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Dr Bernstein queries

Discussion in 'Ask A Question' started by cookie13, Dec 3, 2014.

  1. cookie13

    cookie13 Type 1 · Member

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    Hi,
    Almost finished Dr Bernstein and have been trying his diet (most of the time) for past few weeks but still experiencing see saw BG readings, sometimes having eaten a very low carb meal ie salad with small amount of protein and a fairly substantial amount of insulin - so quite confused really !
    However D r B talks about type one diabetics having 5 shots of insulin per day so I assume he means Levemir (long acting insulin) first thing, with fast acting insulin shots after every meal ie 3 and another long acting shot at bedtime ? Do any type 1's do this and if so how do they find their BG readings ? I currently take 3 shots of basal Novorapid per day to cover meals and 1 shot of levemir (long acting at bedtime so I am wondering about the possibility of a 5th shot to help with my BGs. Unfortunately my hospital doctor is not helpful at all.
    Also is Novorapid regarded as regular or fast acting insulin as Dr B talks about insulin prescribed in the US ?
    Any help or advice would be warmly received.
     
  2. Ali H

    Ali H Type 2 · Well-Known Member

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    I have Levemir morning and evening and Novo with each meal. Levemir is long acting, Novo is rapid acting. Some people split Levemir as it doesn't cover 24 hours, like me.

    I dunno what my type is, awaiting a GAD result, but regardless I am on a basal/bolus regime and in 3 months A1C dropped to 7.1 from 9.2.

    Ali
     
  3. noblehead

    noblehead Type 1 · Guru
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    Not read the Bernstein book but the 5 injections will be 2 basal doses (levemir) and 3 bolus doses (Novorapid). In America Novorapid is called Novolog I believe.

    Levemir, in most people does have to be split-dosed.
     
  4. AlexMBrennan

    AlexMBrennan Type 1 · Well-Known Member

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    Regular insulin means older insulin identical to the insulin produced by the pancreas (which is sometimes still used in the US because it's cheaper).

    The insulin you are more likely to be prescribed are Humalog (insulin lispro), Novorapid (insulin aspart) or Apidra (insulin glulisine) which are very similar to human insulin but have a few molecules switched to make it act faster (which is helpful because, unlike insulin released by the pancreas, it takes longer for insulin injected into fatty tissue to take effect).
    These three insulins are referred to as insulin analogues and considered fast-acting.
     
  5. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    Hi, I take Levemir but never split the dose or even been advised to do so, I continue to take mine before bed.

    Best wishes RRB :)
     
  6. jack412

    jack412 Type 2 · Expert

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  7. Brunneria

    Brunneria Other · Moderator
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    From memory, I think Bernstein recommends splitting insulin into smaller, carefully timed and spaced doses because of the very low carb diet he advises. So the faster acting insulins need special care, because of the slow rise and fall of bg on his diet.
     
  8. phoenix

    phoenix Type 1 · Expert

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    I think that many people who follow Dr Bernstein's advice use three types of insulin. Basal, rapid but also regular insulin.
    They use the regular for dosing for protein.
    Here is one of the posts about it from this forum
    http://www.diabetes.co.uk/forum/threads/potential-low-carb-convert.3929/#post-23863
    Dr Morrison links to her own website on the thread. That site is still there but my Norton tags it with a red cross as a threat. She has brought out a kindle book recently though that is quite cheaply available.
    K Morrison Diabetes Diet. (contrary to the name it does have info on dosing for low carb diets, the diet info in the book is about very low and more moderate carb diets)
    Her son is T1 . There are several posts about him on the forum if you search though I don't think he was totally low carb in the later years since she writes about coping with pizza and Chinese buffets. When he was in his late teens he ended up with a complicated insulin regime trying to emulate a pump with many small injections a day
    http://www.diabetes.co.uk/forum/threads/how-many-times-a-day-do-you-inject.11696/#post-109282
     
  9. AlexMBrennan

    AlexMBrennan Type 1 · Well-Known Member

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    He advises to split doses larger than 10u iirc because he claims that large doses have greater variability (I.e., if you need 35u, Bernstein would recommend four injections of 9u each). If you try this, however, be prepared to explain to your gp that you aren't selling needles on the black market.
     
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  10. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    I take 11 units at night and when I was on a carb counting course at the hospital, I was taken off Inslutard and put on Levemir by DSN, but no has ever suggested split doses ??

    RRB
     
  11. noblehead

    noblehead Type 1 · Guru
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    Not everyone does split-dose RRB as we know from reading this forum.

    it's fair to say that a good proportion of levemir users do split-dose but there are people (much like yourself) who find it gives them a good 24 hour coverage, much can said of lantus insulin, some find a split-dose gives them better control as where some find a single dose works just as effectively. As the saying goes, if it ain't broken don't try and fix it.
     
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  12. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    Well, thinking about it, maybe I should get in touch with hospital DSN and ask, I'm up there this afternoon, for hand therapy and both are on the same floor.

    If you don't try something ,you're not going to know .

    RRB :)
     
  13. cookie13

    cookie13 Type 1 · Member

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    Thanks to everyone for your useful comments - split dosing may be something for me to consider.
     
  14. cookie13

    cookie13 Type 1 · Member

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    Ali H can I just ask you do you have to take your bolus (levemir shot) at a set time each morning and then wait a certain amount of time to do your basal (fast acting novorapid ) shot ? and how many units of levemir do you take ? Thanks
     
  15. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    Had a word with a very nice diabetes nurse about the possibility of splitting my Levimir, also told her about the thread on the forum. She said the clinic has more patients that take just one dose. She said some do split their dose as one dose doesn't last and tapers out about teatime/dinner time. I told her how active I am, especially during the morning, so splitting the dose wouldn't be advisable for me. I asked if it was because I only take 11 units ( not a high dose) and she said the amount of Insulin has nothing to do with splitting the dose of long acting Insulin.
    So, I'm glad I went and asked, as she was very helpful :) ( It was the same nurse who gave me a back up meter last week :))

    Best wishes RRB.
     
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  16. cookie13

    cookie13 Type 1 · Member

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    Thank you RRB, sounds like you are very similar to me - I take 10 units of Levemir and I am very active in the mornings too so maybe not such a good idea
     
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  17. noblehead

    noblehead Type 1 · Guru
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    As said, if ain't broken.................


    There's no need to split-dose and unless there's real need to RRB.
     
  18. jack412

    jack412 Type 2 · Expert

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    Your nurse knows you best, it was a "guidance statement" based on their data that "Analysis of groups taking different types of background insulin (NPH, Detemir or Glargine) correcting for baseline HbA1c, age and duration of diabetes showed no difference in HbA1c outcome between types, but consistently showed statistically significant reductions in HbA1c only in patients taking twice daily background insulin."
     
  19. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    Hi Jack, as I was at the hospital anyway, I just thought I would pop in ask, and I'm glad I did :)

    RRB​
     
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