Newbie, introducing a second type of insulin

[Mungobean]

Hi, and apologies In advance for asking so many questions!
I was diagnosed 3 weeks ago and I am current taking 22 units of a basal insulin every morning. I seem to have just about got my waking sugar under 10 mmol/L every day, but the rest of my readings during the day are up and down like a yo-yo - between around 8mmol/L and 25 mmol/L. When I spoke to the diabetic nurse last week, she mentioned the possibility of introducing a second, fast acting insulin for when my readings are high. So, bearing in mind that 3 weeks ago, I had no idea that you could get different types of insulin - at what kind of reading would one normally inject the fast acting insulin, and is there a naximum number of times per day?

Many thanks for your help and oatuence.


Bean x

 

[EllieM]

Hi @Mungobean, no need to apologise for questions, that is one of the reasons this forum exists.

I'm T1 and not T2, so I can only answer some of your questions.

The basal insulin that you are currently using is designed to give a 24 hour boost to your insulin production. (Some long term T2s find that they eventually stop producing so much insulin, and others find that their insulin resistance goes up to a point where their own natural insulin supply isn't enough ) Even when you sleep you need insulin.

When you eat and introduce extra carbohydrates into your body, you need more insulin to process this. Fast acting bolus insulins are designed so that you can process these carbs, and can also be used as a correction dose if your blood sugar levels get too high.

As a T1, I inject bolus whenever I eat, whether that is 6 times a day or only once. (And sometimes I inject a solitary correction dose as well.) T1s on insulin pumps have a steady drip feed of insulin, whose rate they can alter as desired.

As a T2, your diabetic team will have some idea of how much insulin you are producing (could be a lot or a little) and how much and how often you need to inject extra. The insulin needs for different people can vary enormously, so dosing advice is very individual. And your need for insulin will also vary enormously according to how many carbs you consume.

And there are a large number of different types of insulin, with different time scales for how they act. If your food intake is a regular amount at a regular time (you have a jejunostomy?), they may want to give you a small number of injections of an intermediate acting insulin, though my guess is that if they are talking about correction doses they'll start you with a conventional fast acting bolus insulin, which usually has a life span of 4 to 5 hours.


Having said all that, it is quite unusual for a newly diagnosed T2 to be put on insulin straight away. Are they sure you are T2 and not T1? If you are going to be on insulin anyway, there are advantages to a T1 diagnosis, as T1s tend to be eligible for more NHS technological goodies.

 

[Mungobean]

Thanks for your your reply. They put me on the 24 hour insulin after a week or so because of the jejunostomy and because metformin was having no affect other then making me as sick as a pig. As for type - they have just presumed T2 but haven’t tested. I just feel that it has happened because I have spent so many years being pumped full of sugary carb-heavy ‘stuff’ but they are reluctant to change my feed at the moment, as it took me a while to find one that I could tolerate!

 

[EllieM]

As for type - they have just presumed T2 but haven’t tested. I just feel that it has happened because I have spent so many years being pumped full of sugary carb-heavy ‘stuff’ but they are reluctant to change my feed at the moment, as it took me a while to find one that I could tolerate!

In your position, I'd ask for the T1/T2 tests (cpeptide and GAD antibodies). Though you're right, you could be T2 because of the sugary diet, it is pretty unusual to have to go to insulin straight away, and with a T1 diagnosis you'd be potentially eligible for NHS funding for things like insulin pumps and continuous glucose monitors.