New on insulin

Ask for 4mm needles. Yes, buttocks are fine. You should not be left with scarring. Good luck ;-)


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I have used buttocks and thighs no problem. Maybe some of your pain is psychological ? Fear of the injection itself ? Try getting the 4mm needles and should be virtually pain free ;-) hope you overcome this !


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Personally I can't do my thighs, it hurts. I'm awaiting my 4mm needles which should solve that! I do it in my buttocks loads though, don't feel a thing!

choudhry said:

@ Mo1905
If i calculate(approx)carbs of each meal shall i use your method of
1unit = 15 carbs.

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No you shouldn't attempt this.

You are using a mixed insulin (Novomix) This has long term insulin and faster insulin for meals in the same mixture.
Mo is using two separate insulins for background (basal) and mealtimes (bolus). He can decide how much of the short term to take by calculating the amount of carbs in her meal . This has no effect on the background insulin which he injects at another time . (so normally he would have 3-5 injections a day)

If you varied your Novomix in the same way you would increase and decrease the background insulin so you could either have too much or too little.

The type of insulin regime (mixed insulin twice a day) using works best when you eat regular meals with consistent amounts of carbohydrates (and also consistent small snacks in some cases)
You usually adjust it on the basis of previous glucose levels (and that will only work if you eat regular spaced meals with similar carb loads)

This leaflet from NHS Lanarkshire seems to have a good explanation about how the insulin works and also how to adjust it. Obviously at the start be guided by your nurse on when to adjust. She may well have started you on a lowish dose that can be gradually adjusted upwards.
http://www.nhslanarkshire.org.uk/Servic ... nsulin.pdf

Can't help about needles, once I realised that it didn't usually hurt I had no problem with them.
When on injections I used to use my arms (remember you don't have to pinch up with tiny needles so it is quite easy to do) and my stomach. I avoided my thighs because I was told not to use a limb that I was going to use for exercise (ispeeds absorption.) I now though use my thighs for my pump cannula and find it much better than my stomach as a site . Trial and error here a bit I think.

Nice explanation Phoenix ;-)


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I'm wondering seriously, if it would be beneficial for a separate section to be available for diabetics using mixed twice daily insulins to get help. Just lately it does look like pre mixed insulins are making more of an entry to the world of diabetes.

What is the benefit, if any, of pre-mixed insulin ? Isn't it harder to control ?


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mo1905 said:

What is the benefit, if any, of pre-mixed insulin ? Isn't it harder to control ?


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I'm wondering the same. I guess it's because it's only 2 injections day? If you have a fear of needles I suppose it eases you into the process.

My consultant didnt seem to rate it very much. He was definitely guiding me more towards the basal/bolus regime and I was more than happy to give that a go!

Surely there is a more scientific benefit though!

Noone should be told to inject in any 1 place u must rotate as u can cause insulin pockets if injecting in the same area over and over. This creates a bad issue with insulin build up under the skin and not into the blood. Been there and it's hypo central with insulin releasing into blood unexpetctantly

choudhry said:

Tonight i woke up @ 3:00am with very bad feelin , can not explain that feeling exactly but it was like " i am drowning in the water"

Checked bg and it was 3.2....

(At 21:00 i had 2 slices of bread with curry and at 22:00 i had an apple and a peach.)

I took a spoon full of honey and feelin a bit better now.
Any suggestions about my medication or amount of food ? Also guide me about the feelings or signs to look out for in case for low/high bg levels
Thanks

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Hi

When you had the 2 slices of bread with curry at 21.00hrs did you inject your eve meal dose of Novomix then or did you inject it earlier in the evening at 6-7pm for instance?

If you injected the eve meal Novo at 21.00hrs then its action will still be fairly strong at 3am as its only 6hrs so thats why you went hypo. If I eat an apple I dont have to count the carb content in it or pear for that matter. Im more or less the same regarding pineapple and banana. Some people dont have to count the carb in some types of fruit and you may be like that which also explains why you went hypo. The apple and pear did nothing to your bg levels whereas if you had eaten a biscuit, it would have.

Ive just had a look at the pdf to NHS Lanark that Phoenix posted and will send you a PM as some of the advice regarding adjusting twice daily insulins to cope with high or low bg levels before eve meal is not quite correct....

IHS,
Thanks, interested to know what you thing is wrong with it. There are several such leaflets on the net but all say pretty much the same. As you know I've never used that sort of regime so can only go on what I've learned/read.
I think you're right about having different sections one for MDI and one for 'other' insulin regimes. Sometimes it gets very confusing for new people who not surprisingly don't realise there is more than one.

Twice daily insulins have more or less an affect lasting for 6-9hrs before they lose their effect on bg levels.

