Changing Insulin

V (my hubs) is currently in hospital for a check-up - the French like to have a captive audience.
He’s been using mixed insulin ( rapid at breakfast and for snacks, 50/50 at lunch and 30/70 at dinner) and we’ve convinced the doc to switch him to Lantus for the basal and the same rapid he used before breakfast for the bolus.

Has anyone else switched from the mixed to separate? Did it take a lot of adjusting?

They’re keeping him in until they have it working right - but we know from experience that it will be totally different at home. His bg was in excess of 400 after only one day in hospital (before the switch) - and they yelled at him for injecting a bit or rapid to bring it down - like he does at home
IMHO the diet is horrid in hospital - baguettes, which are like a bowl of sugar, rice pudding, lots and lots of plain pasta… They think he should gain weight and are insisting on 75 carbs per meal, every meal.

Part of the problem, also IMHO, is the docs expect to establish the routine and the patient to follow it without question and without deviation. I was told to give him a ‘sugar dessert’ after every meal to get his carbs up!

Anyway, we’re a little worried about fine-tuning it all when he gets home this weekend. I know - ‘ask your diabetic educator’ - we don’t have one… And I’ve already said what the docs and dietitian will tell us.

But we rather like eating lots of fresh vegetables (like always) rather than sweet desserts (never have).

We want to be normal people…

Any and all hints and advice welcome.

(For the record, we managed to get his numbers fairly stable after the last hospital stay on the old, pre-mixed insulin, but he is using so much less now that he’s recovered from having his pancreas removed that we worried he wasn’t getting sufficient basal - thus the switch)

Katie-- great news about switching to Lantus and rapid acting insulin!

One thing that you may try is giving the Lantus is two doses. Many people find that it doesn’t last the full 24 hours, but when they do one morning and one evening shot, the control is much better. Check for highs in the last 4 hours before the next Lantus injection (to get an idea if it has worn off).

Also, figuring out his insulin to carb ratio and sensitivity (correction) factor will be KEY. Thinking like a pancreas has recommendations on how to calculate these. You can use that for starters and then adjust them up and down based on experience. I think the key is to measure his blood sugar at lot in the beginning and keep a log. That will give you the info that you need to set all the rates correctly.

hi katie. i’m recently dx, and my situation is very similar to v’s. i still have my pancreas, but it was destroyed by years of alcohol abuse. so this is my deal. they started me out on humalin n. THAT’S IT! i was a slave to the insulin. did a shot in the morning before breakfast, and a shot in the evening before dinner. after about 3 weeks. i started doing the lantus/humalog routine-the “poor man’s pump”. i was so happy i cried for a day because i could live life again. i was a professional chef for years, so food is a very important part of my life. i could eat real food again! and there really was no adjustment period for me. i just did my 20 units of lantus in the evening, then bolused for everything i ate. that was the tricky part. but you find your dosing needs and it gets easier. i thought i never would, but i did. i highly recommend the book using insulin by john walsh. it has all the information that you need. it has all the tables and graphs to calculate v’s bolus, correction shots, basal amounts, EVERYTHING. best of luck with it all. don’t be nervous or apprehensive. dive in. he will be SO much happier.

Good advise Kristin - I’m in the same mind meld as you are with that advise to Katie. The way I’ve seen myself over the years with diabetes - is a guinea pig - and I have to experiment on myself - since I didn’t have many people to go to for advise (endo isn’t that much help - just pushes legal drug prescriptions across his desk to me - while he discusses his last golf shot).

May wish to talk w/ the doctors again…express your concern about the diet he is receiving. Often, the hospital diet is not reflective of the medical team’s goals! I, unfortunately, was in the hospital before Christmas and they sent me bagels the size of my head, covered in sugary toppings and multiple juices, etc. I asked to talk w/ the dietitian and explained that I did not eat that way. To cut dietitian’s and docs some slack…diet orders can only be written so specifically and usually it is foodservice workers interpreting the orders. Just say no to the junk and demand better food…if it is weight they want him to gain…he will w/ better blood sugar control and a healthy diet. Good luck:) Big hugs. Hope he is feeling better soon.

