premix versus basal/bolus

[caitycakes]

Hi, I'm new to the forum and was diagnosed t1 in july this year. At the moment I am on humalog 25 premix, but I am thinking about changing to the basal/bolus regime, even though I hate needles and it will mean more jabbing. My control is quite good but I hate the fact that I have to keep feeding the insulin and constantly clock watching to avoid hypos. An average days reading would be as follows.

am 5.2 2hrs after breakfast 11.0
pre lunch 4.4 2hrs after lunch 9.2
pre evening meal 2hrs after evening meal 8.0
bed time reading 7.1

What do you think? Should I take the plunge and go for the basal/bolus? Any advice would be greatly appreciated.

 

[Katharine]

These readings are not too bad.

There are pluses and minuses:

biphasic is less jagging but less versatility.
multiple daily injections is more versatility with meals but more frequent blood sugar monitoring as well as the actual injections.

Have you considered trying shorter needles eg 6mm and seeing if you can get over the jag thing?

 

[caitycakes]

Hi, I didn't even know you could get smaller needles. I use the 8mm ones. I'm not as bad about the jagging as I was at the beginning. I used to have to take a breath, blow it out then stab, but it feels more natural now, unless I hit a blood vessel and get a nice bruise. I will ask my doc about the smaller needles.

The only other thing bothering me about the basal/bolus system is the freedom believe it or not! I think it may be too easy to eat things I wouldn't normally eat on the premix! I'm slim and I don't want to put on weight. Also the amount of insulin I would have to take worries me. At the moment I take 1 in the morning and 5 at teatime. Would it be easy enought to work out how much basal insulin to take and how much bolus?

Thank you everyone for being patient with a rank amateur!

 

[iHs]

Hi, I didn't even know you could get smaller needles. I use the 8mm ones. I'm not as bad about the jagging as I was at the beginning. I used to have to take a breath, blow it out then stab, but it feels more natural now, unless I hit a blood vessel and get a nice bruise. I will ask my doc about the smaller needles.

The only other thing bothering me about the basal/bolus system is the freedom believe it or not! I think it may be too easy to eat things I wouldn't normally eat on the premix! I'm slim and I don't want to put on weight. Also the amount of insulin I would have to take worries me. At the moment I take 1 in the morning and 5 at teatime. Would it be easy enought to work out how much basal insulin to take and how much bolus?

Thank you everyone for being patient with a rank amateur!

Hi, not only can you get 6mm needles but you can also get BD Microfine 5mm ones as well. I would definately go for them esp as you are slim. I am 9st and use 5mm needles with no problems at all.

You are right in thinking the way you do about basal/bolus but it works both ways lol. You can put on weight by eating too much and bolusing more insulin or you can eat less and bolus less and keep your weight where you want to be.

As for you transferring over to bolus/basal, the amount of Humalog Mix that you are taking which is hardly anything might make it a bit tricky to transfer over. Are you still in the 'honeymoon' phase of your diabetes?

 

[caitycakes]

Yes still honeymooning (feels more like divorce to me) lol. I was only diagnosed 2 months ago. I did wonder about making the changeover given that I am only taking such a tiny amount, but I still worry about being over 10 2hrs after eating sometimes (especially if I'm having a lazy day), although I try hard not to eat as much on lazy days but it's hard cause I love being a slob on a Sunday but I also like being a greedy slob on a Sunday!!!! Also I was wondering if it's ok to use low gi fruit to keep my glucose steady until I'm able to get home from work and cook? I usually have a small orange and sometimes an apple also during the period between lunch (around 2pm) and evening meal (8pm).

It's all very confusing but I want to keep as much control as possible.

thanks

 

[iHs]

Yes still honeymooning (feels more like divorce to me) lol. I was only diagnosed 2 months ago. I did wonder about making the changeover given that I am only taking such a tiny amount, but I still worry about being over 10 2hrs after eating sometimes (especially if I'm having a lazy day), although I try hard not to eat as much on lazy days but it's hard cause I love being a slob on a Sunday but I also like being a greedy slob on a Sunday!!!! Also I was wondering if it's ok to use low gi fruit to keep my glucose steady until I'm able to get home from work and cook? I usually have a small orange and sometimes an apple also during the period between lunch (around 2pm) and evening meal (8pm).

It's all very confusing but I want to keep as much control as possible.

thanks

What you might be able to do is ask gp or dsn to give you an insulin pen that delivers in 1/2 unit increments. Lilly do one called Luxura HD so you could use that with Humalog Mix cartridges. By dosing in 1/2 unit measures you might be able to keep your bg more stable mid morning or mid afternoon and so will enable you to snack just small amounts of carb or sometimes depending what your bg is (above 9) you wont have to snack at all.

