novarapid and other 'new diagnosis' issues

[increasingly cynical]

Hi All,

Slightly predictably, after a bit of a long saga with the NHS, much of which is recorded in 'ask experts' I have recently been diagnosed with 'Type 1' (well, 'LADA' as I'm in my 40s, but the consultant feels that tests suggest that I have virtually no insulin production left).

I have a couple of issues I'ld be very grateful for any comments on (I feel a bit of a 'user' here as I have asked a number of questions to date and people have been really helpful on the forum - I'll try and contribute somehow as well once I get my head around all this!).


1st issue: the consultant is recommending a combination of one shot of Lantus overnight, plus 4 shots of Novorapid to cover 'three meals a day'. I am a vegetarian and don't have '3 meals' I have a really busy work life and like to 'graze' (v. healthy very small meals lots of times a day). I find my food regime really keeps me in good condition (apart from the type 1 !!) There is no chance I could change to 3 meals a day - I wouldn't even be able to face them and the nature of my work prohibits taking the time out. Does anyone else have a 'grazing' lifestyle and if so, would the insulin regime suggested by the consultant work, or does anyone have any better suggestions?


2nd issue: My partner, who was originally very supportive when I first got ill, now seems to have lost the plot. His father was a T1 diabetic and recently died due to medical mismanagement of his diabetes during a hospital stay. As soon as the doctors said I was also 'T1/LADA' my partner just lost all sympathy and is now totally unsupportive (and angry), telling me I can't go on insulin and the stress of my disease is too much for him etc. and I should be able to sort it out some other way. I think the unfortunate timing of his father's death and my diagnosis has just been too much for him - has anyone else had a similar experience and are there any ways 'the partner' can be supported in this context - I am finding his reaction (although I understand it) stressful and it is making my decisions regarding treatment more difficult (nb. I asked him to come to the next consultant session with me but he won't , he just thinks, understandably, that the whole NHS is a waste of time and I should be looking to deal with this in a different way...but in what way is a bit of a mysetery!)


Thanks again for help and support
:|

 

[catherinecherub]

Hi,
Unable to help you with the first issue but I am sure someone will.

2nd issue.

Your partner's anger is probably due to the greiving process over his father's death. Although he is directing it at you, it is not really you that he is angry with. He is also angry with the bad treatment he feels his father got from the NHS. He is probably thinking that the same thing is going to happen to you and he cannot bear to think about it. He wants an alternative treatment for these reasons. He may need some professional help if his anger carries on. Give him time to let it all sink in and see how he is in a few days. We know how we feel when diagnosed and that is bad enough. We sometimes forget that we are part of a unit and other people will react too.
Hope this helps,
Catherine.

 

[increasingly cynical]

Hi Catherine,

Thank you for your supportive comments. I agree with you, it is just a little difficult to deal with a partner's response when this is so negative... I am just dealing with things on a daily basis and he seems to have gone into such a deep 'angry depression' that I am now having to deal with everything as well as the illness (my partner has pretty much given up work as a result), whilst he currently seems to feel that any acceptance of insulin on my part will be almost a direct 'insult' to him and/or his father's memory - to the extent that he walks out of the room in disgust if I even measure my blood glucose... I think in his current state of mind he just wants to pretend that this hasn't happened - I'm sure this is not a wholly uncommon response.. :?

 

[kegstore]

There's no reason why your doctor's suggestion can't be manipulated to suit your lifestyle:

• The Lantus injection once every 24 hours is there to provide basal insulin, that works in the background just to keep your body ticking over irrespective of when or whether you actually eat something.
  
  The NovoRapid is a much faster acting insulin, with a much shorter activity period, and is there to cover your meals when your blood sugar may rise, depending on what you've eaten.

The only thing you may have to be aware of is the stacking effect of taking several injections in a relatively short period of time. NovoRapid has a activity span of 4-6 hours I think, so you'd need to be careful of injecting again within that time, reducing the dosage of subsequent injections. There is an element of "trial and error" to this, so you need to find out how this will work for you.

I have always been a grazer like yourself and managed to make it work well for me, at least that's what I thought, but I'm no advert for how things are meant to turn out long term, so maybe another T1 on MDI can advise too?

With regard to your second issue, I agree with catherine. I believe this is a classic self-defence mechanism being exhibited by him, and something that with the right support he should be able to work through without any difficulty.

 

[chocoholic]

I agree with others comments about your partner and some sort of therapy or counselling might help, if their demeanour continues.
With regards the insulin. I am on the same two and I'm also a LADA case. (Though I ended up splitting the Lantus, as I was waking at 4.00 a.m. hypo and as soon as I split it that stopped....you might not have to do that but keep an eye on things.) I was told that with Novorapid, if I wanted to I could skip meals or eat whenever I wanted to as long as I took the insulin to cover my carbs.
As lomg as you keep testing your B.G. to see how things affect you, I'm sure you'll be fine.
All the best, choccie.

