Dropping levels on Humalog Mix

@dex44lego9 The simple answer is yes. You should time your injection so that's it's a suitable time ahead of your meal. Your DSN can advise you how far in advance to inject.

Edited to add that if you're having a lot of lows, you should check that your carb counting is ok. If you're on fixed doses of insulin, you should eat around the same amount of carbs for each meal to avoid going too low or too high.

If you still get lows, soeak to your DSN about a possible reduction in your doses, or maybe a move to a basal/bolus insulin regime as this will give you more flexibility with eating.

with a humalog mix insulin regime timing of meals and similar carb values are pretty critical in trying to keep BG's in range

try to keep snacks to below 15 carbs - possibly 1/2 sandwich , or cheese and a couple of jacobs cream crackers should work !!
it is very much a personal thing and trial and error do come into it -- so testing is very important

dex44lego9 said:

Thanks for that but what is the best types of snacks to eat as I feel I don't eat the proper kind of food at all.

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It depends how many carbs you need. So 15g an apple, 10g could be a digestive biscuit or 200ml milk, etc.

Are you counting carbs?

dex44lego9 said:

No I'm not counting carbs would not have a clue what I'm at.

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Ok, well I'd bet that's a large part of the problem. On set doses of mixed insulin you need to eat the same amount of carbs for each meal. That should have been explained to you and you should have been given guidance about how to count carbs.

I suggest you speak to your nurse or doctor and ask for their advice and help. It's not hard to count carbs and I'm sure you'll soon get the hang of it once you're given a bit of help. I was on mixed insulin when I was first diagnosed, and the dietician explained carb counting to me in a short time. It really is quite easy to get the principle of

dex44lego9 said:

Hi I'm type one on humalog mix 25 I take 30 u in the morning and 20 in the evening I never change it my doctor is really pleased with my blood sugar readings but my levels are always dropping at different times they could be 2.3 or 3.2 or even 1.5 sometimes I give my injection but don't eat for a longtime could this be the cause.

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Hi @dex44lego9 ,

I have been using 25Mix for almost 2 years now with a reasonable amount of success. My glucose levels were all over the place for the first 12 weeks though. After some experimentation I settled on 12u in the morning and on workdays I have a cereal breakfast of approx 25g carbs. So this 12u dose gives 3u of rapid acting insulin to cope with breakfast and 9u of long acting insulin. I am usually injecting around 10 minutes before breakfast at 6 30am.

We all have our own insulin/carbohydrate ratio. I work with a ratio of 1:10 for the rapid acting part of the injection so if I was to inject your dose of 30u of 25mix for breakfast, (25% is 7.5u rapid acting and) I'd need around 75g of carbohydrate for this. For my own personal needs I would also be taking far too much long acting insulin with this dose. I hope that makes sense.

Whilst the action of the rapid acting part of your insulin peaks at around 2hrs and is pretty much gone after 4 (possibly 5) hours the long acting part lasts for around 12 hours. I discovered that my blood glucose drops late morning so a coffee accompanied by a small biscuit (approx 6g of carbs) keeps my glucose levels above 4 until lunchtime.

Lunchtime is another problem. Because the rapid acting part of the insulin has been used by then, even a single round of sandwiches will send blood sugars skywards. I also have a rapid acting insulin that was originally provided for sick days but I use it to have a couple of extra units of insulin for lunch. If this option is not available to you then you probably need to be thinking about a very low carb lunch.

I don't like injecting a lot of mixed insulin for my evening meal because if I do, I'll wake up hypo at 3am. So I try not to go above 16u 25 Mix, ( giving 4u rapid acting and 12u long acting) and I adjust my carbohydrate intake to match. Every now and then I take a lower dose of the mixed insulin and an extra couple of units of rapid. Our insulin is also available as a 50Mix so it might also be worth asking the doc about trying it, up to you.

At the endocrinology centre, 1 nurse told me not to vary my doses, another told me I had to vary them for exercise and carbohydrate intake. I think you should be having a chat with you doctor or specialist about these aspects of your diabetes management. I do find it difficult to balance all this out at times and I've asked about going on a basal/bolus regimen and been talked out of it because my a1c level is good enough.

Hi! Friends @urbanracer thank you for the information on humalog mix insulin and how it works practically. I personally wanted to shift to this but my doctor rejected saying it'd be difficult for you to cope with. At present I'm on basal/bolus regime. Lantus bed time and huminsulin r 40 iu 3 times.

ashmili said:

Hi! Friends @urbanracer thank you for the information on humalog mix insulin and how it works practically. I personally wanted to shift to this but my doctor rejected saying it'd be difficult for you to cope with. At present I'm on basal/bolus regime. Lantus bed time and huminsulin r 40 iu 3 times.

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Hi @ashmili , what were your reasons for wanting to use mixed insulin?

Hi! @urbanracer thank you for asking. Before huminsulin r I was on huminsulin 30/70 twice a day and lantus night. That didn't work. So I thought naturally my next could be 50/50. So I researched a bit and found out that humalog is peaking much faster and also has long acting along. By the time I was using huminsulin r 25/15/10. And still it was not enough. Hence I asked my doctor to prescribe humalog 50/50. But my doctor increased my huminsulin r dosage to 30/20/10(I didn't know I was going on backward regimen?). Slowly i was feeling much better. Last couple of weeks I'm doing ok.(not gong hyper) Still adjusting dosage to find a sweet spot. At present I've come down to bolusing 18/8/8. Started walking since a week. Sorry for a long reply. Thank you once again.

ashmili said:

Hi! @urbanracer thank you for asking. Before huminsulin r I was on huminsulin 30/70 twice a day and lantus night. That didn't work. So I thought naturally my next could be 50/50. So I researched a bit and found out that humalog is peaking much faster and also has long acting along. By the time I was using huminsulin r 25/15/10. And still it was not enough. Hence I asked my doctor to prescribe humalog 50/50. But my doctor increased my huminsulin r dosage to 30/20/10(I didn't know I was going on backward regimen?). Slowly i was feeling much better. Last couple of weeks I'm doing ok.(not gong hyper) Still adjusting dosage to find a sweet spot. At present I've come down to bolusing 18/8/8. Started walking since a week. Sorry for a long reply. Thank you once again.

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Am I understanding your post correctly, you do not have a basal insulin and you only bolus for meals? What is your glucose level like when you wake up, is it OK?

Just interested. If your regimen is working for YOU, that's the most important thing.

Hi. NICE T1 Guidelines 2015 recommends that all T1s are started on the Basal/Bolus regime which gives the best control. If the two mixed insulin injections enable you to manage you sugar levels and enable you to eat fairly freely then fine but if you don't mind having 4 to 5 injections and want that better control then ask to be moved to Basal/Bolus.

Hi! @urbanracer thank you for your reply. Sorry for the confusion. I have basal along all the time 15 units bed time. My fasting sugars are in normal range now. When my doctor increased the dosage further to 30/20/10 of huminsulin r I started responding. I think I have lot of insulin resistance. I still have post breakfast post dinner and post exercise Spikes,(but now below 200 mg/dl.) Post lunch is ok because at that time I think the insulin is overlapping. I'm trying to cut carbs now,as compared to you guys I eat a lot of carbs. Around 200-250 gms per day. These life style changes are happening because of this forum. Thanks to you guys. You all are doing a great job. Keep it up. Sorry again for a long reply. Thank you @diabell.