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The drugs don't work

N

NeilSummers

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Hi there, just after a bit of advice if anyone has been through a similar experience...


I was diagnosed as a type 2 diabetic about 2 years ago which I controlled with metformin, exercise, diet etc. but gradually the drugs stopped working so I upped the doses and included gliclazide until I reacehed the max doses and they weren't keeping my glucose down either. Made an appointment with my local diabetic clinic but as they couldn't fit me in for about 5 week when my glucose levels hit 26 last week I got worried and went to my GP. The GP has given put me on Humelin M3 and started me off on 6 m twice a day (plus 2 metformin twice a day) which I started last Wednesday. Since then my glucose levels have been between 12 and 19, I rang my GP on Friday to see if it would be appropriate to increase the dose to which he agreed. So I took 8m on Friday night, 10 m sat morn/evening and 12 this morning but I've just checked it my glucose and it's 23! I can't work out whether I'm just not doing something right regarding injections or whether the does is just far too low? Any advice would be appreciated as I feel like I'm getting nowhere and very concerned about the damaging having permanently high levels is doing to me. Talking to the doc tomorrow but they don't seem that clued up to be honest.

Cheers,

Neil
 
An important question is .. what does your diet consist of and what are the carb contents? Don't forget that the higher the carb content the more meds you will most definately need.
 
Oats and the flour in bread are 2 things that will push up your blood sugars, plus any milk in the porridge.

Have you tried having a 2 eggs omelette with some cheese? You should find a big difference in blood sugar rises between the two.

Have you kept a diary of blood sugars and foods to see what effects your blood sugars the most?


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Get referred by your gp to a consultant specialising in this area. Might not be the case but, many type 1.5, 2 are miss diagnosed. regular readings that high whilst using max oral meds, then using humilin with oral meds needs proper investigation.

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Hi. As you probably realise you are likely to be T1.5 not T2. I went thru a similar but slower process with max Glic etc with no effect then moved to insulin this year. My nurse first started me on Levemir (once a day Basal) but to tweak things I was lucky that she then added Bolus insulin (NovoRapid) which enables me total control. My nurse used to work at the hospital diabetes clinic and now the local surgery which is great. She preferred adding the Bolus rather than splitting the Levemir to twice a day which surprised me. You might want to ask about adding a Rapid acting Bolus insulin but I suspect until they accept you are not T2 but T1.5 they may be reluctant (rules!). My nurse wasn't interested in what I was but just providing the right insulin solution; I'm lucky. If you aren't overweight then I would try some persuasion for Basal/Bolus. BTW my DN stopped my Sitagliptin and Gliclazide but kept on with the Metformin. This seems to be fairly standard practice.
 
I think that your GP has started you on low doses for sound safety reasons. It might take some time to titrate it upwards to the appropriate dose but at the beginning he has absolutely no idea about how insulin sensitive you are.
(drugs aimed at people who are often insulin resistant don't seem to have worked well so perhaps you could actually be more insulin deficient than resistant as suggested by previous posters).
He has to make sure that he doesn't give too much too quickly with a big hypo as a result. He is probably using a local guideline for insulin initiation and these do differ from area to area.

One guideline I read suggested starting at 60% of average levels and titrating upwards.
An average is often said to be 0.5u of insulin per kg but this is only a rough ball park figure, many take much more or much less
http://library.nhsggc.org.uk/mediaAsset ... 010-01.pdf

When you adjust this type of insulin normal practice is to do it gradually with at least 48 hours between each adjustment . You also don't do it on the basis of one reading.

It's only a week in so it will take time to get better control but obviously discuss it with your doc tomorrow.

It's worth bearing in mind that mixed insulin's contain 2 types of insulin. One covers the glucose released from the liver during the day and the other covers the carb intake. You can't adjust the proportions but can work well with a regular lifestyle.
They work best with consistent carbohydrate amounts both in time of day and amount.
If you eat 20g carb for dinner at 6pm one day and 50g carb at 8pm the next it wont' work well at all.
eg: if the amount you take each day will cover 50g of carbs you would be hypo if you only ate 20g carbs.
If you vary the time too much the background element of the insulin won't be spread out over the 24hours.
Because these insulins have peaks and troughs some people also have to take snacks between some meals or at bedtime .... but that bit comes later when you discover the patterns that apply to you personally. Record keeping is really important to work these out.
 
Hi. Phoenix correctly spotted, which I didn't, that you are on a mixed insulin. This is OK for starters and minimises injections. Yes, your GP may recommend gradually increasing the units. In the longer term if you are happy to have two different pens for short and long acting insulins, perhaps with one or two more injections per day, but have greater control then do discuss this with your GP. My Basal/Bolus comments referred to this regime and are not relevant for mixed insulins.
 
Hi

Twice daily insulin regimes are great for most newbie diabetics who use insulin, but unlike the other regime called bolus/basal which requires doing a lot of injections (approx. 4-6) and adjusting the bolus insulin for the carb content of food, twice daily regimes call for eating set amounts of carb which need to eaten within certain time frames. Often the best control with twice daily insulins is to eat the 'little and often' way which usually means eating a small snack mid morning, mid afternoon and usually a snack before going to bed.

What you need to do at the moment is test your bg levels mid morning, mid afternoon and by doing so, you adjust the carb that you eat and not the insulin. Because twice daily insulins take a while to get going, its best to eat a small carb breakfast, but then do a bg test to see how high the carb has made your bg levels go up by and if less than 10mmol, then you probably need to eat a small snack or if you don't want to eat a snack then you wait to see if you will go hypo about 1hr before you eat your next meal and learn as you go along. So.... count the carb in the food you eat and adjust it to suit the action of the way the Humalin M3 affects your bg levels. Once you've worked out the specific amounts of carb that you can eat in order to make your bg levels ok, then keep to eating those set amounts and you should be ok with any luck. Of course, hot or cold weather can affect bg levels as does exercise but we all get used to it and you will too. Just make sure that you have enough bg teststrips to enable you to test about 7 times a day for a while until you find out what your ideal carb intake is. Make sure that you test during the night about 2-3am to see what your bg levels are and then by doing so you will then be able to adjust the carb snack that you eat before going to bed.

All the best
 
NeilSummers said:
I tend to avoid carbs as much as possible though I did have some porridge this morning then some wholemeal toast later on.
Click to expand...

A lot of people have difficulty with porridge and it took me a few weeks of diet and exercise to be able to eat it without getting big rises in BG levels. Wholemeal toast however is very probably much worse. White bread has a glycaemic response curve very similar to glucose. If you eat it, you may as well be puttimg sugar in your tea and coffee and drinking sugary fizzy drinks. Wholemeal bread should be very much better than white bread but, most wholemeal bread is not wholemeal bread. Waitrose wholemeal bread for example only contains 6% wholegrain flour. see A wholegrain of truth? http://www.sustainweb.org/news/feb13_re ... rain_truth

Even artisan bakers add white flour to wholegrain flour and then add molasses for colour and flavour. You have to be careful with bread. A good starting point for testing would be to avoid all bread for the time being and stick to wholegrain rye ryvita. If that spikes you, you can pretty much forget bread. Stick with it for a while or keep trying some over a period of time because the body does seem to re-adjust.
 
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