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Injections

Jaylee said:
I'll tag in @urbanracer . He recently changed to MDI from this sort of regime.
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NoKindOfSusie said:
Most of my questions are not this totally crazy?

I just want to understand what's going on.
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Sorry, didn't receive a notification for this, just happened to be reading the thread.

So 4 months in to MDI and I have mixed feelings. My own personal pro's and con's for mixed would be:-
Pro's
Only 2 injections per day.
Don't need a degree in maths to eat food.

Con's
Inflexible meal times, always having hypo's mid morning.
Regime does not cope with lunches unless you can zero carb.
Forced to eat only the right amount for your dose.
Cannot skip a meal.
Does not work well with variable activity levels.
 
I was on two injections for a short time when I was first diagnosed but after a few months went on MDI and they 12 years later progressed to a pump.

Reading through these comments is seems 2 injections can work well if you have a very regimented lifestyle - eat similar food at similar time every day, exercising a similar amount at the same time every day, ...

But the "choice"to me is about treating the person not just the diabetes. As some have reported, it is possible to have good BG control on two injections and that fits with your life. However, it would not fit with my varied, unpredictable life where I enjoy the chance to do something different on the spur of the moment. To be honest, I find it frustrating I have to plan my gym 60 minutes in advance to turn down my basal but that is better than having to do the exercise every day.
 
urbanracer said:
Sorry, didn't receive a notification for this, just happened to be reading the thread.

So 4 months in to MDI and I have mixed feelings. My own personal pro's and con's for mixed would be:-
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This ^^^ 100% I've been on MDI since December and believe me my maths has improved!!!!

On MDI you need to calculate EVERYTHING and it's dog to make it work properly below are a few examples:-
  • Take additional shots for hi protein meals if carbs aren't present with it - Never had this on pre-mix
  • BGL rise post heavy workout - Never had this on pre-mix
  • NovoRapid isn't so rapid - whack 5u of M3 into a muscle and see the BGL come down QUICK
  • Protein shakes cause havoc on BGL - 25 years of training and taking shakes on pre-mix never an issue
  • Adding muscle on MDI is a NIGHTMARE on pre-mix i could stack it on pretty quick if I up'd the weights and calorie intake, I've been trying the same on MDI and tbh it's nowhere near as effective.
Some days my brain hurts from all the maths involved on MDI and I end up take 8-9 shots in order to keep things in order Vs the 2 I used to take. Having said the above MDI has given me more flexibility on different food I'd usually avoid on pre-mix and also the ability to apply correction doses when things go wrong (which to me is a dal breaker)

Will I stay on it? I don't know I think I've not been on it long enough to give it a chance yet, and more then likely not manipulated it to work for my like I did with Pre-mix.

I do however like the additional eating flexibility it brings, I had a BIG MAC yesterday and boy did it taste GOOOOOOOD!!!! Could never of had that for lunch on the pre-mix.

Also support for using MDI from my clinic hasn't been great but the info I've got from you guys here has been invaluable.
 
O_DP_T1 said:
Yep on MDI levels post BIG MAC

1hr 7.8
2hr 6.8
3hr 6.2

so not bad at all. On Pre-mix in the afternoon that would have been in the high teens until for about 5 hours until the next evening shot.
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Woah, you are ninja.

Ninja-Logo.jpg
 
Bridie9408 said:
I have no problem with my humalog mix 25 and hope it never changes. Although I am not a very big eater. And when seen at diabetic clinic I am always one of best controlled.
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Then why do you have to change anything? I tell my endo what I am trying and ask for advice to help me succeed, not the other way around.
 
JMK1954 said:
I was swapped to a basal/ bolus regime in the early 1980s and it was very much against my will. From that day to this I have suffered with hypos during the night. As I always eat approximtely the same amount of carbohydrate at each meal, I was not looking for more flexibility. My waking BS was actually 0.1 mml higher on average over the first fortnight on four injections a day. When I went back to the hospital clinic, the doctor I had been seeing was really disappointed, but would not allow me to revert back to my previous insulin, as he said basal /bolus was modern treatment and nothing else could offer the same control. My waking BS levels continued to say otherwise.

If you are happy with your current insulin, I would fight to stay on it. Unfortunately, there are 'fashions' in insulin, like everything else. What suits one person may not be right for the next. The world and his wife have tried to solve my overnight hypo problem. My sister died owing to an overnight hypo. Personally, I wish I had never been put on a basal /bolus. I sleep with Glucotabs under my pillow every night.
Ps. I was diagnosed in August 1964.
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What basal are you using? I would think one of the big benefits of MDI with Levemir, Lantus or Tresiba is less night hypos vs. NPH/Insultard, but pump or Levemir is all I've ever tried and I guess everyone is different.
 
JMK1954 said:
I was swapped to a basal/ bolus regime in the early 1980s and it was very much against my will. From that day to this I have suffered with hypos during the night. As I always eat approximtely the same amount of carbohydrate at each meal, I was not looking for more flexibility. My waking BS was actually 0.1 mml higher on average over the first fortnight on four injections a day. When I went back to the hospital clinic, the doctor I had been seeing was really disappointed, but would not allow me to revert back to my previous insulin, as he said basal /bolus was modern treatment and nothing else could offer the same control. My waking BS levels continued to say otherwise.

If you are happy with your current insulin, I would fight to stay on it. Unfortunately, there are 'fashions' in insulin, like everything else. What suits one person may not be right for the next. The world and his wife have tried to solve my overnight hypo problem. My sister died owing to an overnight hypo. Personally, I wish I had never been put on a basal /bolus. I sleep with Glucotabs under my pillow every night.
Ps. I was diagnosed in August 1964.
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Hi JMK. I know where you are coming from. I was diagnosed in 1966 and back then regular or Soluble insulin and Isophane (another brand of Insultard) were the only insulins in Australia. My hypo troubles started when I was switched from one injection of each in the morning to two injections of each morning and night. Not sure in the 80's whether you were on anything much different. I worked out that the peak phase of the night Isophane was from about 4 to 8 hours after injection, duration about 20 hours , so say 6 pm injection, peak effects from 10 pm on. A bigger supper meant the hypos would happen after midnight and not before. It was only by first lowering nighttime isophane by 20% AND moving the injection time to 10 pm ( so the peak of Isophane action moved much nearer to the "dawn peak" of blood sugar that things settled down. It was then OK moving to basal bolus but never perfect. It was only when I graduated to Novorapid before meals and levemir am and pm that things got much much better. But of course levemir has so little peak effect that hypos at night were non-existant. BUT by the time I reached about 45 years on insulin even intensive basal-bolus regime of up to 8 injections per day was not easing night-time hypos. Then I switched to an insulin pump and that stopped the hypos happening, enabled me to kep my driver's license and my job until retirement.
 
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