Insulin advice

tinka21 · Aug 26, 2020

Been a type 2 for three years but have been told by my diabetic nurse that i need to take insulin,
going to be prescribed Humulin M3, 14 units before breakfast and evening meal then after 5 days up it to 16units, have been told to take my blood readings and insulin 30 mins before breakfast,if my blood reading is high do i up my dosage of that insulin i am about to take or do it before evening meal, one of my main worries is having a hypo whilst asleep if i have been out for a few drinks and have not taken my evening insulin, any advice ,probably should have put these questions to my nurse but to be quite honest i was shocked and it seemed a lot to take in, any help,advice would be much appreciated. Thanks

EllieM · Aug 26, 2020

tinka21 said:
Been a type 2 for three years

That's quite early for a T2 to move to insulin, specially if they've reduced their carb intake. Have you been tested for LADA (slow onset T1)? It's very common for LADA sufferers to be initially misdiagnosed as T2. A c-peptide test would determine how much insulin you are producing, a GAD antibody test would (probably but not necessarily) determine whether your insulin producing cells are being destroyed by your body. It's worth knowing whether you are T1 or T2, as T1s need insulin whatever happens, and T2s can often control their levels by diet. There's a big difference between needing more insulin than your body can produce because of insulin resistance, and just not making any insulin at all. Also, you'll almost certainly want a different insulin regime in the long term if you are T1. because you'll be injecting all your insulin rather than using it to top up your own supply, and T1s need to vary their doses to account for varying meals, correct lows, and varying needs due to illness, exercise etc.

You need to talk to your nurse to clarify your insulin doses but as regards hypos
1) they occur because you have too much insulin in your system, so unlikely to happen if you've forgotten to take it. But if you need insulin it's a very bad idea to forget to take it.
2) Nothing wrong with alcohol necessarily, but be aware that it inhibits your liver's ability to respond to hypos. I'd suggest moderation here, particularly until you've learnt how insulin affects you and have got used to hypos.

Good luck. Please clarify the T1/T2 issue, it is important.

urbanracer · Aug 26, 2020

tinka21 said:
Been a type 2 for three years but have been told by my diabetic nurse that i need to take insulin,
going to be prescribed Humulin M3, 14 units before breakfast and evening meal then after 5 days up it to 16units, have been told to take my blood readings and insulin 30 mins before breakfast,if my blood reading is high do i up my dosage of that insulin i am about to take or do it before evening meal, one of my main worries is having a hypo whilst asleep if i have been out for a few drinks and have not taken my evening insulin, any advice ,probably should have put these questions to my nurse but to be quite honest i was shocked and it seemed a lot to take in, any help,advice would be much appreciated. Thanks

Humulin M3 is a premixed insulin of rapid acting (30%) and long acting (70%) insulin.

What usually happens with these premixed insulins is that you have to match what you're eating to the amount of insulin you've been instructed to dose for. (I used to use Mix25, a similar product).

The short acting part of the insulin is designed to deal with the glucose rise that occurs after meals. The long acting part is designed to deal with a steady trickle of glucose from your liver which keeps your bodily functions going.

With premixed insulins, you cannot up the dose for meals without taking more long acting insulin which can cause problems later.

As instructed, keep an eye on your glucose levels and phone your diabetes nurse if you run into problems

Keep some fast acting carbohydrate source handy- colas and OJ are pretty good as liquids are absorbed quickly by the body. Some people like jelly babies, whatever you prefer.

One point though, you write "one of my main worries is having a hypo whilst asleep if i have been out for a few drinks and have not taken my evening insulin". A hypoglyceamic event occurs when you have too much insulin in your system, with no (or little) insulin in your system you could become hyperglyceamic (too much glucose).

MarkMunday · Aug 26, 2020

urbanracer said:
... With premixed insulins, you cannot up the dose for meals without taking more long acting insulin which can cause problems later. ...

Premixed insulin is often suitable for T2s supplementing their own insulin production. But it doesn't work so well for T1s who are fully dependent on injected insulin. It highlights the need for verification of the T1/T2 diagnosis.

Jaylee · Aug 26, 2020

MarkMunday said:
Premixed insulin is often suitable for T2s supplementing their own insulin production. But it doesn't work so well for T1s who are fully dependent on injected insulin. It highlights the need for verification of the T1/T2 diagnosis.

It's not exclusively prescribed to T2 IDs Neither is any insulin regime. @urbanracer has recent experience of such matters..

