Mixed insulin

It's entirely possible that your pancreas has been kicking out insulin intermittently during the Honeymoon Stage, and now that has reduced.

It may be worth having a wee chat with your diabetes team about changing your mixed to another one with different proportions of Basal/ fast acting if you prefer to stay on a mixed insulin rather than switch to basal/ bolus MDI .

It's an annoying feature of the D beastie that just when you think you have it cracked, it moves the goal posts

Signy

Oh yes, I remember the problems you had now Remind me, what Mixed are you using now ?

Signy

borderter said:

Love the basal bolus but not able to find basal that suits so went onto mixed and at first thought great but now unpredictable results

Click to expand...

I do remember this, did you ever get to try Tresiba?

borderter said:

Signy am on novomix 30/70 and top this up midday with novrapid
No Noblehead did not get Tresiba asked again at my annual review last week but told not yet and there is something new coming which includes metformin and other things mixed in and its at least 18 months away !

Click to expand...

That's a shame, but if you are having to use high doses of insulin then you might want to ask if you can start on Metformin, it's said to help with insulin resistance in those who inject insulin and some type 1's on the forum take this drug and have found it to be beneficial.

Hello, I'm on novomix 30/70 and I found that I needed to up my dose until I started the eight week blood sugar diet. I was taking 24 unit in the morning and 16 in the evening and if I was running high at bed time I added another couple of units . I'm on my second week of the diet and readings are well down from fasting 8 or 9 to 4.2 to 5.6 fasting and staying below 8 all day. I have reduced my insulin to 16 units in the morning and 10 units in the evening.

I take Humulin M3 Insulin. Originally I started on 1 unit per kg a day but I am titrating up through insulin resistance. I am taking 144 units per day and am going up 4 units per week. Metformin is not an option, I had an adverse reaction and I have had major bowel surgery which has contraindicated its use.

borderter said:

Anyone on mixed insulin find themselves using more and more to achieve the same result ?
Only been on mixed for four months and now doubled dose with worse results

Click to expand...

I am on Humalog Mix50 and it is causing me problems. I take 70 units morning and the same at night. I also have a CPAP machine, but due to a nose injury have been unable to wear it for months now. My readings are sky high and show no sign of coming down.

borderter said:

Really liked the freedom of twice daily mixed but for me it just did not work

Click to expand...

It didn't work for me either, I'm now on a regime called 'Basal Plus' which is much better for me and I'm needing about half the units. It was the profile of the basal that caused me difficulty as it lasted a long while in my system giving rise to overlapping doses, but wasn't enough bolus for eating, so I fluctuated wildly.

When I started having difficulties I did some research and it seems that mixed insulins are good at getting control, but not as good for long term maintenance. It's understandable really, they're in a fixed proportion and can only ever be a best guess dose. I like being able to manage the two types separately.

Edited to add: I did well on the mixed for a year, it was only when I got good control that it didn't suit as well. I wouldn't want to put anyone off it if it's been recommended by medics.

borderter said:

Not heard of basal plus so interested to see how that works can you explain it

Click to expand...

It's basically a basal dose, plus one bolus dose at your largest meal - so a trimmed down basal/bolus regime for T2s. It's supposed to give good control with a reduced risk of hypos.

You take a slow acting basal (I'm on Lantus once a day, due to its flat profile, but it could well be a shorter acting twice a day) in order to get your FBG to under your target number, then add a bolus to your meal of the day with what they call 'the largest post prandial excursion' - in my case, my evening meal. You then set a bolus dose at a level to get that post meal number under your target. The idea being that if you don't go too high at the one meal where it's most likely, supported by the background basal, your control for the rest of the 24 hours stays decent. I found a research paper on it and thought it sounded like it might suit me, so mentioned it to my DN who was already familiar with it and had a couple of other patients doing it, so had already put it down as a technique for me to try, when it was clear that the mixed no longer worked.

So far, it's working well for me, my numbers are pretty consistent over the 24 hours, just a smidge higher than optimal just yet, but we don't think we're at final doses yet, I only started 5 or 6 weeks ago and we've titrated slowly. I take Lantus late in an evening, but it appears to run out around teatime the following day, as I start to rise after that, meaning I start my evening meal at one of my highest points of the day, so I'm contemplating changing the time of the Lantus to something like lunchtime/early afternoon, so it will run out in a morning when I'm most active and usually exercise. I need to discuss that with my DN at our chat next week.

I can't just find the original study I read, but I think this is a recent re-publication of the same text:
http://www.primary-care-diabetes.com/article/S1751-9918(15)00073-X/fulltext

borderter said:

I take me basal at lunchtime as like yourself bgs are good in the morning so basal helps keep main meal bg rise down a bit

Click to expand...

That's good to know that it works. I'd like to tweak the timings before I increase the dose further, it feels like it's working well, but the daily pattern could be improved.

Sorry @borderter, I've not been on the forum for a while, so missed this.

I think it's settled to a decent level at the moment, I might need one more upward tweak of insulin to get to optimal numbers - we change dose every 2 weeks as I can rebound if we do things too frequently. I had a week where I was pretty happy with the results, bimbling along pretty consistently between about 5.5 and 9.5 which is only a smidge over my personal target range - although I'm still always high before breakfast - I can actually drop sometimes after I eat breakfast - the dawn phenomena is obviously strong with me!

I still sometimes go a little too high after my evening meal, so maybe 2 more units of NovoRapid will sort that - we've also talked about potentially carb counting and adjusting dose accordingly for that one meal. I'm currently on 10 NovoRapid with my evening meal and 12 Lantus at bedtime (DN didn't want me to change timing just yet). I'm pretty sure that the Lantus runs out about mid-afternoon the day after I take it, so I tend to be a bit too high before my dinner to start with.

But for some reason, I've just had several migraines back to back over the last week (I get the aura without headache) which have left me a bit below par for a few days and my numbers are a bit odd this week - not following my usual pattern.

This is the frustration with insulin, as soon as you think you've got it sussed, something happens to throw you a curve ball. But generally, this regime seems to be working better for me - I'm not worried about hypos which had become a problem and am reasonably consistent throughout the day.

Type 2 fr last 23years aged64 on 30/70 insulin 20unit dose results fluctuating