Insulin Isophane (intermediate)

Hi all

I am very much new to this forum so not sure if any thread already exists on this topic. I am T2 for 13 years now and have been on the following medication since 2017.
Humulin Isophane I at breakfast and dinner
Metformin 1 gm / Alogliptin 12.5 mg One each at breakfast and dinner
Gliclazide 30 mg MR One each at breakfast and dinner
My A1C has been at a range of 5.1-5.2 since I started insulin in 2017.

recently during the lockdown period I decided to bring my overweight status down to normal.

so what I did was :
I started to have a moderately active life (working out almost everyday for about 45 mins)
Doing carb control though on a balanced 45:20:35 diet (carbrotein:fat)
(Earlier I used to have much higher carbs and sedentary lifestyle)
Having my evening meal at 7:30 instead of 9:00 and I hit the bed about 10:30
Reduced my insulin dose at BF to avoid hypos in the daytime
And invested in Abbott Freestyle Libre

as a combined result of all of these I am experiencing the following:
1) sugar level starts falling post workout which I manage by taking a fruit or a protein shake
2) regular hypos at night .. so I stopped taking night time insulin
3) higher BS at fasting than before even if I had a hypo (I found out it’s called dawn effect that’s causing the liver to dump sugar on top of somogyi effect when again the liver dumps sugar after hitting a low). So I definitely have dawn effect everyday but somogyi only if I had a hypo
4) post meal spikes going up to 12-13 even if the carb was less
5) mornings been terrible as the BS is going high even if I don’t eat

I am in a complete awe and very much disturbed. Have contacted the GP and sent them the charts with all the data but just want to be bit prepared before my diabetic appointment.

the three most severe things for me are ->
1) hypos at night
2) 7-8 fasting BS compared to 4.5-6 earlier And which continues to rise even if I don’t eat
3) post meal spikes which I cone to realise more with flash monitor

I am getting to believe that I need a rapid acting insulin for my post meal spikes and need something else to control the amount of sugar dumped by the liver every night.The intermediate insulin I take peaks at a time when I don’t need it as I am already on a lower curb these days.

Could anyone suggest anything please?

thank you all for listening.

xfieldok said:

Hi and welcome to the forum.

How much weight do you want to lose? You need to talk to your team, but if you are lowering your carbs, you may want to reduce the glicazide.

Are you relying on the freestyle for hypos? It is notoriously inaccurate under 4. You should always follow up with a fingerprick.

You can't do anything about the dawn phenomenon.

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hi
Thanks for your response. Well I do track my BG on Freestyle Libre but I get symptoms for my pre-hypos That I get up in the middle of the night sweating and most of the times the tracker shows 4.1 about that time. Also my finger pricks used to give me similar readings when I had not moved to Freestyle. It then follows on with a weird headache, pounding heartbeat if I don’t treat it and eventually I lose 2-3 hrs of sleep until it comes back to 6.5.
But some nights when I am not going low even then BS keeps ride after hitting about 6 and by the time I wake up it’s already 7.5.
If I take the insulin with my dinner even if it’s 4 units, I hit a hypo in the middle of the night.
I am confused because this is happening since the time I have started being active and eating lesser carb than before.
The problem with my medication I guess is gliclazide prescribed to me is modified release which does not help post meal spikes but works at a time when I don’t need it. Likewise my insulin is an intermediate one as well.so I get spikes after breakfast too!!
I have given all the information to my diabetic nurse. Got to go for a blood test this week followed by a review appointment.

EllieM said:

T2s don't process carbs well, which leads their bodies to overproduce insulin in a vain attempt to maintain normal blood sugars. If they continue with the typical high carb modern diet, the result of high insulin and high blood sugars is increased weight and insulin resistance, and long term, increased medication, with the end result being insulin.
MRGD: this is exactly what I was experiencing until now that I reduced my insulin dose and started being active with some carb control.
I have lost 6 pounds in 3 months so far. Got to lose another 10 pounds to come to a normal BMI.

My suggestion would be to consider reducing your carbs further and ultimately cutting out the insulin (with the proviso that I don't know if your insulin producing cells have been damaged by long term overproduction).


This seems crazy to me. I'd want to manage this by reducing external insulin, not by increasing carbs. Carbs are not your friend.

MRGD: actually I have reduced insulin but then could not stop it completely due to the postmeal spikes. But the intermediate insulin is not helpful that way either. I am completely confused and need to find a more flexible way of managing my BG.

Not so balanced for a T2, who can't process carbs.
MRGD: I know. I am currently limiting it up to 160 gms a day but the problem is I am not able to eat enough to consume my calorie allowance.

Its fairly typical for diet controlled T2s to have their dawn bs ne the last to go down.'

Obviously you need to be careful of hypos as you reduce your carbs, but this can hopefully be managed by talking to your team and reducing your insulin quantities appropriately.

Good luck.

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Thank you. I am hoping for the GP to sort this out as I am pretty much disturbed and in a confused state.

xfieldok said:

Do you know what your last hba1c was?

The majority of the NHS don't understand low carb or keto. You may be lucky but your team may be resistant to it. The majority of us control our T2 with diet, I chose keto.

Please read The diabetes Code by dr Jason Fung, you can get it on kindle.

Click to expand...

Thank you so much. Let my try get hold of this book. My A1C had been 52-54 since 2017. Earlier I was on medication only but could not manage well then moved onto insulin. That improved my A1C but now my medication needs to review my positive lifestyle changes.
You are absolutely correct in saying our GP is not used to handle the complex conditions like this where they need to prescribe as per the lifestyle.
They had not even shared any knowledge as to how to handle sick days, how to alter doses.
My BMI is 26.5 and I need to lose another 10 lb weight.

Thank you @xfieldok for atleast trying to help. I have lost my complete peace of mind seeing the reality of my BG levels after investing in freestyle Libre. Earlier I was depending on NHS prescribed accu-check and finger pricks every alternate days so I could hardly see what was happening ..
When I started getting more of these hypos I purchased this flash monitor myself without waiting for the GP. I am sure they will not prescribe it. The damage I have done to myself is already so immense and that too without understanding it at all.
I had inherited T2D as I belong to a family of Indian origin with everyone diabetics. Now at 44, I got a wake up call when the COVID situation pointed out the higher risk for T2D.
Thanks again for your suggestions. It helps so much to know others ways of handling such issues, which otherwise would sound so difficult or impossible to follow. I will update the thread after my review is done.