But if you remember the days of fixed dose? Mark, my friend. it wasn't as flexible as MDI. But does work for others...

tinka21 · Aug 27, 2020

A month ago my medication was ..
Breakfast...2 x 500mg metformin,
2 x 80 mg gliclazide, 1 x 10mg empagliflozin, the same with evening meal apart from the empagliflozin.....contacted nurse regarding weight loss as i had lost a stone but could not regain the weight also bloods were up and down, had blood test which came back at 76, was told to stop empagliflozin and to keep an eye on blood readings and that if it was going high to contact nurse which i did after 4 days, she did say during the conversation that my oral meds were at the max and insulin would be the next step as to where i am now.....Thanks

EllieM said:
That's quite early for a T2 to move to insulin, specially if they've reduced their carb intake. Have you been tested for LADA (slow onset T1)? It's very common for LADA sufferers to be initially misdiagnosed as T2. A c-peptide test would determine how much insulin you are producing, a GAD antibody test would (probably but not necessarily) determine whether your insulin producing cells are being destroyed by your body. It's worth knowing whether you are T1 or T2, as T1s need insulin whatever happens, and T2s can often control their levels by diet. There's a big difference between needing more insulin than your body can produce because of insulin resistance, and just not making any insulin at all. Also, you'll almost certainly want a different insulin regime in the long term if you are T1. because you'll be injecting all your insulin rather than using it to top up your own supply, and T1s need to vary their doses to account for varying meals, correct lows, and varying needs due to illness, exercise etc.

You need to talk to your nurse to clarify your insulin doses but as regards hypos
1) they occur because you have too much insulin in your system, so unlikely to happen if you've forgotten to take it. But if you need insulin it's a very bad idea to forget to take it.
2) Nothing wrong with alcohol necessarily, but be aware that it inhibits your liver's ability to respond to hypos. I'd suggest moderation here, particularly until you've learnt how insulin affects you and have got used to hypos.

Good luck. Please clarify the T1/T2 issue, it is important.

becca59 · Aug 27, 2020

I would reiterate others and say a definitive type 1/2 blood test is required promptly. Do not take no for an answer.

EllieM · Aug 27, 2020

tinka21 said:
contacted nurse regarding weight loss

And yet another T1 symptom. You need that diagnosis.

MarkMunday · Aug 27, 2020

High blood glucose, weight loss and not responding to Type 2 medications would be a red flag to me. It is sounding more and more like Type 1. If it is Type 1, things could go downhill quickly. I would make an urgent appointment with the doctor, explaining that there is reason to suspect Type 1, and insist on the antibody tests being done.

EllieM · Aug 27, 2020

MarkMunday said:
I would make an urgent appointment with the doctor, explaining that there is reason to suspect Type 1, and insist on the antibody tests being done.

@tinka21

And the c-peptide, as negative antibody tests don't always disprove T1. Unfortunately GPs tend to assume T2 in older people, regardless of other symptoms. If they try to tell you you must be T1 because of age, remind them that the UK's ex prime minister was an older diagnosed T1....

Good luck.

tinka21 · Aug 27, 2020

Must apologise, been type2 for around 5 year not 3, contacted nurse and enquired whether im classed as type 1 or 2, she said still type 2, put the weight loss down to taking empagliflozin when i shouldn't have been taking it.

EllieM said:
That's quite early for a T2 to move to insulin, specially if they've reduced their carb intake. Have you been tested for LADA (slow onset T1)? It's very common for LADA sufferers to be initially misdiagnosed as T2. A c-peptide test would determine how much insulin you are producing, a GAD antibody test would (probably but not necessarily) determine whether your insulin producing cells are being destroyed by your body. It's worth knowing whether you are T1 or T2, as T1s need insulin whatever happens, and T2s can often control their levels by diet. There's a big difference between needing more insulin than your body can produce because of insulin resistance, and just not making any insulin at all. Also, you'll almost certainly want a different insulin regime in the long term if you are T1. because you'll be injecting all your insulin rather than using it to top up your own supply, and T1s need to vary their doses to account for varying meals, correct lows, and varying needs due to illness, exercise etc.

You need to talk to your nurse to clarify your insulin doses but as regards hypos
1) they occur because you have too much insulin in your system, so unlikely to happen if you've forgotten to take it. But if you need insulin it's a very bad idea to forget to take it.
2) Nothing wrong with alcohol necessarily, but be aware that it inhibits your liver's ability to respond to hypos. I'd suggest moderation here, particularly until you've learnt how insulin affects you and have got used to hypos.

Good luck. Please clarify the T1/T2 issue, it is important.

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