
I used my rainy days n times to plot n plan out 'what' I was going to do with my life and routine
to improve my daily life .
Gave myself something to look forward to [ gave myself hope for the future ]
Am just 'starting' to do this lately and its fabulous . . .
Went to my gentle excersise class yesterday, joined an art , pottery , painting class too.
Small starts but a new life and routine opening up for me ! :thumbup:
Try making a list if things you would love to do when your sunshine days come along !
And they WILL do ... Anna. x

Mervyn...

I have read some of your other threads and it sounds like you are having a hard time! Also I note that you discuss diet in those threads and from the sounds of it you are reasonably low carb..

The problem that you have is that at the sort of blood glucose you are running the insulin you are injecting becomes less and less potent.. higher blood glucose reduce insulin effectiveness meaning you need to inject more.. Now from the sounds of it your pancreas is shot to pieces so I would imagine that you are going to need a relatively large amount of insulin especially if you have a high insulin resistance as well.. Insulin is a quick acting solution.. In reality if you were a type I you would inject rapid insulin until those BG's came down (in a matter of hours).. as you only have a mixtard, limited experience of insulin and are taking a whole host of other diabetes drugs we are going to have to treat things a little differently..

The normal calculation used for a non-insulin resistant type 1 is 0.55 units / KG of body weight. So if you weight 100kg then you would need around 55 units a day.. Its not uncommon however for someone with double diabetes i.e. type I with insulin resistance to take over 100 units a day (in some cases much more!)... if you pancreas is not producing insulin then this is effectively your position.

Now I am not suggesting you inject yourself with 100 units of insulin..but I certainly think you can increase your dose.. also I would suggest you split it three ways and inject once before each meal... Given what you have posted previously I also think you need to treat yourself like you are type I as you have limited pancreas function.

If I were you I would do the following:

1. Until you have control reduce your carbohydrate intake to less than 30g per meal
2. Inject before each meal, I would start with 15 units before each meal.
3. Go back to your GP and get test strips.. this is so important.. you are insulin controlled and should be treated like a type I as you need to establish a testing regime to keep control.
4. Establish a testing regime - Test before each meal and 2 hours post meal.. record the results.
5. Start adjusting your insulin - If your blood glucose is higher at +2 hours then next time increase your insulin, by say 2 units if its slightly higher or up to 5 units if its moved more than + 5mmol from where it started.

It may take several weeks for you to see an effect but eventually your blood glucose will start to drop.. at this point you need to be VERY careful! As your blood glucose drops the insulin will become MORE effective and therefore you will probably need to start adjusting your dose down.. once you have stabilised your blood glucose between 4 - 8 mmol/l then you will feel 100 times better than you do now! Once you have reached this point you can then look to re-introduce more carbohydrate to your diet and monitor the effect it has on your blood glucose.. you may also consider researching into carbohydrate counting / a bolus, basal regime (but that's for a few months down the line).

Hi mervyn .
I do hope you are feeling a bit brighter today?
Its bright sunshine here over my way. . .
You will need to do things at your OWN pace, and at the advice of your medical advisors and professionals .
I too was so wary as I had to crank up the basal insulin levels [am STILL doing this!]
So I truly DO KNOW how it feels. . . .
The lack of support you seem to be recieving is more knocking your confidence [ my angle on this]
Could you ask to speak to the DSN team leader/manager ?
Discuss your thoughts and feelings through with him/her.
I 'HAD' to do this myself - as I was far from happy with my allocated DSN [she was so clinical and didnt enjoy her job either!]
So WASNT being supportive or helpful with me. . .
As a result of going to the "top dog" I managed to turn ALL things around for myself, and now recieve FANTASTIC support and care .
Am up to 70 units of insulin now and finally starting to see a fair dip in my BG levels .
It's my ' D ' DAY CLINIC THIS weds , will be seeing my consultant since 6months ago, am going armed with my list of
questions and will ask IF to stay on just basal regime? is the best way forward for me.
Am soooo tiny in limbs and I am weight gain 'phobic' , he knows this as my notes strongly state this too!
Hope this helps ? as I DO KNOW what you must feel like.
Anna.x

Mervyn,

Using insulin can be pretty scary! I know when I first started years back I was really cautious and quite rightly it can do you some harm if your not.. However if you are regularly testing and checking post meal then I do not think you have many worries about a slow increase in dose.

The tiredness you are suffering is because of your high blood glucose; I can imagine how you feel! having had BG's in the low 40's when I was diagnosed! A reduction in blood glucose will make you feel alive and so much better.

If you want or have any questions then please feel free to ask or PM me.