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Insulin Practices?

handicapable

Active Member
Messages
26
Type of diabetes
Type 1
Treatment type
Insulin
I know nobody on here can really give me a definitive answer to this (I did just download an app to ask a diabetologist but when I clicked 'post' it wanted £20 p/m hence me pasting it here) but somebody must be able to tell me how they were started on insulin or give an educated answer. Any reply would be much appreciated, ta.

Can you please tell me the best practice for insulin therapy in a newly diagnosed type 1 diabetic 30 years of age, weighing 70kg (down from 80kg) on a basal/bolus regime. How many units of each would you generally prescribe to begin with? I think this one is self explanatory but would you start off with lower doses and work them up in increments over a period of time until the desired blood glucose levels are achieved, or would you do it the other way round?
 
I am not a type 1, but it seems to me that the best thing to do is ask whoever is in charge of your diagnosis and treatment.
 
What I'm ultimately looking to be answered is if being prescribed a lot of insulin (way too much) to begin with is in accordance with good practice guidelines or is it as dangerous and unprofessional as I believe it to be?

I'm not speaking with my treatment team until I get this answered.
 
@handicapable - Allow me to draw your attention to the following excerpt from our Forum Rules:

"....... A11 Important: Members are generally not Health Care Professionals, and those who are participate on the Forum as Members, not Health Care Professionals. Members are unable to diagnose any condition, or instruct in the alteration of medication, irrespective of personal or professional standing or experience....."

The full rules can be found here: http://www.diabetes.co.uk/forum/threads/community-ethos-forum-rules.50278/
 
Can I ask to be pointed in the direction of somewhere this can be answered? I've spent the best part of the first 3 weeks of my new life as a diabetic suffering from a hypo's and feeling as though I'm about to drop dead, looking for some clarification before I speak with my management team. That is all.
 

Your management team can answer this, or ask your GP for a second opinion.
 
DCUKMod said:
Your management team can answer this, or ask your GP for a second opinion.
Click to expand...
I've been over prescribed (double) by the hospital, I found the error on my discharge forms earlier. The consultant, my DN and GP all missed it.. If I wanted to speak to any of them about this before I know if it could have killed me I would have done so earlier. Thanks.
 
@handicapable can you elaborate further what you mean by over prescribed. like they gave you more for the month than you need or they wrote down that you’re on more daily then you are?

as a member of the forum we can’t give dosing advice but would recommend keeping your doses as they currently are until you can talk to either a diabetic nurse or doctor!



EDIT: just read your above post properly and noticed you are saying you are having lots of hypos. Hypos can be caused by the heat or by the insulin doses being too high. The best way to find out if your long-acting insulin is the culprit is to do basal testing. This involves eating only carb-free food or no food for the duration of the day I think, however there is more information on this in another section of the forum. Search for Basal Testing and you should find it.

As a general rule of thumb which I know we are allowed to share on this forum is that if you are waking up hypo to reduce your long acting by 2 units every few days until you don’t wake up hypo!
Please bare in mind that the heat causes havoc with blood sugars, some manage fine, some have highs, some have lows. I personally get lots of stubborn highs then rebound lows.


Good Luck!!
 
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I would try looking up the NICE recommendations.
 
bamba said:
I would try looking up the NICE recommendations.
Click to expand...
I tried there first but all the information on insulin practices is about not giving hospital patients double doses and double checking the prescribed dose (which they obviously didn't but I was no longer an inpatient at the time).

If anyone can find a link to what I'm looking for it would be appreciated.

I know it's not right because I saw an image on Google when I was looking at BG and ketone charts but at the time I hadn't seen the error on my discharge forms so didn't save it, now I need it I can't find it.
 
The DN I saw in hospital was under the belief I should be starting on 24 units Lantus and 6 units NovoRapid at meal times, all the DN's I have spoken with on the phone are under the same impression and my GP whom I showed my discharge letter to for a repeat prescription all missed it... Despite the error being on the next page of a 3 page document...

Just to make it clear I was never informed by the consultant I was starting on 10 units Lantus, 4 units NovoRapid tds* and to prevent breaking any forum rules or shaming those responsible I have removed all identification from the following two documents*

*tds = [Latin.] ter die sumendum (three times a day).

 
I was diagnosed so long ago I really can't remember the details. There are a number of issues here. Did you have any time in hospital? I think most people spend a bit of time in hospital, were the dose is tested.

Sometimes there is a honeymoon period, which you can google, when after diagnosis, the pancreas comes back to life for a bit, but I think that might be too early.

I also think there is an assumption that something around 20 units of basal is just the right amount. But it often isn't. If you weren't in hospital, they may have treated you as that statistically rare, but also in their minds, average person. So you got the average dose, regardless of it's appropriateness for you.

