Do you think I should switch my insulin?

I’m on Novolog 70/30, and I have been since I was diagnosed in 2005. Until recently, I haven’t had any problems with it. I’m constantly getting dawn phenomenon and delayed blood sugar rises throughout the day. If I didn’t make a concious effort to limit fat in my diet, I would think it was a fat spike. Two hours post-prandial, I’m in the normal range, but at around the four hour mark I quickly rise about 100 points! I’m wondering if these are basal issues? If they are, I cannot adjust my basal since I’m on a mixed insulin. Do you think that I should switch over to Novolog/Lantus? I’m so confused, and I have a doctor’s appointment in a few days, and I’m wondering if I should bring up the idea that it might be basal. I would REALLY appreciate your insight!

I wonder if it’s because you don’t eat on a strict schedule? I haven’t used the mixed pens for many years, but it seems that if you don’t eat on a strict schedule, that when you don’t eat, you don’t bolus, and if you don’t bolus, then your basal isn’t holding up anymore.

I’m sorry if that doesn’t make sense? I don’t remember too much of the mixed pens.

I would reccommend definitely talking with your doc about your trends. It is really important that he offers suggestions. Maybe you should switch to separate pens.

I know that I’m using Levemir once per day (some take it twice per day) and I’m using Humalog for bolusing and corrections. This seems to work best for me.

When I was on Lantus, I had severe spikes and drops. I went into insulin shock comas and ketoacidosis while I was sleeping. It was a reaction my body had to the Lantus. I tried it for two years, but after my tenth episode in an insulin coma, I switched to Levemir. Not everyone has this issue, but just please be careful if you do switch over. And don’t be afraid to call your doc if you see the same symptoms. It seems to be happening to many T1D on Lantus on other forums and across the internet.

Good luck!

Thanks for replying. I know that when you’re on mixed insulin, you’re supposed to eat on a schedule, but I’ve been on it long enough to where I know what my I:C ratio is, so I don’t have to do that. For a while it was 1:3, and I know that doesn’t sound like much, but things are probably different since it’s a mixed insulin. Now my ratio has dramatically changed to like 4:1, plus I keep getting that spike and DP, whereas I NEVER had that happen before.

I bolus for corrections, and that works temporarily, but then it starts creeping up on it’s own, without eating anything. That’s why I think it might be a basal issue.

I always thought that Lantus and Levimir were the same thing, basically. Well, thank you for the warning! I’ll have to bring that up at my doctor’s appointment, too.

yeah, they are basically the same thing. For some reason I don’t have the same reaction with Levemir that I had with Lantus. I’ve been on Levemir for two years now.

My ratio has been changing too. When I switched meds (I used to be on Novolog) it seemed to get better, back up to 1 unit: 10 carbs… now, it’s back down to 1:6.

It’s okay to try many meds (with doc prescription and instructions, of course) to see which works best for you. I’ve been through many in the past 11 years.

I’m considering Symlin now- I’ve heard great things about it from people who used to be on Humalog (like I am now). So, it sounds like a good med for me- and it might bring my ratio back up to where it should be so I wont have to take so much insulin with food.

They just came out with a Levemir pen. I’m on the Humalog pen and I have a vial and syringe for Levemir now, but my doc appt is in July and I’ll be asking for the scrip to get the Levemir pen then!

I’ve heard good things about Symlin, too. Do you happen to know if Apidra is okay? I’ve heard great things about it. I’m still kind of confused as to whether or not it’s basal or bolus. I want to bring a lot of things up when I’m at the office

Apidra is a bolus insulin. I use it in a pump. Symlin might also be an option for spikes. It slows down the release of glucose from the food you eat and affects appetite. It’s good for weight control as it can kill your appetite, but can give some pretty nasty hypos if not used right. Talk to the doc…

Thanks, I didn’t know that! I never knew that insulin could slow down the release of glucose. That’s good to know.

Hi David… Are there side effects? What about if you’re not overweight- is this an issue?
My doc appoointment is next month and I have a ton of questions to ask! haha.

If you are a T1, you should NOT be on a mixed insulin like 70/30. Do you see an endo? You need to get in with one A.S.A.P. if you aren’t currently seeing one. If you are seeing one, find a different one.
70/30 is a VERY outdated treatment for T1 diabetics. I’ve been a T1 since 1985 and I never took a mixed insulin.

Yeah, I didn’t think it made sense.
But, I don’t know all of the meds out there. haha.

When I was on the mixed, I was seeing an endo who didn’t have any other T1Ds, only T2Ds… so I switched to a new endo and I’ve been doing fine since then.

Yes, switch insulins… there is really no reason a Type 1 should EVER be on a mixed insulin like that… you really do need seperate basal and bolus coverage!! Mixed insulins are most often used by T2’s who want a simpler routine than having to mess with more than one type of insulin, but they are not appropriate at all for a T1 - you’re not getting nearly the basal coverage you need with a 70/30 mix.

i take lantus/humalog and i’ve never had any problems

Wow! I had no idea that 70/30 was outdated! I do see an endocrinologist, and I have been seeing one the entire time. I guess 70/30 is a good insulin to first start out on, but since I was doing so well on it, they never introduced any ideas of switching me to any other ones? I’m not sure exactly. There’s another doctor at the office that I see when the endocrinologist doesn’t necessarily need to personally see me, and she’s a type 1 also on 70/30.

I guess it was kind of a freak thing that it worked out, and I was just lucky for the 4 years that I’ve been doing so well on the mixed insulin. Throughout that whole time I’ve had A1c’s in the 5-6 range consistently. Even now, my numbers aren’t that bad. They’re just not as easy to control.

Good A1cs, but yes, you really deserve to have a program that is customized just for you…which usually means taking control yourself, test, test, test, and figuring out what works for you.

Basal works wonders for me…I barely need to bolus with my basal under control.

Yes, switch insulin! Novolog/Lantus would be way better and you’d be able to confirm your problem is with the basal (it does seem like your problem is basal). Humalog/Lantus also works really well for me. You might consider splitting your daily basal insulin doses into two doses if it seems like your basal need varies at different times of day. And looking way ahead, if you can’t seem to get things stabilized, talk to your endo about pumping which allows customizing your basal delivery hour by hour (but maybe a different endo?).

is mixed insulin bad?

It’s not bad. It’s just VERY hard to give the correct amounts as you basal amounts can vary greatly from the amounts you need for the food you eat.

Symlin is not an insulin. It’s another hormone produced by your pancreas (or in my case not produced) and it works in concert with insulin. Visit the Symlin users at Tudiabetes for lots of information. It affects digestion which in turn affects BG. Symlin also has a great site of their own. Read up.

Go to the Symlin web site and read up. It is not without it’s side effects, but they generally go away with a little time. I’ve been on it since November and have no side effects.

I was put on Humalog 75/25 by a new family doc who was sponsored by the stuff (his entire office was decorated with 75/25 ads) and I hated every second of it. When he finally got me into an endo he (the endo) took me off it immediately. He told me to go straight to the pharmacy and fill his RX, then go home and throw the 75/25 away.

This is just my personal story and feelings and as always different strokes for different folks.