 

[caitycakes]

Thank you so much for your advice. It's nice to be able to talk to people who understand and who have personal expertise. I'm going to make an appointment to see my diabetic nurse and ask about the smaller needles and the pen that gives half doses. I wouldn't have known any of this if it were not for you. Basically you get given a carrier bag full of equipment and you stumble from the clinic looking like a rabbit caught in the headlights of a car and all you want to do is throw the bag over the nearest hedge and run for the hills!

Thank you so much for your patience and help.

 

[iHs]

Subject: premix versus basal/bolus

Hi, I'm new to the forum and was diagnosed t1 in july this year. At the moment I am on humalog 25 premix, but I am thinking about changing to the basal/bolus regime, even though I hate needles and it will mean more jabbing. My control is quite good but I hate the fact that I have to keep feeding the insulin and constantly clock watching to avoid hypos. An average days reading would be as follows.

Hi

Although I use MDI, I still feed my insulin some carb every 2-3 hrs in much the same way you do. For me, this is the best way to control my bg levels. However, I might also get a 1/2 unit pen to see if I can tweak my insulin a bit more though. I used to think it was a nuisance having to eat mid morning and mid afternoon but truth be told, when I did office work, it was the done thing to get out a tin of bicci's with a cup of coffee about 10am so having to eat something wasnt so much of a big deal lol.

Many consultants - young and old do think for best control its best to feed your insulin - small and often.

If I was you, I would stay on Humalog Mix for as long as you can and just ask your dsn for some plain Humalog in a pen. That way when you want to eat more at weekends etc, you can just use a few units of fast acting insulin (Humalog) to boost up Humalog Mix's action.

 

[caitycakes]

My god, why don't they tell you this at the clinics. I have been twice to the clinic other than the visit for diagnosis and I haven't to go back until Jan to see my consultant. Saw dietician twice but already had a good idea of food values etc from years of making sure I didn't get fat, so didn't want to take up the dieticians time, but there as been no discussion regarding types etc of insulin and I was only told about the basal/bolus regime at last visit. Didn't know I could add some plain humalog to the mix.

Basically, I think the school of thought of health professionals seems to be not to tell you much unless you ask. I know it's my disease and if I want to have any kind of reasonable quality of life I will have to take resposibility for it and deal with it, but it's a real BIGGIE and a little bit of namby pambying by the docs wouldn't go amiss, just for a short while initially. I think they really should have classes or something that you could attend just until you get a firm grasp of the situation.

I'm making an appointment for the clinic and I have written everything down to make sure I get the best out of the appointment.

Thanks everyone and thank god for this forum!!!!!

 

[iHs]

Its ok you are really welcome

Its up to you to decide which way you want to go but for simplicity twice daily is good as long as you remember to eat some food to cope with its action on your bg levels. The drawback to twice daily is that it tends to have a peak approx 3hrs after you have injected so if you tend to have raised bg towards late afternoon, injecting more of the insulin in the morning will only make you go hypo by late mid morning. This is where a fast acting insulin comes in handy as you can give yourself 2-3 units to deal with that situation. But on saying all this, you can also cut down on the amount of carb that you eat lunchtime or mid afternoon. Its all swings and roundabouts really.

Definately get yourself some 5mm needles and ask about using Humalog or Apidra as a backup. I stayed on Humalog Mix for about 15 years and was quite happy especially when my consultant gave me a Humalog pen as well. I felt I had the best of both worlds as the Humalog gave me the freedom to over indulge when I wanted to.

All the Best

 

[caitycakes]

Your suggestions make perfect sense to me. I have already been experimenting with carbs and spent the entire weekend testing like a looney, but it is definitely the only way to know what's going on. I have also become quite good at minimising the pain of testing and getting just the right amount of blood to keep the test strip happy. I wish the docs wouldn't tell you to have carbs all the time. I've only been T1 for 2 months and I have already discovered that high carbs is not the way to go. It is quite difficult getting the balance right though, but definitely worth the effort. It also leaves room (calorie wise) for other foods. I have also noticed that lower carbs for me means less hunger. I would have thought that it would be the other way round but it's not. I also have much more energy. Can't wait for my appointment at the clinic. Feel a lot more positive now.

A big thank you.

 

[Katharine]

Don't worry, Caitycakes, many of us test like loonies too. That's what you have to do to keep on top of your diabetes instead of it getting on top of you.