If you are getting hypos reduce the basal a bit. Unless the bolus ratio is too high.

It's hard to get used to adjusting insulin. Do you have anyone to contact, that might be worth doing.

I don't know what the standard practice is, but too many hypos aren't good. So reduce the insulin a little, preferably with advice, but if not, do it anyway. You can always put it back up if your blood sugars go too high.
 
I read that letter to mean they were “starting you” on 10u Lantus and 4u Humalog tds. And that by the time of discharge you’d be on 24u Lantus and 6u tds Novorapid. Perhaps they started you on a smaller dose to see how you responded and then increased it to that by the time you left? You rarely start on your “final” dose, and fairly soon they’ll teach you to count carbs and adjust it for yourself anyway.

I’d get hold of your hospital medicine chart from this stay, as not only the doses, but one of the insulins is different. Could they have built you up from that initial dose profile to what you left with while you were there?
 
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That is a very strange document. It does say start on 10 Lantus, but then gives you 24. It's clearly too much, if you're having lots of hypos. In reality, the reason for the mistake, at this point in time, is irrelevant, what matters is changing to a lower dose so that you don't have too many hypos.

You can point accusatory fingers at people later, get the right dose sorted first. You may find yourself thrown into adjusting your own insulin at bit of an early stage, but better that then feeling ill with too many hypos.

But advice would be the best thing.
 
I didn't stay in hospital because there were no beds. So I left A&E at 3 am and returned as a diabetic outpatient a few hours later.

That meant nurses had to make best guesses about my dosages and asked me to phone through daily so we could increase / decrease as required. Can you call anyone in the department to discuss?
 
I spent 4 days in hospital with DKA and had a drip of insulin in one arm, fluids in the other for the first 3 days. On the final day I was given the opportunity to inject with the pen myself before meals but I can't remember what dose it was.

To be honest I think I remember the nurse dialling it up so I didn't start on 10 Lantus 4 NovoRapid 3x a day I can tell you that much. Even if I'm wrong, that's one hell of an increase in dose for a 24 hour period eh..

Page 1 was the notes from resuscitation stating primary diagnosis T1, Page 2 is secondary diagnosis DKA & the consultants instructions and Page 3 is the prescription form I had to take to the hospital pharmacy.

I don't need lessons in carb-counting, I have it under control. I'm just taking 9 units Lantus, eating well and my BG levels are spot on, my average over the past 7 days is 8.6 mmol/l.

The past 4 days since I stopped taking the meal time insulin and halved the 24 hour insulin my levels haven't changed, I've only had one Hypo and a few falsies.

Whenever I called my DN to say I thought I was taking too much I was told to drop it by 2 units which wasn't enough. I was eating out of necessity for the first two weeks and it was making me sick.

It's a good job my brain listens to my belly because 3 times I woke up after just a couple of hours sleep for no other reason than low blood sugar. As early as 2am and as low as 3.4 mmol/l so this isn't directed at you (on my mobile and can only figure out how to reply to posts).

For those saying 'before I point my accusatory finger', tell me that is not dangerous.
 
@handicapable it’s not right, whatever has happened. The fact it mentions Humalog as the bolus on one sheet and Novorapid on the other as well as the different doses makes me wonder if you got given the wrong prescription - was it intended for another patient, I wonder? Having thought about it, that seems the most logical explanation to me.
 
Are you having hypos? Regularly? The f not you’re not on too much insulin. Jystvread your thread against n. Sorry but tge first few months are experiments in working out what works for you. I don’t l understand ttge NHS but I’d be back t my doctor for advice. Mistakes happen and surely the best thing is to get it fixed.
 
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I have to say I strongly disagree with everything you have said there.

Oh yeah we're they regular.. I had hypos 2 hours after eating 3 course meals, hypos when falling to sleep (realising the back of my head and neck were sweating that much my pillows p*as wet through), hypos after exercise despite following the carb-counting advice given (plus another 20g for good measure) and hypos that would wake me up (luckily).

That last one I know for a fact is a sign I was on too much insulin and if it wasn't so late I would go get my laptop and post the link.

It's also extremely dangerous to go hypoglycemic in your sleep, check the diabetes.co.uk and search for dead in bed syndrome.

And I make no apologies in saying if they want to conduct experiments on me with a drug that can kill you so easily they can get to ****.

I wouldn't have lasted another week on that much insulin, let alone a few months and I know my body's limitations better than you.

I'm done with this thread now because the majority seem to be baiting me into a rant rather than being helpful.

Thanks to those who have replied with useful information. Even if it was against my way of thinking at least it had some kind of sensible reasoning behind it, unlike this unsubstantiated drivel.

edited by moderator for language
 
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