Changing from Humulin 1 to Novomix 30 (Type 2)

Following a review of his insulin medication my partner (Type 2) is being moved on to Novomix 30 from Humulin 1….his morning bs readings were in the range of 9 to 11 and pre dinner readings in the mid teens 14-17…

…he was currently on 22 units of Humulin 1 in the morning and had recently introduced a pre dinner dose of 6 units by the diabetic nurse…….he is also on Metformin but has been told to stop the Gliclazide (both maximum doses per day) when starting the Novomix30...

It has been suggested that he starts Novomix 30 on 12 units in the morning / effectively at lunchtime as he doesn’t get up early or eat breakfast with another 12 units with his evening meal….

This in my head raises a number of questions….

…firstly he does not believe he will ever have a hypo….in his head he is “hyper, not hypo”….despite my efforts at explaining this (and believe me, I have tried) he still will not accept this….my question is to forum members what is the possibility of him having a hypo on this new regime ….

….secondly, looking at the profile of Novomix 30 it says it has an onset of 10 -20 minutes, a peak of 1 to 4 hours and a duration of 10 -12 hours (hope I have got that right)….on this basis and on my calculations this means that if he is only taking the doses 6 hours apart (with meals) they will clearly be some overlap (say between 6pm and midnight) …..and a period that is not effectively covered (between 6am and midday)….…apologies if I am getting too technical but just trying to get my head round how this will work….

My concerns are over how this will work in practice….he regularly goes out on a daily basis for lunch at a local supermarket café (on his own / whilst I am at work)….this means he will have to take insulin and testing kit etc with him in order to inject with meal (nurse has suggested immediately after is ok in case he ends up in queue or waiting for food to arrive)…so he will need to eat his food and then find somewhere to test and inject prior to doing any shopping I presume…….in theory he should test again after shopping and prior to driving home but personally doubt he will…

…from personal experience of those using Novomix 30 how soon does insulin kick in and is this something I should be concerned about....(his lunch is normally something like two eggs on toast and a latte so am assuming that the quantity of insulin suggested is appropriate to his food consumption at this time)...…or am I worrying unnecessarily…

As stated earlier he is starting on 12 units twice a day ….is this the normal starting point based on his previous insulin experience / dose of Humulin 1 ….am assuming this will potentially increase depending on his readings…nurse has advised to keep more readings (4 times per day rather than current 2-3) and will be contacting him later in week to see how it is going…

One final concern is that no mention was made of what to do about dose if bs levels are already low …..they are unlikely to be but there is always an outside chance or possibility that they could be…..is this something else that needs to be thought of or considered….it sounded as if the dose was fixed and not food dependent (in terms of counting carbs / calculating quantity of insulin)...is this correct...

Sorry for all the questions but any advice as we move into new territory would be welcomed…..

donnellysdogs said:

@iHs has a good knowledge of novomix actions and requirements ref eating times...
I think @iHs used it previously.

You are right that it is best taken at 12 hours apart.... I too would be concerned with the overlap time...

Hopefully you'll get iHS and others giving some advice and answersx

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@donnellysdogs Starting on new insulin today so only time will tell what effect it has...

Regarding overlap time this will be in the evening between 6pm and bedtime so am guessing this is the potential time for low bs and any hypo symptoms......perhaps increased monitoring and checking bs levels before bed are essential to see what is going on over this period...

...still seems a bit odd that there will then be a 6 hour period when insulin levels will be very low or not covered....I think this will be a question I ask the diabetic nurse if and when I get the chance....perhaps this will be reflected in higher morning readings....will monitor at a distance and see...

iHs said:

l
Molly56...........your OH is not going to get wonderfully controlled bg by carrying on like he is doing. He should get up by 9am and do his morning jab and eat a small breakfast and start testing bg to see how the dose with the carb affects him and not stay in bed all morniing. There will be an overlap with the eve dose if he injects at lunchtime but only bg testing will determine how much. Ideally, the doses should be spaced 12hrs apart but sone find it ok to just leave it 10hrs and adjust the carb.

I only used Novomix 30 for about 6 months and had to keep eating snacks to ward off hypos but my bg levels were low compared to yr OH. I changed to Humalog Mix 25/75 and was much better and just carried on with the 'lttle and often' way of eating.

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@iHs ....thanks for advice....sadly your scenario is just not going to happen re breakfast as he is so set in his ways....

....potentially there could be less than six hours between doses ...assuming he eats lunch out then injects immediately after and then has pre dinner injection (we normally eat around 6pm)....how worried should I be about this and overlap....

Re hypos....he is insistent that he will not have a hypo...."I am hyper, not hypo"...an argument we have had on many occasions but he still will not have it.....am just waiting for the day he has a hypo so that I can tell him.... " I told you so"....apologies if that sounds cruel to diabetics out there but it is the only way he will accept he can have a hypo...

..diabetic nurse prescribed some glucogel for me yesterday (in his name) .....so at least I am prepared should something happen that needs to be dealt with......saying that he is not prepared to deal with hypos himself as is insistent that he doesn't need anything...glucose tablets were purchased by myself but dismissed as not needed...

Looking at and adjusting carbs was not discussed by diabetic nurse though I did raise the question as to whether it was a fixed dose or food intake had to be considered....no mention was made of quantities of carbs being consumed .....

Will just have to see what the next few days bring...

Wineman said:

Molly I'm on Novomix 30 taking 40 am with breakfast54 at night with evening meal I am also taking 2 metformin in AM 2 metformin PM.
I also have the occasional hypo.

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@Wineman...am guessing my partner has some way to go to get his levels down....he has increased his dose today to 14 units at lunchtime (he doesn't get up till late or eat breakast) and 14 units pre dinner...bs levels in the morning are currently around 12 and pre dinner around 16...they always were high on his other medication so this is not unusual for him...

How quickly did you increase your dose to get to the ones you are at now.....and what have you managed to get your bs levels down to.

..no real instruction has been given as to how often to increase on this insulin though he does have weekly telephone contact with his diabetic nurse to discuss progress and increases....at this rate it will take ages / weeks to reach where you are if that is where he needs to be...I know everyone is different but feel he will need considerably more than what he is on now to have any effect on levels...

My concern also is with the hypos as he is absolutely convinced he will not have a hypo and is not prepared to deal with it should it happen.....also the timing of doses means that he has quite an overlap as doses could be less than six hours apart....am guessing this will increase possibility of hypo as insulin levels increase...

...what time of day have you had a hypo....is it roughly the same time or at different times...

Hope you are managing to see some improvements and good to know someone in a similar position.

@iHs ....I am aware that his levels are currently too high to experience a hypo....my point is though that he is in total denial that he will ever have a hypo...have tried to explain that one day (perhaps not any day soon but at some point in the future) his blood sugar levels may come down to a level such as you mention that will trigger a hypo..

My concerns are that he will not be prepared to deal with this...I have suggested he needs to test more regularly and be aware of levels....I know that he doesn't test when driving back from any trip out (he tests in morning and then goes out so is covered at that point) ....have suggested he keeps glucose tablets on him or in car but he doesn't see why he needs to and doesn't (despite diabetic nurse telling him same)...

So guess it is just a waiting game to see what happens if and when his bs levels fall....if he isn't prepared to deal with it or does not deal with it he will end up with having to have third party assistance....probably from me if I am here or someone else if he is out and about...
....one worry is that he will just think he feels a bit ill or unwell and will just take to his bed without testing or treating.....but nothing I can do about that....