Two Insulin’s??

[Libby3781]

I’m new to insulin, only been taking it a month. Taking Levemir last thing at night.

On my last hospital appointment with the diabetic nurse, she advised it’s quite likely I’m going to require another insulin injection with my food. So far taking metformin twice a day, and a dose of insulin last thing at night isn’t bringing my levels down enough.
Thank
Has anyone got experience of having two insulin’s to take?

Please can someone give me some names of insulin that would be secondary ones?

If you’re in this position have you seen a difference?

Thanks all in advance x

 

[Antje77]

Almost all type1's are either on two insulins or a pump. It's called a basal/bolus regime or MDI - multiple daily injections. It means you dose your mealtime insulin according to the amount of carbs you'll eat, just like the pancreas does in non diabetics. You also need to take account of your current blood sugar when deciding on a dose and on things like exercise.
It may very well be that you'll start out eating meals with the same amount of carbs so it's easier to find out the right insulin doses for you. They might be different through the day as well: I need a lot more insulin for the same amount of carbs in the morning than in the evening.
It will take some time to get the hang of it, that's fine. A big help with learning to dose would be a CGM or FreeStyle Libre. That would allow you to see what diffent foods, amounts of insulin and exercise do to your bg, making it easier to change something next time.

I have been on NovoRapid and am now on Fiasp, next to my long acting insulin, but there are more brands.

You write that you are on Levemir for your long-acting and take it at night. Many people find that they need to split their Levemir dose because it doesn't always work 24 hours. Are you seeing a lot of high blood sugars in the last hours before your injection?

Good luck!

 

[enzina]

Hi Libby,

Three month ago i have started using Novorap 3x the day, just before meals. Lantus, the long acting insulin i split in two doses, so i have to inject five times the day. I thought i'll never get used to it and can't handle it. But i could. The a1c went down to 6.6 from 9.
All the best, good luck!

 

[Libby3781]

Almost all type1's are either on two insulins or a pump. It's called a basal/bolus regime or MDI - multiple daily injections. It means you dose your mealtime insulin according to the amount of carbs you'll eat, just like the pancreas does in non diabetics. You also need to take account of your current blood sugar when deciding on a dose and on things like exercise.
It may very well be that you'll start out eating meals with the same amount of carbs so it's easier to find out the right insulin doses for you. They might be different through the day as well: I need a lot more insulin for the same amount of carbs in the morning than in the evening.
It will take some time to get the hang of it, that's fine. A big help with learning to dose would be a CGM or FreeStyle Libre. That would allow you to see what diffent foods, amounts of insulin and exercise do to your bg, making it easier to change something next time.

I have been on NovoRapid and am now on Fiasp, next to my long acting insulin, but there are more brands.

You write that you are on Levemir for your long-acting and take it at night. Many people find that they need to split their Levemir dose because it doesn't always work 24 hours. Are you seeing a lot of high blood sugars in the last hours before your injection?

Good luck!

Thanks for all the information, it’s much appreciated. I’ve only ever been classed as T2 diabetic, but for the duration I’ve been on medication (since March 16) my sugars have not lowered to a controlled level. The pattern I am seeing is my blood glucose is low in the morning based on having insulin at bedtime. Then from breakfast time onwards they rise, being considerably high by teatime.

I try and watch what I eat. I don’t eat excessive carbs, I’m vegetarian but eat fish. I do like sweet things, but I’m very good at resisting. I can make cakes for all my family & friends and not have a taste/try etc.
When you have to inject more than one lot of insulin do you have to test you’re blood before/after?

 

[NicoleC1971]

Thanks for all the information, it’s much appreciated. I’ve only ever been classed as T2 diabetic, but for the duration I’ve been on medication (since March 16) my sugars have not lowered to a controlled level. The pattern I am seeing is my blood glucose is low in the morning based on having insulin at bedtime. Then from breakfast time onwards they rise, being considerably high by teatime.

I try and watch what I eat. I don’t eat excessive carbs, I’m vegetarian but eat fish. I do like sweet things, but I’m very good at resisting. I can make cakes for all my family & friends and not have a taste/try etc.
When you have to inject more than one lot of insulin do you have to test you’re blood before/after?

