Help with insulin and DAFNE etc

[Deekh1965]

Hi All

My name is Derek and I have had type1 diabetes for almost 17 years.
When first diagnosed I had never heard of diabetes.
I was put on Humilin Soluble and Humilin Isophane mix twice a day
but due to not having a fixed lunchtime I was quite often going hypo.
I was switched to Humalog maybe a year after diagnosis and told to only take the Isophane
at dinnertime.
I was frequently high at breakfast and told just to increase my Isophane.Was taking upto 20 units of Isophane.

I would have a supper/bedtime snack and take Humalog for that.

I heard about the peak action of Isophane about a year ago and still thought I would need the quick acting for the snack.

It wasn't until about 6 months ago I thought about when the peak would come on, coinciding roughly with the time of my bedtime snack.

So one night I decided, apprehensibly, to not take any, or very little Humalog.
Took 2 units, which I was certain would do nothing, but surprisingly woke with a BS at 6.5.

I was put on Lantus around the same time to see if it would help with my raised morning sugars and started off at 20 units which eventually raised to 32 in the evening.

Felt really bad on the Lantus, no energy, depressed. looked it up here and found a few people were the same.

Incidentally, I joined a gym about 3 months before going on the lantus and struggled to go back, haven't been back in over a month.

Asked to try animal insulin and was put on Hypurin Porcine about 4 weeks ago.

Graduated from DAFNE 2 weeks ago and think it was great regarding info had never heard about, carb counting and ratios, basal and bolus.

Used a 3:1 ratio and was then moved upto a 4:1 because they reckon I am very insulin resistant. I don't know if it is the Porcine insulin as i seem to need a lot more than when i was on the Humalog.An example, this week I was 12.9 at 8:20am had 1.5 CPs and had
7.5+7.5 (trying a 5:1 ratio), I also had 20 units of Porcine Isophane at 8:40am.By lunchtime my BS was 13.8.

Would i be better going back onto the humalog and what BI would you recommend other than Lantus?

Does the Hypurin take time to start working?

Also over the past 5 years my weight has been increasing dramatically, I am 5'7" and currently weigh 19 stone, BMI of 43. Finding it difficult to lose weight. tried low carb atkins style but lost maybe 7lbs and then nothing. I know the carbs are the problem with the weight as it's not like I pig on chips and pies, was eating low fat stuff with brown rice, wholemeal pasta etc, as recommended by the govenment's current healthy diet.

Trouble with Atkins style is I don't know how to follow it. His first book says don't count calories and use lots of healthy oils to encourage fat burning, then the new one recommends 2 tablespoons of oil per meal.

I hate being fat and unfit. Hate how everyone assumes you eat too much, joined tesco diets
last year and couldn't eat all the stuff they wanted you to eat.

Any help anyone can give would be gratefully appreciated.

Sorry for the long post, looks like I need a counselling session with someone.

Best regards


Derek

 

[AndyS]

Re: Help with insukin and DAFNE etc

Hi Derek,

I don't quite have the time under my belt with T1 that you do but I managed to get to grips with it very quickly. I did a DAFNE course a couple months ago now.
When I was diagnosed I went nuts with studying and asking questions and experimenting so I had a handle on carb counting and adjusting fast acting insulin but the DAFNE course helped me polish up titrating my background insulin and also taught me the sick day rules which were an eye opener.

On to your questions, is there a reason you are not using the analogue insulins? DO you have some kind or reaction. As I understood it they tended to try and use that with DAFNE since they have more predictable profiles. Also the quick acting analogues are much faster than the animal insulins.

I was originally on Lantus and was up to 36u at one point. A few weeks before DAFNE I was switched to Levemir and overnight I had more energy and felt a load better.
I am not on a split dose of Levemir 13u in morning and 18u in evening. But the most important thing is that my quick acting (NovoRapid) ratios are now pretty much 1:1 so my overall daily Insulin intake dropped by probably around 15u.

With the reduction in overall insulin I have started to lose a bit of weight which in turn should result in lower insulin requirements I hope.

Perhaps you should discuss with your Dr / DSN the possibility of trying Levemir. I know plenty of people on here found they felt much better on Levemir compared to Lantus (me included)

Hope you manage to find something that works for you.

/A

 

[Deekh1965]

Re: Help with insukin and DAFNE etc

Hi Andy

|Thanks for your reply.

