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Questions about insulin and LADA

Discussion in 'Type 1.5/LADA Diabetes' started by rosemaree, Sep 10, 2021.

  1. rosemaree

    rosemaree LADA · Well-Known Member

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    Hello,

    My doctor started me on a mixed insulin, I think it is 70% long acting 30% quick acting, and I take it it with breakfast and dinner.

    I do still produce some of my own insulin, and am sure I have some level of insulin resistance. I have read and been told that using separate long and fast acting insulin is better, and more flexible, but my doctor says this mix is one of the best.

    My blood sugar was extremely high and has been coming down as I adjust the dose, but I still get rather high spikes after eating. My concern is that I am ultimately taking more long acting then I need to try and balance my meal spikes. But I am also wondering if I maybe need a better insulin regime, or if it is just insulin resistance and I should focus on diet/exercise and weight loss.

    Also curious if anyone else experienced muscle weakness? I worry about autoimmune conditions as my antibodies were so high, but then I think I have had issues with my sugar for so long, between the high sugar damage and my muscles not getting the energy they need, it would make sense that they are not so happy at the moment.
     
  2. In Response

    In Response Type 1 · Well-Known Member

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    Fixed doses of a mixed insulin will provide little flexibility if you want to eat at a different time or miss out a meal or do extra exercise or eat a low carb meal. I am surprised that your doctor is not allowing you to have this flexibility.
    On the other hand, if you are not hypoing between meals and your levels are still high, you are unlikely to be taking too much long acting insulin.
    If you are the sort of person who has a regimented lifestyle, eating at the same time every day, doing the same amount of exercise, et.c the mixed should be fine. But if you want to break out of it, it is worthwhile discussing and explaining this with your doctor.

    With regard to muscle wastage, this s not something I have experienced but, as you say, it makes sense if your levels were high and your body was breaking down your muscles to provide the necessary energy it needed. I recommend discussing this with your doctor.
     
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  3. urbanracer

    urbanracer Type 1 · Expert
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    hi @rosemaree
    I was on 70/30 for while when first diagnosed and after interacting with people in these forums I soon became aware that it wasn't the best solution for me. Injecting for breakfast and evening meal is fine if I had zero carb lunches but even a few carbs at lunch could send my glucose levels through the roof by mid-afternoon.
    I also had an Endocrinologist who kept telling me that pre-mixed insulin was easier to manage and it wasn't until just before he left the hospital that he agreed to let me try an MDI (Multiple Daily Injections) regime. (Don't know why he changed his mind at that point other than perhaps not caring any more).
    I found it so much easier to cope on MDI and can skip a meal if I am really busy at work etc. I would recommend that you keep asking until you get what you want.
     
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  4. rosemaree

    rosemaree LADA · Well-Known Member

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    @In Response, I feel like I have the far extreme to a regimented lifestyle! Me and schedules don't seem to get along :wideyed:
    My thinking was that if I am not taking fast acting to deal with the meals (or at least not getting enough), the long acting is trying to stabilize those spikes. Maybe a better way to put it is not that I am taking too much long acting, but that if I had calculated doses of short acting to cope with meals, my requirement for long acting would be less (if that makes sense). I don't really understand how they work relative to me still producing some of my own insulin.
    Yes, I will be chatting to my doctor about it, thinking to try make a plan to go and see this one chiro when I have the cash - he specializes in neuro-muscular something or other!

    @urbanracer, my doctor also seems to go with it being easier, I asked about skipping meals and she said to just inject at the next meal, so if I skip breakfast inject with lunch and dinner. It does feel a bit rigid, and I am still trying to figure out the right dose, my numbers have come down to around 7 to 10 mmol, but then spikes into the high teens with most meals. At this point I am supposed to increase the dose by 1 unit every 3 days until I am happy with my readings, but the spikes are confusing me - I get similar spikes after breakfast lunch and dinner, even though I only inject with breakfast and dinner. That is what makes me wonder if I am just really insulin resistant and the shots aren't doing much anyway. I have been stricter with my eating since starting insulin so it is hard to say.
     
