Insulin Practices?

[EllieM]

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.

This is why your diabetic team should have given you a number to phone to discuss your readings - your dose should have been lowered as soon as you started to get hypos.... They should also have told you to reduce your insulin if you were getting hypos.

This is a forum, we're here to support each other, and honestly I think that includes listening to people rant occasionally.

(I just posted and then deleted an off topic long rant about the treatment of my T1 mother in a UK hospital - the short version - no one should be forced to choose between too much basal or too much bolus when the presiding nurses can't find a doctor to authorise a lower insulin dose and their only choice is to refuse one of the injections! There, micro rant over, I'm feeling slightly better for it.)

 

[Janetoby]

There are sites on the internet that you can calculate (roughly) you daily required dose of insulin by body weight. However in saying this it also depends on if you are sensitive to insulin or insulin resistant as this will vary the amount that you need. Unfortunately this comes with trial and error. You can also find how to test if your basal dose is correct, same for meal ratios. There is lots of (sometimes conflicting) information out there - if you are having trouble finding it, change how you are asking the question. Of course all of this should be with consulting a doctor as well, but their word is not necessarily gospel I have found after 43 years of type 1!

 

[EllieM]

Agreed, plus there's the fact that new T1s can be affected by the honeymoon effect, where their pancreases start produce extra insulin when they're no longer under the strain of having to supply insulin for the whole body's needs....

Plus there's the fact that no two T1s are the same, and most people know more about their own bodies than the specialists do once they've been diabetic for a while. But when you're starting out you're really at the mercy of the specialists, because they really do have more experience than you do....

 

[Alison54321]

For those saying 'before I point my accusatory finger', tell me that is not dangerous.

I wasn't saying don't point the accusatory finger. I was saying lower your insulin so you don't get hypos, and then point the accusatory finger.

You seemed more concerned with how the process was failing you, than sorting out your insulin dose so you didn't get hypos.

A big part of T1D is about surviving despite, not because of., doctors. They are necessary in a crisis, but the only person, really, who can know what is the right insulin dose for you, is you.

 

[DCUKMod]

@handicapable - If you continue to have apparent issues with hypos - for whatever reason, you should be discussing those with health care professionals. Whilst venting on a forum helps get it off your chest, it is unlikely to get to the root cause of the problem.

I strongly suggest you engage with your health care professionals, rather than tackling it as you appear to be now.

 

[Struma]

Have you looked here www.lantus.com ? Might be worth it.

Reaffirmation: You desperately need contact with Health Care Professional.

 

[tim2000s]

@handicapable - I agree with @Mel dCP - I think you've been given someone else's prescription to take home. They'd normally leave you on the same insulin, and to have such a large discrepancy in doses of Lantus makes no sense.

In your position, I would revert back to the dose that it says I was on in hospital, and call them up ASAP and refuse to get off the phone until someone spoke to you, as you need to clear this up right now.

 

[Roseanne01]

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 f*ck.

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.

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 f*ck

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.

That wasn’t what I meant. Everyone I know has had to work out the correct doses according to food, exercise and them, and it takes time and adjustments (experiment). As an individual, because we're all different. I was not suggesting for a second accepting the doses, but getting help until you feel better adjusting the dose yourself. My experience isn’t NHS and in Australia there are so many supports available that you’re not left on your own trying to fix an issue. I don't know anyone who has been told 'take this' and off you go. I think you’re reading what I said so you can take offence. So, having let off steam at me I hope you do what everyone is saying and access some professional help.

 

[kitedoc]

Hi @handicapable,
Some of what you have said is on another thread and I have answered there rather than here.
Yes, I experience hypos if I take too much insulin and (just for completeness, I can suffer from hypos if i eat too little carbs for my insulin dose)s).
You mention having to put up with the increased dose for about 4 days, or was it up to 3 weeks?.
Once discharged on insulin injections, patients are usually encouraged to contact their health team if things are not going well, for example, high or low sugars so that adjustments can be made (and errors discovered and corrected). If you refuse to speak to your health team until you have something to fire at them you will only be hurting yourself.
People come in all different sizes, rates of metabolism, and positions along a continuum of diabetes. You get to see that after going to diabetes clinics for many, many years.
So whilst there may be some 'rules of thumb' about what amounts of insulin MIGHT be expected to control a person's BSL my doctors (and over 51 years on insulin I have seen plenty of them) have told me they adjust doses and types of insulin according to how the individual responds.
And my own experience, and we can each be different, is that when I was switched from insulin injections to use of an insulin pump, my total dose was eased back for starting on the pump as my doctor's experience was that the pump was more efficient in lowering BSLs than the injection regimes.
I was suffering with hypos at night and that was the reason for changing to a pump.
My diabetes education included information on hypos and their potential to be harmful. I was also told about my liver's ability to store glucose and release it in response to a hypo as a protective mechanism.

 

[handicapable]

Have you looked here www.lantus.com ? Might be worth it.

Reaffirmation: You desperately need contact with Health Care Professional.

'Lantus should only account for 33% of your total daily insulin needs' - straight from the people who make the stuff.