If diabetics who experience high bg levels before their eve meal is due, increase the morning dose of insulin, all that will happen is that bg levels will be lower before lunch (even to hypo level) which will make people eat more food to deal with the low, and bg levels will be no better when eve meal is due unless they eat less carb as a snack mid afternoon or even no carb .

The only way that twice daily users can alter insulins affect to deal with high or low bg levels before eve meal, will be by adjusting the lunch time carb and also the mid afternoon carb snack as well and then that will deal with the high or low bg levels before eve meal. Testing bg levels will help guide them adjust the carb so that bg levels will have a different effect.

Does that make sense?

phoenix said:

I think you're right about having different sections one for MDI and one for 'other' insulin regimes. Sometimes it gets very confusing for new people who not surprisingly don't realise there is more than one.

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Would that not be self defeating phoenix? As someone newly diagnosed would no doubt be unaware that there is more than one insulin regime, as this thread clearly shows. Would it not just cause more general confusion for someone newly diagnosed looking to ask for help?

I find that the more sections or boards a forum has the more confusing they get which may be OK for experienced members t navigate but not for newbies who may be confused already.

Plus by splitting the T1 section more is there not the danger that some T1's may not see questions from new members who they may be able to offer help and support to but as they are following a different regime they may not read that thread?

I tend the use the "recent Questions" link so get to read all sorts of questions but many members may only look in their own section, as it is I rarely if ever reply to the Parents, T1 or Pump boards as there is little I can offer these groups but I still like to read some of the threads as all information is useful.

Of course as a T2 you can tell me I am wrong and there may be good reasons that I am unaware of but thats how it seems to me

phoenix said:

The type of insulin regime (mixed insulin twice a day) using works best when you eat regular meals with consistent amounts of carbohydrates (and also consistent small snacks in some cases)
You usually adjust it on the basis of previous glucose levels (and that will only work if you eat regular spaced meals with similar carb loads)

.

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I still wonder why anybody would choose this mixed insulin regime. Why would you want to make life so difficult ? Same carbs each meal etc ? I've been told that it may suit those who don't like injecting but is that the only reason ? Apologies, I have asked this before but I'm still intrigued ! Thanks !



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Over the past few months there have been more msgs left on the forum from twice daily insulin users and some of the replies sent back to them have come from diabetics who have never used twice daily insulins and start giving advice regarding the adjustment of insulin re bolus/basal. Utterley confusing...........

That's why as there are sub sections for LADA and all the rest, there should also now be a sub section for Twice Daily(Pre mixed or biphasic).

IHS
Yes, I agree that adjusting the carb content makes sense though I read the guideline when it says raise the morning dose as referring only to when the levels are high before both lunch and evening meal.

It says that if a person is high when the next injection is due they should consider the reasons ie diet/exercise etc presumably with a view to changing things and that it might be necessary in that case to raise the earlier dose.

I think that it must be imperative to find the optimal carb level for each meal and stick to it. Even on MDI I was prescribed a set carb level and was meant to adjust on the previous days readings, not the best use of the regime but it gave a safe and workable starting point.
I haven't the foggiest idea how someone can be told to take a certain amount of insulin with each meal but at the same time be given no guidance about the amount of carbs to eat. It appears that they used to do this when they used the exchange diet with set amounts for each meal/snack. No doubt some people were given inappropriate amounts for their activity levels but at least if someone is given a ballpark figure informed decisions an be made about adjusting things, otherwise the day to day variations make any changes pure guesswork.

Sid, I also agree about the cons, I do know a couple of times that its been confusing, not sure if there is any best way.

Mo.
I wasn't given the option, I haven't met anyone at my hospital (in France) that is using a bimodal insulin, though when I check it is still available here.
From what I've read.
Some people prefer it as they prefer fewer injections Some health care professionals seem to think that it's easier at first.(not sure that is true)
I think that it is often used successfully with older people who have very regular routines. It is often used for T2s who need to go onto insulin so it supplements their own albeit reduced insulin function, this may even out some of the variation.
Some children still use the regime but when they change most parents seem to prefer MDI. When I taught the diabetic children I came across were all on this type of regime. I think it was easier for the school and the parents .It meant that parents didn't have to think about how injections could be done at school. It meant that as teachers all we had to know about was when to give snacks and how to deal with hypos. MDI and pumps seem to cause big issues for both the school and the parent. However the very big downside was that many children weren't as well controlled as they maybe could be using more intensive regimes.

Lastly, I've read of a few teenagers who are reluctant to inject being put 'back' onto this sort of insulin. (better to try enforcing a couple of injections a day than none at all, think that's the theory ; not sure of how effective it is)

I can't see that it works well if your life varies from day to day (and if you work shiftwork as it appeared one person did recently, it must be a nightmare.)