Am I on the wrong insulin?

I’m starting to think that I am on the wrong insulin. I use NovoMix 30 (30% rapid acting, 70% intermediate acting). Initially my doctor told me to go off the insulin, because I was having a lot of lows. It was fine for a while, but I started getting really sluggish and tired, and my fasting BG crept higher and higher. I started on small doses of NovoMix again, and am feeling more energetic. The problem is that I seem to have a low roughly 4 hours after I take it in the morning. I initially suggested to my doctor that I have a snack to stave off this low, but he was against the idea. Should I be eating more carbs at breakfast?

I feel like I’m treating my diabetes with a sledge hammer at the moment - it’s a case of all or nothing. Either I take insulin and feel good and have a low, or I don’t and feel bad. Am I just using the wrong tool?

Yes, you are on the wrong insulin.

70/30 mixes two different types of insulin, long acting and short acting, in a way that make it impossible to titrate the correct dose of either kind properly.

If you split out the insulins and use one shot to control your fasting blood sugar (the 70% part of your combination shot) and one shot for each meal that is dosed so that it covers the amount of carbohydrates in your meal, you will do much, much better.

The 70/30 is an insulin prescribed by doctors trained years ago when the strategy was to give people just enough insulin to keep them alive but allow them to run very high blood sugars in order to avoid hypos. That lead to lots of very ugly complications.

Thanks for the response Jenny. I’m glad to hear it’s not just me who has struggled with this insulin. My average over the past week has been 5.5 (99), but i can’t get it down without having hypos. I’m literally had 1 hypo every second day this week. I’m going to try to see my doctor again soon and talk to him about it.

The manufacturers make pre-mixed because they are easy and cheap to make (they use regular and NPH, or there are some “newer” varieties which use NPH and Humalog or Novolog, but the same flaw exists in these), not because it has any proven patient benefit based on clinical trial results. They were able to obtain abbreviated new drug approvals (e.g. not undertake the usual number of clinical trials) because both of the insulins in the pre-mixed formulations were already approved by the FDA. But Jenny is absolutely correct; pre-mixed insulin varieties are seldom ideal for everyone, and you would be far better off adjusting your basal and pre-meal dosages individually. Some doctors prescribe them because they don’t have to give very extensive education, but that doesn’t render them ideal for patients, only for the prescribing doctor!

Prior to being on county health care, I was on Lantus for basal insulin and Novolog for fast acting, It was maybe a little better but still not perfect. Health dept gets the cheapest of everything. They slapped me on Humulin 70/30 and I have to take twice as much, and of course the novolog when necessary.

sorry to say, that’s just the nature of the beast. I know when I eliminate the highs, i’m plagued by lows. It has to be balanced by what you eat and timing. keep some trail mix granola bars handy, Pop three glucose tabs and then eat a trail mix bar, then test fifteen minutes later.

nothing is wrong with your insulin, you are normal