I have been on Humalog for he last 15 yrs and it was ok.
Reason for change was because of how I felt on lantus and read a few others were the same.
Some reccommended animal insulin so asked to try it out.
Think I wil go back to the Humalog and definitely ask about the Levirmir.

I had never had explained to me what the BI insulins role was, just take it at dinnertime.

Was never told about sick day rules either. Found out to my cost about 13 yrs ago when ended up in hospital for 7 weeks. Was not feeling very well 1 day and because I hadn't ate didn't think I would need insulin. Couple days later couldn't hold anything down. Got doc out and she got me to hospital straight away. Morning after being admitted to hospital had a fit, woke up with doctors around me. Had an MRI which showed I had a stroke and liquid forming in the brain that was causing pressure on the part of the brain which tells you to be sick so couldn't even sit up without vomiting and ended up being there 7 weeks until the pressure subsided.

I now know to check all the time lol.


As for insulin doses after DAFNE I am having to take a lot more than I had previously.
Last night befoe bed my BS was 8, had a CP free meal but took 2 units of Porcine Neutral as a precaution incase any liver spike etc and woke up withn BS at 13.9. Decided to go with the Humalog all day and had 1.5 CPs, took 8 for the meal and an extra 7 for correction and by lunchtime I was 15!!! For Lunch had 3 CPs and took a total 22 units, would never have taken that much insulin in the past. By dinnertime I was down to 8.5. I must have become really insulin resistant.

Kind reagrds

Derek

 

[AndyS]

Re: Help with insukin and DAFNE etc

Hi Derek,

Are you keeping a log as you learned on DAFNE?
Just based on that one night (which is not the way to do it really) it looks almost like your background insulin is not doing the job.

Did they not teach you about the background insulin?
Forgive me if I am covering old ground but here is a quick Insulin 101.

Background Insulin is there so that your body can essentially process the sugars that your liver slowly releases over time. Even if you are not eating at all the background insulin is always required otherwise your body can't process the sugars naturally floating around your system.
The quick acting is obviously required to counter any food you eat or to do corrections.

Essentially your background insulin whatever it is should pretty much keep you level if you are eating or not. If your sugars rise then it could mean your background is not up to scratch.

As I said I used to be on Lantus but it turned out that it was running out after only 18 hours or so which meant I was correcting a lot with quick acting. When I was switched to Levemir I was put on a split dose so that I could do a smaller dose at one time of the day and larger at another so that I was kept stable.

As I understand it the absorbption rates for the insulin analogs is a lot more consistent and predictable. Having never been on animal insulin I couldn't answer from experience.

I think perhaps you should contact contact your DSN or DAFNE educator and have a chat over your diary to see if you need to tweak your doses a little.

Good luck.

A

 

[Deekh1965]

Hi davy

Yes keeping diary, I have posted a 5 day one on the DAFNE community website. If your a member there my username is derekh1965 you can check out the sugars.
The example I gave you was how they have been for the past week.
I graduated dafne on april 15, had o go back into see the dsn tutor? to discuss my high sugars.
She was under the impression the BI was fine due to the consistent sugars, eg breakfast 12 and lunch still 12, although I don't think she took into account the amount of corrections I was having to give and them having no effect, though she did say I was very insulin resistant.

It is so frustrating, yesterday breakfast ( 9am)I was 13.9, had 1.5 cp's and took 15 units of Humalog, then by lunchtime (1.30pm) I was 15. For lunch had 3 cp's and ended up taking 22 units of Humalog and by dinnertime (5.30PM) I was 8.5.
In the past I would have hypo'd with all that insulin, AND trying to lose weight seems impossible if I am having to inject so much insulin.

Took my BI, which was increased to 16 last night at 8pm. At 9:30pm I was giving someone a lift and tested, I was 7.0 and by 11:30 before bed I was 8.0, probably the QA had run out, but the BI onset is 2hrs so don't really know.

Sound like I maybe need another dafne lesson lol.

Thank you so much for tasking the time to read and respond to my long posts.


Best regards


Derek

 

[AndyS]

Hmm.. have you checked for ketones?

I have found that in some cases when I have felt fine in myself but had unexpected highs that just don't seem to respond till I get very aggresive with Insulin that I have actually been ill with something that has.

In those cases I switched to sick day rules and then the amounts of insulin actually made sense.

Given you are constantly going up overnight I still wonder if your BI is where it should be.
You should really be holding steady or dropping a mmol or two overnight.

What sort of time do you eat your evening meal? I started eating much earlier so I had at least 3 or 4 hours before bed and that also gave me a clearer picture.

Andy