Different types of insulin

[mo1905]

What determines what type of insulin you are put on ? I am currently on a basal insulin an Humalog fast acting insulin which I take when I eat. I have read here a few times about mixed insulins etc and slight difficulty in maintaining control. What are the advantages/disadvantages of the different insulins ? Thanks, Mo


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[hale710]

I was given the choice of basal/bolus or mixed. I chose basal/bolus as it allows more freedom in what I eat. The fact I'm on Novorapid and levemir was a bit more haphazard! They laid the pen styles out in front of me and I chose the pen, the insulin was dictated by the pen type! I guess for me they wanted to just get me started on something and then if it doesn't work for me then it can be changed down the line.

 

[mo1905]

I haven't been diagnosed that long but ignorantly thought "insulin was insulin" ! Why would anyone choose mixed though if it's harder to control ? Is it cost ?


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[hale710]

Less injections a day! If you have a fear of needles then 2 a day is a lot simpler than 4 or 5. Or at least I'm assuming that's why.

We have a history of diabetes in the family so I already knew there were 2 regimes and so didnt really listen much when they were explaining them to me!

 

[hale710]

Less injections a day! If you have a fear of needles then 2 a day is a lot simpler than 4 or 5. Or at least I'm assuming that's why.

We have a history of diabetes in the family so I already knew there were 2 regimes and so didnt really listen much when they were explaining them to me!

 

[Diddly]

I am on mixed twice daily and wasn't given a choice when I was diagnosed back in February.Have asked and should be changing onto the separate type when I see my consultant next month.

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[mo1905]

I see you're point but less injections for the sake of less control ??
Can't be the only reason surely ?



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[hale710]

I see you're point but less injections for the sake of less control ??
Can't be the only reason surely ?



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It doesn't have to mean less control. Provided you eat regularly and eat the right amount of carb then your control will be just fine (my cousin was on this for many years)
The difference is flexibility. Basal/bolus you can essentially eat what you want, when you want.

 

[mo1905]

Cheers Hale ! Makes more sense although I'm glad I'm on the basal/bolus !


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[hale710]

Cheers Hale ! Makes more sense although I'm glad I'm on the basal/bolus !


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Absolutely - I had no desire to go anywhere near the mixed type. And my consultant definitely seemed to push me towards the basal/bolus too because of my "young lifestyle" (whatever that means! I'm 23 and everyone tells me I'm more middle-aged than my parents) but I guess mixed must have benefits otherwise no one would ever use it

 

[Thundercat]

Diabetes 27 years. Basal/Bolus 26 years. About a year after diagnosis my bs started getting very erratic so doc suggested B/B. Wasn't keen on extra injections (was 13 years old) so kept saying no. Doc then said I would have to spend a week in hospital to get bs back under control (the horror!!!) or a weekend in hospital if I switched to B/B. Naturally I switched and even though emotional blackmail is a dubious medical tool I'm glad I did. I know you can have good control on any regime but the freedom of B/B is worth the extra injections. I have a peculiar appetite and eating set amounts at set times wouldn't work for me.

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[mo1905]

So do we all agree that the only benefit with the mixed insulin is fewer injections ? I'm still slightly confused lol !


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[noblehead]

What determines what type of insulin you are put on ? I am currently on a basal insulin an Humalog fast acting insulin which I take when I eat. I have read here a few times about mixed insulins etc and slight difficulty in maintaining control. What are the advantages/disadvantages of the different insulins ? Thanks, Mo


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The advantage (for me anyways) of basal/bolus is that you can eat when you like and not have to snack between meals, it gives you a great deal of flexibility to eat what you like and is useful when dining out etc, provided you understand about the impact on bg that carbs have and you know how your insulin works it is (for me again) the best insulin regime to be on.

 

[mo1905]

@noblehead, I'm the same as you. My question is why anyone would want to not be on basal/bolus ? I don't understand the different types of insulin and why some people are on different types an mixes etc !


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[noblehead]

@noblehead, I'm the same as you. My question is why anyone would want to not be on basal/bolus ? I don't understand the different types of insulin and why some people are on different types an mixes etc !


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I think (although I may be wrong here) that when people are newly diagnosed they start people on twice daily injections just to get them use to injecting, over a period of time they will eventually be given the option of moving onto MDI.

Lets not also forget that preference is important here, not everyone is suited to MDI and will much prefer to be on mixed insulin's.

 

[mo1905]

Thanks noblehead ! I went straight onto basal and Humalog and am happy I did I think ! I was never offered alternatives which was probably a good thing as I may have made the wrong choice. When you say MDI may not suit all do you mean the insulin itself or the number of injections and carb counting ? Does the mixed insulin mean you take a set amount of units each time or do you still have to work out the carbs and adjust accordingly ? Thanks !


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[Daibell]

My excellent DN put me onto just basal once a day; although I think she almost suggested twice a day split. She suggested Levemir over Lantus as she knew I went to the gym and said that Levemir had a flatter 24 hr profile. Searching the web I find they are in practice both fairly flat with an 6-8 hour peak. I'm pleased I'm on Levemir as it doesn't sting but it only lasts 18 hrs not 24 hrs as Lantus does. I'm glad I wasn't offered mixed insulin. As I don't have much for breakfast and the Levemir peaks at that time I would probably only do a bolus twice a day, lunch & dinner, making 3 injections per day in total. I was offered a choice of pens i.e. disposable or cartridge and told the cost was the same. I chose cartridge as there is less to carry on holiday and I'm pleased with the way the Novopen 4 works. So, like others, I can't really see the overall advantage of mixed insulin and Basal/Bolus gives complete flexibility but needs two pens and perhaps 1 or 2 extra injections per day.

 

[mo1905]

Thanks Daibell, great answer and yet another one for the basal/bolus camp ! I'd be intrigued to hear from a mixed insulin taker and understand their reasons for it !


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[jackie21123]

My daughter is on 3 different types of insulin, humulin m3 during the day, novorapid at teatime and levemir at bed.

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[etmsreec]

It's not completely clear to me whether the mixed insulins are any different (other than being a fixed ratio) to manually mixing which was the norm when I was diagnosed in 1981. That said, the downside of manually mixing is that the later meal (e.g. lunch if you inject before breakfast) is absolutely key if you want to avoid going hypo before lunch. Several times when I was admitted to hospital from a hypo it was early afternoon when I'd been late having my lunch.
I was only made aware of basal/bolus in about 1997, when my new DSN thought me very old-fashioned for still manually mixing!