I am type 1 on a basal/bolus regime and test before meals then at other critical points such as before bed or before exercise. If you drive you probably already know that you need to test before doing that too.
2 years and onto insulin seems a rapid progression to me. Were you never recommended any other medications in between? Has the doc tested your insulin levels to confirm that they are low or are you simply very insulin resistant?

 

[Libby3781]

Hi Libby,

Three month ago i have started using Novorap 3x the day, just before meals. Lantus, the long acting insulin i split in two doses, so i have to inject five times the day. I thought i'll never get used to it and can't handle it. But i could. The a1c went down to 6.6 from 9.
All the best, good luck!

Thanks for the information much appreciated.
Do you have to test you’re blood before/during & after with injecting so many times a day?
Currently my blood is mostly in high figures anything from 9 upwards, the highest it’s been is 21 . The insulin and metformin is bringing it down but not consistently, on Saturday I’ll be increasing my dosage. Currently on 20u’s, but will go to 22u’s.

 

[Libby3781]

I am type 1 on a basal/bolus regime and test before meals then at other critical points such as before bed or before exercise. If you drive you probably already know that you need to test before doing that too.
2 years and onto insulin seems a rapid progression to me. Were you never recommended any other medications in between? Has the doc tested your insulin levels to confirm that they are low or are you simply very insulin resistant?

You make really interesting points NicoleC1971. When I was first diagnosed (March 16) had very little support from gp. Was given metformin and left to it. Saw the diabetic nurse in my surgery, but again really left. Then had a year with personal struggles work related so taking medication didn’t happen.

Only now, on going back to my gp and stating me and hubby want to have children. Have my gp/surgery nurse have taken notice. Gp referred me to hospital, and since being under the hospital I’ve had more support/advice and help (1 month) from them. First appointment with hospital nurse, put straight onto insulin, seen her every 2 weeks...and been advised will likely need more insulin. So have another hospital appointment on the 27/7.

 

[Antje77]

When you have to inject more than one lot of insulin do you have to test you’re blood before/after?

Testing before and 2 hours after food will tell you a lot about the correct dose, so I'd certainly recommend that. Before I had the FreeStyle Libre monitoring my bg I did about 11 fingerpricks a day. That allowed me to learn very fast about the best dosing.

Have you been tested for type1/LADA?

 

[Antje77]

Only now, on going back to my gp and stating me and hubby want to have children.

Prepare to test a lot!

 

[Libby3781]

Testing before and 2 hours after food will tell you a lot about the correct dose, so I'd certainly recommend that. Before I had the FreeStyle Libre monitoring my bg I did about 11 fingerpricks a day. That allowed me to learn very fast about the best dosing.

Have you been tested for type1/LADA?

My fingers are bruising from all the fingerpricks . The diabetic nurse I’m seeing in the hospital told me not to worry about testing for the reason I’ve been on holidays for two weeks. But, I’ve kept testing 3 times a day as I’ve wanted to monitor for myself.

As far as I’m aware, I’ve not been tested for T1.

 

[NicoleC1971]

You make really interesting points NicoleC1971. When I was first diagnosed (March 16) had very little support from gp. Was given metformin and left to it. Saw the diabetic nurse in my surgery, but again really left. Then had a year with personal struggles work related so taking medication didn’t happen.

Only now, on going back to my gp and stating me and hubby want to have children. Have my gp/surgery nurse have taken notice. Gp referred me to hospital, and since being under the hospital I’ve had more support/advice and help (1 month) from them. First appointment with hospital nurse, put straight onto insulin, seen her every 2 weeks...and been advised will likely need more insulin. So have another hospital appointment on the 27/7.

Glad that you are getting the help you need and hope you can therefore get answers before upping the insulin. It is possible that you have adult onset type 1 which typically results in less and less insulin being produced rather than the more dramatic illness which results in kids being diagnosed with dramatic weight loss etc. The tests are not totally reliable but C peptide looks for antibodies to the insulin making beta cells. A fasting insulin test may show low levels of your own insulin (type 1 or possibly type 2 of long duration) whereas a type 2 would expect to be having high levels of insulin coupled with insulin resistance.
If you have to be on insulin because you can't make your own then that is totally necessary obviously but if you are a type 2 then taking more and more insulin will just make you more and more resistant to it. Your doctors and nurses are rightly concerned with high blood glucose especially when trying for a baby but using insulin is associated with weight gain, renal and heart disease. In other words just treating the blood sugars alone won't stop those complications (this has been known for 10 years since the Advance and Accord studies btw).
SO that is why I think its important to know and then to ask what other options there are.