 

[LooperCat]

'Lantus should only account for 33% of your total daily insulin needs' - straight from the people who make the stuff.

The usual advice is that basal insulin makes up half of your TDD.

 

[handicapable]

@handicapable - I agree with @Mel dCP - I think you've been given someone else's prescription to take home. They'd normally leave you on the same insulin, and to have such a large discrepancy in doses of Lantus makes no sense.

In your position, I would revert back to the dose that it says I was on in hospital, and call them up ASAP and refuse to get off the phone until someone spoke to you, as you need to clear this up right now.

This is the closest anybody has got to the truth to date although if it was a mistake on behalf of the hospital, I should probably have received a phone call from them telling me they were calling urgently about a mix up with another patients prescription.

Also the consultant never took my weight which asks the question, how did he calculate my body's total daily insulin needs?

Plus if that prescription was in fact for another patient they owe that patient an apology too because 24 units Lantus to 18 units NovoRapid is almost double the manufacturers guidelines of 33% of your total daily intake (it is actually 57%!) but hey what do they know? They only make the stuff.

Haven't got around to that phone call yet, can't see it being a lot of fun.. It is on my to do list though.

 

[handicapable]

The usual advice is that basal insulin makes up half of your TDD.

Like I said I was quoting Lantus' own manufacturers guidelines, the University of California's scientists say 40/60.. I'd rather take my advice from those who make the stuff and actual scientists / professors from world renowned universities than the attitude I've got from my diabetes team up to this date which is 'throw the **** and see if it sticks'.

edited by moderator for language

 

[LooperCat]

Like I said I was quoting Lantus' own manufacturers guidelines, the University of California's scientists say 40/60.. I'd rather take my advice from those who make the stuff and actual scientists / professors from world renowned universities than the attitude I've got from my diabetes team up to this date which is 'throw the **** and see if it sticks'.

It’s basically whatever works for you. My ratio is usually 80% basal to 20% bolus.

 

[kitedoc]

'Lantus should only account for 33% of your total daily insulin needs' - straight from the people who make the stuff.

I am afraid 'should' is a restrictive and misleading word to use.
What is more: On the drug company site of the makers of Lantus it says under "Getting the dose right for you" : That your doctor will base your dose on: your blood sugar test results, your blood sugar goal number and your needs. And in full prescribing information for Lantus (products.sanofi.us) Dose and Administration : depends on your metabolic needs, your blood glucose monitoring, glycemic control and the type of diabetes prior to administration of insulin. That all suggests a wide possible variation in doses and possible ratios of total daily insulin dose.
I could not could not find the statement you quoted. Perhaps you would be so kind as to direct me to it.
In over 51 years of being on insulin I have never heard of a doctor saying that a definite, proscribed ratio of long to short acting insulin applies to every diabetic prescribed such insulins. I would be interested if any one has.

 

[kitedoc]

The usual advice is that basal insulin makes up half of your TDD.

But as an approximate only !

 

[handicapable]

Yeah you're right, it is an approximation by the manufacturers but if you are interested in checking it up:

http://products.sanofi.us/lantus/lantus.html

2.3 Initiation of LANTUS Therapy

Under 'General Prescribing Information'

 

[kitedoc]

Yeah you're right, it is an approximation by the manufacturers but if you are interested in checking it up:

http://products.sanofi.us/lantus/lantus.html

2.3 Initiation of LANTUS Therapy

Under 'General Prescribing Information'

Thankyou @handicapable, This is an American company making assumptions about what a diabetic diet is and what a standard type 1 diabetic is, following some standard diet advice from their medical director, based on an American medical standard which is not necessarily what countries that Lantus is distributed to will follow. The dose and ratio will vary and the 'should' is misleading, I think, personally. You have seen some of the ratios mentioned/posted. Mine on an insulin pump for example is close to 50:50

 

[JMK1954]

You are right to be angry, handicapable. Too much insulin is very definitely dangerous. I agree that you seem to be dealing with the consequences of an error with the paperwork when you were discharged. From what you say, you have now dealt with the immediate problem, but you need to contact the hospital urgently, to check how much insulin you were supposed to be on and tell them of what has happened. You must have an emergency contact number for a specialist Diabetic nurse, at least ? Or have you told them your story now ?

The one thing I don't understand is why you didn't get straight back to them as soon as it became apparent that you were having a ridiculous number of hypos.

 

[kitedoc]

This is the closest anybody has got to the truth to date although if it was a mistake on behalf of the hospital, I should probably have received a phone call from them telling me they were calling urgently about a mix up with another patients prescription.

Also the consultant never took my weight which asks the question, how did he calculate my body's total daily insulin needs?

Plus if that prescription was in fact for another patient they owe that patient an apology too because 24 units Lantus to 18 units NovoRapid is almost double the manufacturers guidelines of 33% of your total daily intake (it is actually 57%!) but hey what do they know? They only make the stuff.

Haven't got around to that phone call yet, can't see it being a lot of fun.. It is on my to do list though.

Insulin dosage is based on many factors and body weight is just one of many.