  5. In Response

    In Response Type 1 · Well-Known Member

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    @rosemaree out of interest, is your doctor a GP at your local surgery or an endocrinologist?
    GPs can be a little out of date especially when it comes to managing Type 1 - they see far more people with type 2. So, what they think of as "easier" is easier to dose by harder to live with.
     
  6. rosemaree

    rosemaree LADA · Well-Known Member

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    @In Response, she is a GP, but a diabetes specialist. I don't imagine getting to an endo would be easy here, I am in SA and getting anything is such a fight with the medical schemes :banghead:
    She has been great compared to the last few doctors I have seen, two of which were also diabetes specialists :bag:

    I will ask her about doing separate doses when I chat to her again, just trying to read up and learn in the mean time!
     
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  7. ert

    ert Type 1 · Well-Known Member

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    Getting your sugars under control is a marathon and not a sprint. If you have been running high for some time, it may be worthwhile sticking to the mixed plan until they are back down to manageable levels. The GP will be trying to take the edge off them. If you eat normally you will spike your blood sugars with MDI also. Fast-acting insulin does not match the food you eat and follows a fixed curve over 4 hours. I don't eat carbs to manage this successfully. I hope you get a referral to a specialist soon who is the person to start your MDI journey.
     
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    #7 ert, Sep 10, 2021 at 6:31 PM
    Last edited: Sep 11, 2021
  8. searley

    searley Type 1 · Moderator
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    im my mind mixed is worse..

    the way i see it is most of your control is done by the long acting.. and the 30% rapid simply acts more as a correction dose, there is not much flexibility in what you can eat etc as the dose is always the same,

    with proper basal bolus you have your long acting.. then fast acting when you eat.. and you vary your dose based on what you eat... and can do correction doses if needed.... BUT its harder work, you have to work out your doses and correction.. and potentially more risk of hypo's. but you could have better control meaning less risk of long term complications..

    so it come down to are you willing to work a little harder with basal/bolus?

    if i stop insulin i lose muscle first and i lose it fast
     
  9. rosemaree

    rosemaree LADA · Well-Known Member

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    @searley I'm sure I have lost muscle, when I lost weight and got my numbers down after being diagnosed type 2 I felt so miserably weak, and I've lost quite a bit again now before being re-diagnosed so may just be that, thank you!

    Better control would be my best option, so the extra work wouldn't be an issue, I am a little concerned about hypos as I'm not actually too sure where to try keep my numbers on insulin (I was aiming for 4-6 mmol as a type 2), but like @ert said maybe mixed is okay just for getting my levels down for now - I feel pretty awful and not up to much at the moment :depressed:
     
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  10. searley

    searley Type 1 · Moderator
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    i have a lot of muscle and little fat so really notice the loss very fast.. on insulin you be better with slightly higher targets.. the main one being the pre bed.. as you are going to be a long time without food.. before i was on the pump i would goto bed if lower than 7

    even during the day and you are in the UK and drive you shouldn't start driving if below 5

    i went straight onto basal bolus and had no concerns just took it careful and kept checking my bg, and learning what happen in different circumstances
     
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  11. urbanracer

    urbanracer Type 1 · Expert
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    When I eat, I look at a plate of food (or the labels on the wrappers) and decide how many grams of carbohydrate I am eating and bolus for it. To put it plainly, the insulin dose matches the food I am about to consume.

    Whilst I was on premixed, my food matched the insulin dose which is a subtle but important difference. If you are continually spiking after meals, then you are probably eating more carbs than the fast acting part of your insulin can deal with.

    If you skip breakfast and inject for lunch and dinner, you will most likely still have a fair amount of longer acting insulin (from the 1st dose) in your system when you take the 2nd dose. This may leave you at risk of night-time hypo's.

