Changing Insulin - Type 1

[skybluegilby]

Hi all,

New to the group, I have been a type1 diabetic for 15 years ( I am now 25 ) I need some advice on the insulin I am using. I was on Humalog Mix 30 for around ten years. Due my routine - I worked long shifts in a bar I was moved onto a combination of Novorapid and Lantus, since then I have had relatively poor control, I tend to Yoyo. For example after lunch I have just tested after a sandwich and KitKat and my sugars were 27.3?? but I know before the day is out i will have had a Hypo. I have been on courses etc but I just cant seem to get it under any sort of control. My weight has also increased by around 2 stone and am now in the obese catagory for my BMI.

Having now got routine working 9-5, not drinking as much as my uni days etc would it be more beneficial to go back to mixard 30? Also In understand I will have less freedom being on Mixard, how dramatic will this be?

Any advice will be appreciated as I am consulting a doctor but would like to know some facts/ideas etc.

Many thanks

Mike

 

[iHs]

Hello Mike

You say that you ate a sandwich plus a kitkat for lunch and yr bg level was 27.3. Was this reading taken 2 hours after the meal or just 1 hour?

If it was 2 hours later, then your insulin to carb ratio was not correct so common sense has to tell you to inject a larger bolus and then hope that yr bg level will be lower when you test at the 2hr point. You are looking for a bg level no higher than 8. Its only by testing and using trial and error that people find out exactly how much bolus insulin they need to inject and that the ratio changes at different times of the day. I don't think I am wrong in saying that the best control usually comes though from eating smaller amounts of carb but on a more often basis, similar to what you did when using Humalog Mix.

 

[skybluegilby]

Hi thanks for your reply,

Common sense would suggest that I did need a bigger shot than the one i took. I just struggle with gauging the right amount (even after I have been on various courses)

Im not sure if it would be to much of a lifestyle change to go back to Humalog Mix but I am at the end of my tether with Novorapid.

Thanks again!

Mike

 

[iHs]

Hi again

Exactly how much Novorapid did you use for the kitkat and sandwich and also what was yr bg level before you ate? It's my guess that you might be using 1 unit of bolus to every 10g carb and this is where you might be coming unstuck.

 

[timo2]

Hi Mike,

You really need to be testing both before and after meals to get a proper idea of what's going on.
If your pre-meal sugars are reasonable, then it's the Novorapid that's to blame. If your pre-meal sugars are up, then you need to look at the Lantus dose - it often needs to be split and given twice daily in order to work evenly.

It's most likely that your loss of libido is simply down to erratic blood sugars; although, I wouldn't rule out the Lantus as a possible cause.

All the best,
timo.

 

[skybluegilby]

Hi thanks for the responses,

I had 12 units after lunch and yes I operate on a 1 - 10grms scale. Its just gets frustrating as I think there must be more options out there for me that would suit me better but I am on my 4th trip to the docs tomorrow to "discuss" this...

I have also been diabetic for almost 15 years and I have never felt like it is so out of control! With regards to libido I just dont know what to do. I got married 4 months ago and I think there are more 100yr olds more appetite than me!

 

[timo2]

Swap the Kit Kat for an avocado and a generous handful of pecan nuts, Mike - your wife will be fending you off with a stick in no time.

 

[iHs]

Hi Mike

The 1:10 ratio is only a rough guideline. Try eating a carb meal of just 20g and then increase yr insulin to carb ratio to about 2:10 to see what that does to your bg level. Using MDI, it is difficult to get yr exact insulin dose correct but usually guesswork, doing loads of bg tests gets you sorted.

You could discuss changing bolus insulins to a much faster one than Novorapid and try Humalog or Apidra. As Timo has said lots of people get better more evened out control using basal insulin twice per day than just once but you will still need to use a different insulin to carb ratio for breakfast, lunch, and evening meal. It won't be the same all day long.

 

[kegstore]

My insulin/carb ratio varies throughout the day, between 1:8 in early morning, 1:10 late morning, 1:12 afternoon and 1:14 in the evening. Thankfully this follows the same pattern every day and is quite common, but no less tricky to pin down. It makes a HUGE difference to my control to know this, and be able to adjust insulin dose accordingly.