Starting Insulin for first time

[daniel2]

I was diagnosed with Type 2 about 6 yrs ago, last week my 6 monthly HbA1c was 7.2 and my nurse has advised me to go on insulin. She has left it to me to what regime I go on, either Twice a day Novomix 30 or Multiple Lantus basel-bolus regimen? I can't decide which would be the best for me, I have read that the basel-bolus is best for mimicking the pancrease but don't like idea injecting 4 times a day, twice would suit my lifestyle better.
Any advice would be welcome. Thanks

 

[sugarless sue]

Have you any idea why the nurse suggested insulin ,Daniel? Your Hba1c is not that bad so is there another reason?

 

[daniel2]

She has suggested insulin because apart from my readings before breakfast being around 6 mml,s, my readings for the rest of the day are always in double figures, eg breakfast this morning was porridge, toast and a cup of tea 3 hours later my reading was 14.5 !!! I suppose it is because the readings are so erratic.

 

[sugarless sue]

I think that maybe what you are eating does that.tell us what an average days diet is like.Porridge for instance will put up your blood sugar levels quite a bit.

 

[fergus]

Hi Daniel,

You might want to give some careful thought to your diet before you take the plunge. A high carb meal like porridge and toast will be hard to reconcile with non-diabetic blood sugars, even when you use insulin.

I'm type 1 and have been on both regimes in my time.
In my view, there is no comparison. The basal-bolus regime is far more flexible, and much better at replicating the effect of a proper pancreas!
I can understand your reservations though. The prospect of 2 or 4 injections per day ought to make the Novomix option a clear winner. In reality however, the injections themselves are painless once you get the knack. You shouldn't allow that to influence your choice.
Twice-daily regimes are a bit old hat these days, something of a relic from the days before the rapid acting insulins came on the market. You will find yourself eating meals because your insulin demands you do, or risking hypoglycemia if you run late. With basal-bolus you will be able to fine-tune things to suit your lifestyle. You can skip meals if necessary, and correct your blood sugar easily if things go wrong.

Lots of things to consider, but basal-bolus is a clear winner in my book.

All the best,

fergus

 

[graham64]

Hi Daniel,
I agree with Fergus and Sue, Porridge and toast are not good for your BG, have you thought about reducing your carbs? have a read through the forum and you will see what has been achieved by many of the forum members. Your HbA1c is not to bad, with attention to your diet it could easily be reduced then you could avoid going on insulin.

Regards Graham

 

[phoenix]

I don't know what other factors have influenced your health care team into deciding that you need to go on insulin.(other tests?)
If it is indeed necessary, I'd completely endorse Fergus's comments about biphasic insulin. Basal bolus is much more flexible and allows you to live your lifestyle, rather than suiting your life and eating pattern to the insulin duration. It really is no hassle to inject, the thought of it is far worse than the reality.
I've gone on long distance walks eating at fairly irregular intervals and I've been able to adapt insulin intake for long drawn out 4 hour meals. I have injected discreetly under the table in restaurants, and (normally) it doesn't matter if the meal is a long time coming since you don't inject until just before eating. With a twice daily insulin regime, routine is very important and these things would have been very much more difficult if not impossible. You might think that you live a very regular lifestyle but think about times such holidays or at the other extreme family crises when you don't want to be constrained by your insulin action.

 

[daniel2]

Thanks guys for your replies, they are really helpful, it will give me something to ask my diabetic nurse tomorrow.

Sugerless Sue asks about other things in my diet, I think I do have a healthy diet but my readings are so up and down!!! A good example was this morning before breakfast my Bg was 5mmls, I had weetabix, 2 digestive biscuits and a cup of tea, 2 hours later my BG was 14.5, 31/2 hours later 14.9 and before lunch 12.3?.

I will discuss some of the points you have mentioned and thanks again for the advice, especially what regime to go on (if I have to)

 

[sugarless sue]

I'm not surprised your BG is up after breakfast.Do you have one weetabix or two? Two weetabix is about 25g carb and goodness only knows what two digestives is!!Please try and get a copy of Collins Gem carb counter and you will be able to see what the carb values are in things that you are eating.

 

[daniel2]

Hi Sugerless Sue,

Thanks for your reply, I will try and get a copy of the book you suggest.

Can you please give me an example of what you have for breakfast?

Thanks

 

[sugarless sue]

Sure Daniel,I have one weetabix which is about 12.5 carbs and about 50ml of tropicana which is about 5carbs works out altogether about 18 carbs.Now a lot of members who low carb have a cooked breakfast in the morning resulting in very few carbs it's just that I can't face either cooking or eating a cooked breakfast in the morning!!(I don't do mornings!!)I also sprinkle cinnamon on my weetabix,again there is some debate as to whether this helps but I like the taste!.This keeps me going till lunch time but then I am not that active in the mornings.If you work then may I suggest a cooked breakfast to give you the energy till lunch time.

 

[sugarless sue]

I'm not surprised your BG is up after breakfast.Do you have one weetabix or two? Two weetabix is about 25g carb and goodness only knows what two digestives is!!Please try and get a copy of Collins Gem carb counter and you will be able to see what the carb values are in things that you are eating.

Just looked up digestives they are 9.6 carbs each.Therefore your total for breakfast is 44.2 carbs which is very nearly what I eat for the whole day carb -wise.

 

[chocoholic]

Hi Daniel,
I too have been on both regimes since being diabetic. I was on Novomix30 twice a day and was then changed to Novorapid/Lantus. I actually inject 5 times a day,'cause I have now split the Lantus dosage to gain better length of coverage.
Like you, I was not keen on upping the jabs every day but that doesn't bother me much now. Certainly going the basal/bolus route has given me more flexibility. On the days when I want to eat out or a bit later than usual, it is no longer a problem. Also I hope to achieve matching insulin to carbs. far more easily. I say "hope to" because I won't get my new half-unit pen until next week and I've found it tricky to do a proper match, as I'm on tiny amounts of insulin. IYSWIM.
On the whole I think I'm better off on basal/bolus system and I'm sure you'd find it more flexible too.
Hope that helps.
All the best, chocoholic.

 

[daniel2]

Thanks Chocoholic, great advice.

I think after what you have said and one or two of the others I will go down this route.

Thanks again.

 

[Trinkwasser]

Some information that may be useful

http://loraldiabetes.blogspot.com/2006/10/d-day.html

http://loraldiabetes.blogspot.com/2006/ ... fasts.html

Many of us find breakfast to be the most carb-intolerant time of day. Your nurse sounds like the old school "eat lots of carbs and cover the ridiculously high BG with insulin" there are other ways you could explore first

More useful advice here

http://www.dsolve.com/learn-the-solution