T1 for 38 years switching to new insulin :-(

[Chris.L]

Firstly I would like to say hello to everyone on this forum as it this is my first ever post on it!
My name is Chris and I am a type1 diabetic 40 years old from South Wales
My pancreas decided to shut shop at the age of 2, so I have being injecting for the last 38 years, all be it mum had to do it for the first 6 to 7!!
My insulin regime over the last decade or so has been twice daily, human actrapid and insulatard via syringe. I would vary the amounts depeninding on BG reading, expected carb intake and exercise. Ive been quite good at predetermining the amounts required. However, i have been injecting high daily doses, averaging 60 units to cover a typically high carb diet 200/250 day
My quarterly HB1ac have always been 6 point something, and my weight has never exceeded 81kg - im 5ft 10 and have regular exercise.

My last Hb1Ac shot up to 8 and now I have agreed to switch to lantus and novorapid in pursuit of better control. Ive started reading up on this forum to get more info on the new insulin regimes, particularly insulin/carb ratios but things are not adding up - ive stabilised my Bg betwwen 7/10 with no hypos by injecting 30 units of lantus, and 42 units of novorapid - this has covered 225 grams of carb ive consumed today - but the consensus on here is a 1 to 10 ratio; does this suggest my body has a low tolerance to insulin? i am also finding that the onset of novarapid is no where near as fast as the manufacturer or diabetic clinic suggests - i am begining to wonder if my insulin pens are a duff batch - ive been using the new insulin for a week now.

Your thoughts on all of this would be appreciated.


Chris

 

[NickW]

Hi Chris,

Insulin to carb ratios are very personal. Yours may well be different to others on this forum, that's nothing to worry about - you just need to work out your own ratios. They might be different at different times of the day - many people find they need more insulin in the mornings (e.g. my morning ratio is 1 unit for about 5g carbs; later in the day it's one unit per 7g). This just takes time, experimentation and careful monitoring. Your relatively high carb intake means you inject a relatively large amount of insulin, which may be making you slightly insulin resistant - you might find that if you move to eating fewer carbs, your ratios change slightly over the course of a few weeks or months - again, this is something you'll just need to monitor and adjust for.

The way I determined my ratios was to simply have a period of fasting to make sure I had the correct basal dose; a day without eating anything at all and testing my blood to make sure it was fairly stable. Repeat as necessary to refine the basal dose. I then had further days (not necessarily straight after the fast!) where I'd eat a single meal, take what I thought was a reasonable amount of insulin, and test for a few hours afterwards to check whether I was right or not; this let me find my early morning, daytime, and evening ratios. It wasn't really pleasant to do this, but it worked for me; this plus a low-carb paleo diet have taken my A1C's from 7.6 (a typical result over the past 10 years, I'd never had anything better than 6.9) to 6.2 in under three months, and I expect my next result to be five-point-something.

Your comments about the speed of Novorapid are interesting - I also find that Novorapid takes a fair while to kick in. I haven't used Humalog or Apidra so I can't compare it, but with the Novorapid it seems to take an hour before I get any affect at all, then it works over the following 2 - 2.5 hours (e.g. if I wake with a high BG it won't even start to lowerin the first hour; after 2 hours it'll have dropped slightly; after 3 - 3.5 hours it'll be down where I want it). I counteract this by injecting early where I can, but for times where that isn't possible (e.g. an unexpected high or waking up high), it's a pain that it takes so long to work for me.

I'll be interested in what others might have to say about this, I may have to have a medication review and give Apidra or something a try...