Help with Background Insulin

[Deekh1965]

Hi all

Hope someone can give me help regarding background insulin.
I am taking Isophane insulin which I have been taking for 17 years (humilin I).
Took it at dinnertime and always had high BS upon waking. Moved me onto lantus late last year and was on 32 units split, previously used to only take 15-20 of Humilin I. The bs improved but I felt pretty poor with the lantus so asked to try animal insulin. Was put on Hypurin Porcine neutral and isophane. Graduated from dafne a month ago and found it quite hard with the neutral so went back on my humalog but still using the porcine isophane.
Should I o back to using Humilin Isophane with the Humalog and what is the best time to take the isophane? I was told take at bedtime and upon waking. As I said I was taking 32 lantus but now taking 18 units of isophane at bed and 20 in the morning and despite having carb free snack at bedtime I am waking with a high BS 12-13. Also if I have a carb free lunch i still go high.
This morning my BS was 12.9 had 1.5CPs and took 8+6 humalog (5:1 ratio at breakfast, 4:1 other times). Tested 10.1 at lunch, had carb free and took 5 correction 30 mins after because didn't have confidence in not going high. Tested 2.5 hrs later and my BS was 11.5.

Hopefully someone can help as it is beginning to really depress me.


best regards

Derek

 

[Snodger]

Hey there Derek,

So, let me check I've understood:
1) your bgs are running too high in general, and you are going high even when carb-free
2) you were on humulin, not really a problem, then they put you on lantus, it wasn't good, so now you are on hypurin and wondering about changing back to humulin?
3) you are wondering when to take the basal.

This site is helpful: http://www.mims.co.uk/Tables/882439/Ins ... parations/. It shows that hypurin lasts 6-8 hours and humulin lasts 6-12 hours. It could be you are running out of basal, and a split dose of humulin every 12 hours (eg, 8am and 8pm) might be a good solution.
But I'd also say that your basal might just be a bit low overall. I know you were on a lower dose of lantus but I've found that I need quite low doses of lantus compared to my old basal (protophane).

I think if it was me, I'd up the basal dose by a unit each and see what happens. And I would be tempted to go and get a prescription for humulin while I waited to see what was happening.

I hope that I've understood it right and hope that helps? Others may think differently of course...

 

[Deekh1965]

Hi Snodger

Thanks for your reply. You got it right, I am confused why I still seem to need insulin when eating no carbs and unsure about the BI.
When I was put on the BI at diagnosis 17 yrs ago was just told it was long acting, no explanation of what it done, how it worked and now after dafne I have a lot better idea of it's function.

Usually every morning I am high. Despite taking no carbs I would still inject some QA because of my expeiences with going high in the past. However I had my BI at 11:30pm of which I raised it 2 units to 20 and for my supper I took no QA. I was 7.6 at bed and woke up expecting it to be sky high and to my delight and surprise it was 9.7, which is good for me.

All these years BS high in the morning and being told to just increase my long acting, but never asked or told about the QA, or carb counting. I hadn't a clue about CPs etc.

I'll get there eventually.


best regards

Derek

 

[Snodger]

That sounds good, sounds like maybe the basal increase is working.

I know what you mean, they told me "this is the long acting stuff" too and didn't really explain what it was used for. I was putting up with lots of night hypos and only after DAFNE did I really start to get to grips with it and reduce my basal properly.

Let us know how you get on!

Snodger

 

[josie38]

Hi Deekh1965,

I used to have a problem with my background insulin. I was very sensitive to any change in dosage and type. When i questioned my high bs in morning I was told to do bs in middle of night to see what was happening and found out i was going low in night but not waking up, so levels were going high upon waking. This is called the dawn phenomenon. I was advised to have a couple of biscuits before bed to help combat low levels during night. Maybe this is happening to you.

If you are having a low carb meal you could still need insulin for the carb that you are eating (even if it is only a unit). If you eat a no carb meal then theoretically you wouldn't need any insulin. Maybe testing an hour after you have eaten could give you a better indication. By THEORY if you have eaten a no carb meal then your bs is meant to be the same as before you have eaten.

You could also try changing the time of your morning BI by bringing forward an hour or so (if it is practical).

I think it may be trial and error.

Let us know how you are coping and the best of luck

Josie

 

[noblehead]

If you eat a no carb meal then theoretically you wouldn't need any insulin. Maybe testing an hour after you have eaten could give you a better indication. By THEORY if you have eaten a no carb meal then your bs is meant to be the same as before you have eaten.

In theory Josie this should be the case but in practise it doesn't always work that way! Say the meal has a high protein content then the likelyhood is that bg will rise slowly over a period of hours, protein in the absence of carbs converts to glucose in the body by around 60% and I have mistakenly eaten a no carb meal without insulin and seen the effects afterwards.

Nigel