If you give it in 2 doses - 50% each time? I think they had him do 8 units last night and are doing 10 tonight. We’ll try to do it their way to start…

Guinea pig is exactly right… I have a surprise for him when he gets home… A ‘man bag’ to carry all his stuff. Fortunately, they are very popular here, even the old farmers carry them…
We are going to be like you - figuring it out on our own. We’re just not willing to live under the restrictions they would like to impose. At least they’re good about the wine - French and all!

There are many options- 50%-50%, 60%-40%, 70%-30%. If he seems to have highs at one point of the day and lows in another, then you can give more Lantus before the time where he tends to be high. Lantus is slightly more active for 6 hours after injection and lasts 20-24 hours.

Yes, it will be good to try it the way they started. When I was on Lantus, I only took it once a day and I think it was OK. Just heard this advice from others.

Switching from one shot a day to two shots can be a bit tricky on the transition day. So it might be a good idea to wait on this and see how he does on one shot a day.

I know for myself Katie - when I was using Lantus for my basal insulin (the one that runs in the background inbetween the fast acting insulin used when we eat) - that I had to split up my Lantus shot as I was having too many lows (hypos) at night time and upon waking. It was horrible - feeling semi drunk when I was going to off to work!!! For myself, what worked for me was splitting up my 18 units of Lantus that I used to take only at night into a combination of 8 units before I went to bed - and then 10 units of Lantus in the morning - along with my shot of rapid insulin to cover my breakfast. I had to experiment abit until I got the right formula - so be patient - and do the blood tests diligently - as they will reveal how V’s doing.

Like you say - let them do it their way until you get more acquainted with this chess game of diabetes. It’ll take time - so be patient (no pun intended there for V).

We are BIG foodies, too. We couldn’t begin to imagine life without all the wonderful food choices we have gotten so used to. Oatmeal, yogurt and rice pudding as staples just aren’t going to do it. Thanks for the encouraging words and the book recommendation. Now if I could only figure out how to test him at night without waking him up… I have to get up with the dogs…
Tables and graphs… I like that.
Did you have a doctor getting you started on the switch?
Who knows what we’ve been doing, trying to make what he had work for our lifestyle… We were getting creative.

Actually, I probably had the same problem as Anna… because the reason that I switched from Lantus to the pump was due to lows almost every morning. No one mentioned the idea to split the Lantus or even to move the injection to the morning. Your system would probably work for me too Anna! I will keep it in mind if I go back to multiple daily injections (MDI).

He’s in the endocrine unit of a teaching hospital so they should know - and the dietitian is pushing this food on him. A very different philosophy about food. To be kind, they are probably not used to having a ‘foodie’ in there and the diet is probably acceptable for most of their patients. They were astounded when I told them how many carbs and calories V was eating every day. First, they told me I must be wrong (V had told them what he eats - but not how I make it), and then were amazed when I was able to prove me right. Having a baguette, yogurt and rice pudding is much more a part of everyday French life than having a Quinoa and Red Bean pilaf…
Oh, and he;s perfectly fine - he’s in hospital so they could give him his check-up… It’s easier for them to have him there 24 hours a day

follow kristin’s advice about the log. i have kept a regular log of all my bg readings and a detailed food journal ever since i was released from hospital. i write down EVERY morsel of food that passes my lips. it’s not been that long since dx, so i need to know who different things affect by bg. it will really help to figure out v’s dosing. it sounds like ya’ll have a very sensible diet. i would lose my mind eating all things i know i shouldn’t if i lived in france! =^)

oh i forgot. you can test him while he sleeps. they did it to me every 2 hours when i was in hospital. i think they just used a lancet on my arm or shoulder, not really sure. but i didn’t have to wake up to test. maybe someone else has a suggestion.

But I thought he could eat anything - as long as he did the insulin right…
(Okay, so I know that the answer is: within reason and occasionally. He stopped at the bakery the other day… without insulin before hand… A lesson well-learned.)