 

[increasingly cynical]

Thanks All for your support and comments. I feel a bit more comfortable with the idea of the insulin regime since other people seem to have made it work. I think you're also right about my partner's 'defence reaction', I think I'll just have to hope he works through it over time.

 

[phoenix]

I agree with the comments about insulin stacking. This link shows the profile of insulin aspart (novorapid) , you can see if you dose too often you not only have to take into account the carbs that you are eating but the insulin already present. http://www.endotext.org/Diabetes/diabetes20/ch01s10.html
I know you prefer to graze but when you start MDI, (multiple dose insulin) I think that its a very much easier if you start with regular meals with a fairly fixed carb amount (carefully counted and weighed) ie the same amount for breakfast every day ditto for lunch and dinner. My dietitian started me with 45,60,70 but I gradually cut it down a bit because I didn't want to eat that much every day, now it varies from day to day. By doing it this way at first, there is one less variable to adjust and you can begin to understand how much insulin you need to cover this fixed amount of carbs and produce on target post prandial results You will still need to take into account starting blood glucose level and exercise so one fixed variable helps. When you begin to understand the effects of the insulin on your body, then you will be in a better position to eat more flexibly.
Others have answered about your partner, I do hope that he starts to see things in a more positive light. I 'm glad that you yourself have decided to accept insulin, it can only make things better.

 

[lilibet]

Hi IC
Cant really add any more I suppose except to say I hope partner gets a bit more with the programme when he calms down a bit. Its such a huge shock when you get diagnosed, and if his father has passed away then I can see why he would react that way.

As for the Novo. Am not on MDI but have been asking to get on it since about week two but apparently am on too low a dose of mix so it would be dangerous apparently :roll:

The whole point of Novo is to dose adjust. Eat what you like and then shoot for it. In theory you can eat what you like though I personally will be trying to stick to a diet that doesnt need lots of insulin and has low spikes. Novo profiles are on the Novo Nordisk site, and many other diabetic sites too.
I was led to believe that a snack under 10g within the same period where there is novo floating about still doesnt need to be bolused for, But I could stand corrected.

In theory, as long as the lantus is set correctly, you dont need to eat during the day if you dont want, though for energy/health purposes I wouldnt recommend that course of action.

Dr Katherine's DSOLVE site has some info on MDI. IIRC her son doesnt take any more than 7u at a time and doses more than the usualy 4 or 5 but he/she are experts in their own diabetes so maybe not try that right away.

Only way is to try and test.
Good luck.

L

 

[increasingly cynical]

Hi Lilibet,

Thanks for your comments. The consultant I now have seems very good and also runs a good team. He is also honest, however, and hence seems to concur with the general impression on the forum that there are so many variables and so much individual variance with the reaction to insulin that there is no way in advance to tell whether it well go well or badly (many of the outcomes of insulin therapy are at least as bad as the long-term outcomes of hyperglycaemia). In theory there is no other option with Type 1, so I guess it is the devil you know or the devil you don't! :twisted:

 

[Jen&Khaleb]

(many of the outcomes of insulin therapy are at least as bad as the long-term outcomes of hyperglycaemia).

Hi there,
I just wanted to ask what the bad outcomes of insulin therapy might be. Insulin is a product needed by the body. My 2 year old would be dead within a week without insulin. Are you talking about the risk of a severe hypo or are there a range of problems just from insulin use?

Quite curious,
Jen.

 

[increasingly cynical]

Hallo Jenny (and Khaleb),

Oh dear - I didn't mean to worry anyone. It is primarily the long-term impact of hypos that I am concerned about. However, there is accumulating information that the newer insulins are under-researched and also may have a 'poor cost/benefit' profile. I say 'may' because I have only had the chance to look at data for Lantus so far and haven't examined this in huge detail yet. If you would like to look at some independent summaries of the evidence then two sources are:

1. Insulin Dependent Diabetes Trust (www.iddtinternational.org)

2. The Cochrane Collaboration (www.Cochrane.org)

The 2nd of the two above is likely to be the most objective as they have no axes to grind, they are just a bunch of academics who carry out systematic reviews of the medical research evidence (to very stringent criteria).

I hope this helps. With such a young person with Type 1 I don't see that you have a lot of choice but to trust your doctor, although having the evidence to hand can be helpful in making sure that the NHS are giving the best treatment. A medic and medical researcher called Edwin Gale is mentioned on the IDDT site. I have looked at his publications and he is clearly something of an expert in the field of childhood diabetes. I am told by a colleague of his that he is a very approachable chap - if you have any concerns or issues, you could track him down on the internet and give him a call, I'm sure he would be happy to help.