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.)