 

[Libby3781]

Tomorrow I have another appointment with the diabetic nurse.

I am very much anticipating being given another insulin to take when I eat. She said on my last appointment it’s highly likely, but obviously she didn’t go into further detail.

Therefore, I’d be very grateful for hints, tips & advice from any of you on two insulin’s.

 

[Kittycat_7_]

Hi Libby,
My mum is type two she takes Lantus a long-acting insulin and humalog a short acting. She is on four injections a day of short acting and once daily long acting.
Lots of type twos are on two different insulins.
Take care

 

[Libby3781]

Hi Libby,
My mum is type two she takes Lantus a long-acting insulin and humalog a short acting. She is on four injections a day of short acting and once daily long acting.
Lots of type twos are on two different insulins.
Take care

Thanks Kittycat.
My mum is on Lantus I think, but only last thing at night. It’s reassuring to know other types 2 are on more than one insulin.
Does your mum have to monitor her sugars? I’m currently taking my sugars 3 times a day, and my fingers are bruising from all the finger pricking . Thanks for your kind words xxx

 

[Kittycat_7_]

Yes she does monitor she does 4 times a day, I know finger pricking can hurt. I'm on oral meds but test radomonly.
I rotate where I prick regularly. Thank you.
Good luck and take care

 

[slip]

When you do a finger prick test are you using the sides of your fingers? also don't just stick to one or 2 fingers - share the love between all fingers and thumbs!

If you do go on MDI you will need to test alot, before every injection basically and it would be good initially to test 2 hrs after a meal. Keep a log of tests, injections and food/carbs as it will help you and your nurse find the right levels for you.

I was going to say about the LADA/T1, ask for GAD and c-pep tests to hopefully confirm (although about 25% of tests give a false positive), however with your mum being T2 you may just be genetically more prone to T2, if thats you in your avatar you don't look like the classic T2 'shape' - no offence intended by that comment to anyone and everyone (we all know there are slim T2s!).

 

[Libby3781]

Hi all,

I trust everyone is well? Well I got to meet the consultant today for the first time. As expected I’ve been put on a fast acting insulin. Novo Rapid.....it all seems rather daunting at this point in time.

I’ve been advised to inject 4 units with meals, been advised it can drop down to 3 units and 2 units if necessary. They have also advised to continue with the Levemir last thing at night and not to increase beyond 30units.

The consultant also advised I need to lose some weight, and do more exercise. I did my first dose of new insulin earlier bg was on 8. Then had my meal about 40 mins after doing insulin, unfortunately meal was lots of carbs . So on checking bg 2 hrs after bg was on 14.7. So I’m hoping when I do night insulin it will bring it into single figures in the morning.

Would be really grateful for more help and advice. Thanks all xxx

 

[Resurgam]

I was wondering why your meal was lots of carbs.
As a Type two controlled only by diet for almost two years I am most likely rather blase about eating low carb.

 

[XxTinkerxx]

Hi all,

I trust everyone is well? Well I got to meet the consultant today for the first time. As expected I’ve been put on a fast acting insulin. Novo Rapid.....it all seems rather daunting at this point in time.

I’ve been advised to inject 4 units with meals, been advised it can drop down to 3 units and 2 units if necessary. They have also advised to continue with the Levemir last thing at night and not to increase beyond 30units.

The consultant also advised I need to lose some weight, and do more exercise. I did my first dose of new insulin earlier bg was on 8. Then had my meal about 40 mins after doing insulin, unfortunately meal was lots of carbs . So on checking bg 2 hrs after bg was on 14.7. So I’m hoping when I do night insulin it will bring it into single figures in the morning.

Would be really grateful for more help and advice. Thanks all xxx

Stay away from the carbs.

My DN suggested I take fast acting insulin after meals and I politely declined. I take long acting insulin which has brought my morning sugars down to an average of 4.

I told her I was working hard to reduce my carb intake and she was happy with that and suggested I took a small dose of insulin in the mornings to "top me up"

You really need to cut out the carbs. They are not our friend.

Good luck. It's tough but you can get there.