Insulin switched today!

Janeliz66 said:

Fasting glucose this morning 11.7 which id's better Than the usual 14

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Hi Janeliz - Switching medication is naturally a bit of a stressful time, as you work out what's best for you.

Right now, I would say it is really important that you are testing lots, and that you should try to only change one things at a time. If you change more than one thing at any given time, it can be impossible to work out exactly what caused any change you made (first thing, second thing, or a combination of both things).

Having read of several members switching from pre-mixed insulins to what can be more the flexible long acting + short acting insulin, often referred to as MDI (Multiple Daily Injections), it is quite a learning curve.

Most who make the change see it as a positive move, once their initial steep learning curve has passed, as it can, over time, allow you to more closely match your medication to your body's needs.

Most T1s on MDI are offered a carb counting course to help with that matching, but that appears less usual for T2s.

There is at least one online carb counting course, called, BERTIE, which others have found useful, even if it designed for T1s.

I would suggest taking things steadily, as sometimes these things can be a bit like the tortoise catching the hare, with a sure and steady approach achieving more than rushing to make so many changes you end up bewildered.

I seem to recall @Cumberland making a change to MDI along the way, although if I recall properly, that was also around the time his diagnosis changed from T2 to T1.

Hopefully there'll be other dropping by today who can give you some more specific information.

ickihun said:

Wow. Just 48units of mixed insulin even with metformin is very good for an insulin resistant diabetic.
I'm guessing you were having hypos for your m3 to be changed to mdi (multiple dose insulin-injections)?
You maybe able to drop your insulin one day. Is your diabetic team asking you to carb count with your insulin? Mine doesn't as I eat as low carb as I can without feeling ill (palpatations) due to other health problems.
I was taking just under 300units of m3 at xmas 2016. I'm now on 66units of basal and 20, 20, 20 units of novarapid or 30, 20/30 if I'm fasting. Fasting doesn't benefit me, I've found. Although taking the pressure off my swollen water balloon tummy feels less uncomfortable with less food.
Do you think if you seriously reduced potato, pasta, rice and bread if you could maybe eventually reduce your bolus injections, like me?
Settle into your new routine of what insulin you will currently need first. Then you'll know your starting point.
Stick to your dn advice for increasing or decreasing your novarapid and lantus. They are invaluable when insulin needs changing. Mine has decades of experience. Of which I'd never ignore.
I bet you feel excited about the prospect of reducing your insulin units more?
How much carb and protein do you currently eat daily?

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Ickihun, reading @Janeliz66 's posts, it looks like the rationale for changing her insulin therapy was to trim back an HbA1c of 92, not as far as I can read, to reduce the amount of insulin being taken.

My thoughts would be that the amount of insulin needs to take to balance their requirements is very personal, with some requiring more or less than others. I can't say I have read of any insulin dependent diabetics (IDDs) experimenting by mirroring each other, over any period. My guess is that would be extremely tricky, bearing in mind that sleep, stress and so many other things can get into the mix and impact blood glucose and insulin requirements

I appreciate you have always wanted to trim back your insulin requirements, and that's admirable, bearing in mind your "bigger picture" objectives. Provided it can be done without risking one's health (which you seem to be managing to do), I salute you in your efforts.

I do however agree that it makes sense for janeliz to sort out a steady state, before experimenting too much with diet or anything, if she even wants to do that.

@janeliz - I really wish you well on your exciting, but scary journey. It sounds like you want to take a careful approach and I agree that makes sense.

Oooops, looks like I was composing as you were posting @janeliz .

ickihun said:

What I've found is insulin resistant diabetics on m3 would just need to add and add their units to reduce there hba1c @DCUKMod . I admire OPs diabetic team as they have recognised early that more units would reduce her hba1c but feed the insulin resistance. Making her type2 condition more difficult to manage. Like dr beinstein wrote.... smaller changes cause smaller errors. So less likelihood of a hypo.
That is why she has been advised to just adjust in small units not like some who have to adjust in larger amounts of units due to severe insulin resistance.
Her team will always evaluate the risk of her hypo for her, first and for most. The reduction of hba1c may never come for some. No matter what treatment is offered.
Insulin treatment is the best treatment for lowering hba1c. In type 2s too!
Anyone can sustain lower hba1cs on insulin treatment.
The more insulin you take, the lower the hba1c if hypos are not more frequent than ideal bgs.
Hypo treatment is essential but too many hypo treatments can interfer with your hba1c result.
The less hypos, the better, all round. Nasty side affect to too much insulin injected.

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I don't want to get into any tiff on insulin therapy, but I would take issue with this phrasing in your post, "Insulin treatment is the best treatment for lowering hba1c. In type 2s too!"

I don't for an instant argue that insulin is an inappropriate tool for blood glucose management in T2, but it isn't best for everyone, if HbA1cs can be moderated by other means, whether that be diet or oral medication. I'd guess those usual things didn't work out for @Janeliz66

Clearly insulin doses need to be set appropriately for the individual's requirements, and many find MDI offers significant flexibility, but right now, I think it's important that janeliz66 works toward finding her steady state before considering too many other changes.

Having observed others go through this, it strikes me that for the most part the medics tend to start the person in a safe place, but test, test and then test some more seems like the way to go.

I'll dip out of this thread for now, as I seem to be becoming a party to deflecting it away from janeliz66. My apologies.