    On 70/30 pre-mixed, If I injected for a 30g breakfast (average bowl of cereal) I would need 3 units of fast acting (1:10 ratio) and would therefore also be injecting 7 units of longer acting which always gave me mid-morning hypo's. Now on MDI, I take my long acting approx 7am and can have breakfast anytime, or even skip it.
     
  12. rosemaree

    rosemaree LADA · Well-Known Member

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    @searley, do you mean you would not go to bed below 7? I definitely need to learn a bit more before changing over.

    @urbanracer, I am not entirely happy with the way I am eating at the moment, definitely have room for improvement. At this point I have no idea what my carb to insulin ratio would be, so it is hard to know what/how much to eat to match the dose.
    I wasn't too sure about doc telling me to just inject with lunch so have been making sure to eat breakfast, but that makes sense, although she said I am not taking enough insulin to go low at this point.

    I do think I need to work on my insulin resistance too as I have a feeling it is what is throwing me off quite a bit.
     
  13. Daibell

    Daibell LADA · Master

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    In the UK, NICE recommends using the Basal/Bolus (MDI) regime rather than mixed for T1 and as LADA is essentially T1 I would try to get your GP to change to that.
     
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  14. GrahamSJ

    GrahamSJ · Newbie

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    Hi Folks,

    I'm new to this group (joined yesterday) however I think I might be able to contribute something useful to this topic.
    I am Type 2 but switched from Metformin to slow insulin (Humulin) about five years ago due to a depressed kidney function. I was both testing and injecting twice daily, first thing in the morning and last thing at night. Needless to say, my blood glucose levels (BGL) were somewhat erratic.

    After about two years, I came across fast insulin (Humulog). How this came about is a long story and interesting but not really pertinent to this topic. However, after some thought, I came up with an idea which I discussed with my diabetic specialist namely that I would continue self testing twice a day, pick a target BGL and then, after testing my BGL, determine the amount of fast insulin that was necessary to bring my current BGL down to my target BGL and then inject that together with a contant amount of slow insulin that should keep my BGL correct at the evening check time.

    In other words, use fast insulin to drop to target and then slow insulin to cover a long time period.
    My testing times were immediately after taking other meds amd typically worked out to be 0730hrs and 2300hrs. and my main meal of the day was usually at 1800hrs.

    I initially set a target of 4 mmols and at the fasting check at 0730hrs, I was usually somewhere in the range 3.8 to 5 mmols. My diabetic specialist was impressed with the cosistency of the readings but uncomfortable with the fact thst it was a bit close to her suggested ABSOLUTE MINIMUM level of 4 mmols. So I upped the target to 5 mmols and then, surprise surprise, ended up with the fasting results at between 4.5 and 6 mmols and again, this was VERY CONSISTENT.

    The night-time results were not that impressive, being in the range 9.6 to 12.5 mmols, dependant upon what I had had for dinner, but my diabetic specialist was not worried about this in the slightest, only in the morning fasting result which was absulutely superb. Additionally, I never came anywhere near a hypo, neither day nor night.

    During this time, my Hba1c was 5.8% , i.e. 40 mmol/mol.

    Rosemaree, I hope that this helps you decide what to do. I can only say that it worked just fine for me.
     
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  15. Antje77

    Antje77 LADA · Moderator
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    Testing only twice a day on a basal/bolus regime sounds rather dangerous, you're flying blind most of the day.
    Do you drive?
    If you're in the UK it's illegal to do so without regularly testing your blood glucose.
     
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  16. Jaylee

    Jaylee Type 1 · Moderator
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    Hello,

    Welcome to the forum.

    I have to admit. If I adopted a simalar testing regime using my insulin, I'd have a wide "blind spot" on how my day is going regarding assessments on BG management with diet & activity?
    Using a sensor these days for me up's the game further, by spotting BG trends too.
     
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