New insulin user; advice, please?

Insulatard insulin is just a background insulin and isn't meant to cover food at meal-times, he needs to discuss his bg readings with his diabetes team to find a solution, but in the mean-time you may want to have a look at the advice that @daisy gives in her introductory post.

Had he only been given insulatard?

Golfgirl said:

Thank you, I will read that, but I wonder if I've given the wrong impression.

He is not injecting according to what he's eating.

He is prescribed 14 units twice a day. He doesn't adjust the dose according to how much carb he's eaten.

This is early days for him. It's just his second day on insulin. We just thoiught it would have more of an effect, more quickly. :-/

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That's what I was saying, I didn't know if you were aware of that too. It is early days, but the likelihood is that the 14 units is just a starting point and he may have to increase the dose further, give it a few more days and if things don't improve contact his diabetes care team.

Hi. If your diabetes isn't too advanced then people are often just put on daily Basal insulin; may be once a day or split. This insulin takes care of background liver output of glucose but doesn't cater for meal-time carbs. It would normnally be adjusted to give fasting a BS level of between 5-7 mmol. I was put on just daily Basal insulin but within 4 weeks my DN could see that it wasn't adequate and added mealtime insulin. This is called the Basal/Bolus regime. Try to get the Basal insulin shots right to achieve bewteen 5 - 7 mmol fasting. Make any changes slowly day by day and use the meter to avoid hypos. If you are unhappy with the BS control then do ask the DN to add the mealtime Bolus insulin. As a generalisation the Basal only regime is mainly targetted at T2s who find tablets don't provide enough control. The Basal/Bolus regime is for those with T1 or LADA.

Golfgirl said:

Right. Thanks. So you're saying that 14 units is the base from which everyone starts. And many/most people need more than that.

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No, not necessarily, Golfgirl. I'll come back to that.

But most importantly, it takes time for basal insulin (that's what you have) to build up in your system and take effect. At least two to three days for changes to take effect. Which is one reason why you should be CAUTIOUS and never change insulin doses too fast. You have to watch, wait, write your test results down.

So do that. A few days of running high won't do much damage. If you were to up the dose too fast, you might discover after a few days and you might have a problem, even a nasty one.

Add to that that as far as I can see (correct me if Im wrong people), once you finally get insulin, often you get a little remission and your requirement goes down for a bit.

I have Insulatard too. I get on with it quite well actually.

Your husband will discover how much he actually needs with patience and by experiment. He can do basal testing, which Gary Scheiner describes in this link: http://www.diabetesselfmanagement.com/articles/insulin/getting_down_to_basals/all/

(I strongly suggest you get the book, Think like a pancreas, BTW. Really helpful, patient, detailed. http://www.amazon.co.uk/gp/aw/d/B005XQ97FK/ref=mp_s_a_1_1?qid=1418945678&sr=8-1&pi=AC_SX110_SY165 )

In the meantime, as an Insulatard user myself, a couple of practical things. The kind of insulin this is, NPH, has a tendency to behave erratically. It's because of the way it's composed. So it is very important to make sure it's really blended properly before you inject. Ten slow shakes is not enough. I do at least thirty. The more so as these are substantial doses. Also, consider splitting the injection into 2 injections - same time, same needle, but two different sites. It makes for more even absorption. For an explanation of why, see the section entitled *The Law of Insulin Dose Absorption* on this page: http://www.diabetes-book.com/book/chapter7.shtml

So in essence, be calm, test, write it all down, and make slow changes. Your husband has lots of time. It's worth getting it right.

Do make sure you test around night and morning - I'd consider setting the alarm to test at night. Metformin is an excellent safe drug that among other things lowers your insulin requirement so makes what you take more effective. But it makes the liver less able to deliver glucose when you are running very low or nearing a hypo. Seen in that light, that insulin dose is quite high.

Last thing - if after three days there's no reduction in your husband's BG, it could be a bad insulin batch. Apparently it happens occasionally. Either way, get straight back to the doctor.

Golfgirl said:

Right. Thanks. So you're saying that 14 units is the base from which everyone starts. And many/most people need more than that.

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His diabetes team would have worked out a starting dos based on the information they have to hand, the dose will vary from person to person so I wouldn't say that 28 units (split into 2 doses of 14) would be the normal starting dose for everyone.

Lucy offers some good advice in her previous posts, the book Think Like a Pancreas comes highly recommended on the forum, so do purchase if you can

noblehead said:

Insulatard insulin is just a background insulin and isn't meant to cover food at meal-times, he needs to discuss his bg readings with his diabetes team to find a solution, but in the mean-time you may want to have a look at the advice that @daisy gives in her introductory post.

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@Golfgirl

Hello Golfgirl and welcome to the forum

Here is the information we give to new members mentioned by Noblehead in his post. Ask more questions and I hope you will get all the answers you need.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 130,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.

BTW, one other point ref 24 hour insulin types. They all have their pros and cons but if your husband finds that he can't get the Insulatard right then it might be worth discussing a change to Levermir. Hopefully the Insulatard will turn out to be fine, but there are options if not. This, of course, has nothing to do with the possible need for the Bolus insulin which is yet another option! The good thing about insulin is that there is vurtually always a solution that works well.

I was put onto humulin mixed insulin twice a day and it took about 3 days before it brought the levels down properly and then I had to adjust the doses for quite a while before I found the right doses. My evening dose is like twice as much as my morning dose but I'm obviously still producing some of my own insulin as my levels are constantly between 4 and 6 mmol all the time with just those two daily doses of insulin.... Shame about the weight gain though!! :'(

elaine77 said:

I was put onto humulin mixed insulin twice a day and it took about 3 days before it brought the levels down properly and then I had to adjust the doses for quite a while before I found the right doses. My evening dose is like twice as much as my morning dose but I'm obviously still producing some of my own insulin as my levels are constantly between 4 and 6 mmol all the time with just those two daily doses of insulin.... Shame about the weight gain though!! :'(

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Elaine I am on Humulin M3 too. How much do you take ? I take 52 units at breakfast and 38 at tea time and still hasn't brought my BGs down to acceptable levels...and injecting such large amounts stings like hell.

eddie1968 said:

Elaine I am on Humulin M3 too. How much do you take ? I take 52 units at breakfast and 38 at tea time and still hasn't brought my BGs down to acceptable levels...and injecting such large amounts stings like hell.

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Hi Eddie. Am I right in guessing your BMI is a bit on the high side? If so then it is important to get this down to reduce insulin resistance which can cause a vicious circle with insulin. Do low-carb if not already doing so. As weight reduces the amount of insulin will also need reducing to keep checking with the meter.

Daibell, BMI of 27. Not overweight, in fact losing weight on insulin .

eddie1968 said:

Daibell, BMI of 27. Not overweight, in fact losing weight on insulin .

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Thanks for the reply. Yes, a BMI of 27 isn't too bad and you're losing weight. As you know your BMI is very high. I wonder whether you are actually a Late onset T1 and possibly mis-diagnosed like I was as a T2. I wonder whether a move to the Basal/Bolus regimer might help? It gives much better control than mixed insulin and is a better solution if you are essentially a T1. It does mean more injections and two insulins but you can tweak things to get the best carb/insulin match. Do discuss with the DN/GP.