I am now on insulin! any advice/tips?

Type 2
1

I got swapped over to insulin after dealing with the crappy side effects of Metformin for the past few years. I was dx with type 2 Feb 2019. I refused to take my Metformin even if ER due to the poopy side effect.

So I got no training or anything WHATSOEVER on this! I had to find videos and talk to my dad who is a diabetic on how to do the injections. 10 units with a pen nightly for now, but dad said if it’s high you should consider shooting up regardless of time.

So backstory on WHY this is happening. I got a kidney stone procedure done last Friday, and of course I assumed the medications and stuff given to me being put under would mess me up. I met with my doctor’s nurse Wednesday afternoon, and she said the surgery likely put me over the edge causing high BG readings etc. My BG reading before surgery was at 266… I’m usually in the 200’s range if my BG is high. Low was 90 one time.

So after I checked it that Friday evening it was 500s, then the next day it was 400s. Anyway, I am dealing with this insulin stuff and it is new to me.

Any advice or tips? I am super darn lucky and only had to pay $4 for my pens and then $4 for the needles.

I’m on Lantus for the insulin. My pens are the 31GX5/16") / 31G X 8 MM type.

2

What insulin have you been prescribed?

3

Lantus

4

lantus is long acting insulin taken once per day or 2 smaller doses twice per day. 10 units is a good starting point. Take it at the same time each day and check you blood glucose several times a day. In the morning when rising, before meals and 2 hours after meals.

Did your doctor give you any goals for your blood glucose?

2 Likes
5

A1C is 11.5 last time I got it checked. This was recent too. I’m thinking under that is a good goal, and wasn’t given a goal for my BG.

6

You might benefit from a fast acting insulin so you can lower those numbers better.

Originally I was misdiagnosed as a type 2 and I ended up refusing the different medications because they were making me sick. I commonly ended up in the 200 and 300’s. (even 400’s sometimes) I literally was handed Lantus and told to start at 10 units a day and raise it 1 unit every two days until it works. I had to ask how to give a shot even. And when I was given a fast acting insulin I was told 1 unit for every 3 carbs you eat and no other information. A real lack of help.

So that brings me to telling you, even Lantus can make you drop too low. At your numbers right now, it’s not likely to happen, But as you get closer to the right dose, it can happen. I would advise you to carry and keep by your bedside a fast acting hypo treatment like glucose tablets. But honestly, you will have better success with control with a fast acting insulin added but also more of a possibility of hypos.

But the reason a fast acting can really help is a long lasting can’t always cope with the food you eat. A long lasting is meant to make up for what your liver makes and in a type 2 sometimes some food you are eating and is really supposed to be more of a consistent amount each day. . A fast acting can be adjusted for need.

And that brings me to the next thing. 40% of type 1’s are misdiagnosed as type 2’s at first. It’s still very common and medication and diet changes work at first because you still produce some insulin literally for many years if you are a LADA/type 1.

I am not saying you are a type 1, I just like to make sure people are informed because we are misdiagnosed so much. But if things don’t end up making sense, you could be a type 1 and not a type 2. I was misdiagnosed for over 8 years even though I asked if I could be a type 1 because I had an uncle that was a type 1. I was told no several times and never tested until I switched doctors. That turns out to be one of the common ways we are finally diagnosed right.

If you think you might be you will want an antibody test. If positive it is a sign of being a type 1. Some people test negative but don’t make insulin and they don’t know why. The next test is a C-peptide test. If it’s low or low normal it’s a sign of type 1, as you are losing the ability to make insulin as time goes on. If it’s high or high normal it’s a sign of type 2, because you are insulin resistant and you make more insulin to try to make up for it.

If you can afford it a CGM, a Libre will be the cheapest route if you self fund. It runs about $35 for a 14 day sensor and as long as you get the 14 day and not Libre2 there is a free ap you can add to most smartphones that you can use as a reader. It will give you a 24/7 reading of your blood sugars. You will still have to finger stick some as you have to check it’s accuracy. But it makes life a lot easier.

Most want a goal under 7.5% A1c at least. A lot aim for lower. Go for baby steps at first for one until you figure out what amount of insulin you even need.

7.5% A1c equals an average of a BG level at 136.

https://www.diabeteschart.org/mgmmol.html

Edited with some additional information.

7 Likes
7

I second the suggestion to obtain a CGM. It is highly unlikely that your diabetes is miraculously going to get better and the sooner you get your blood sugars under control, the better off you are going to be, i.e. avoid severe complications.

Check with your health insurance provider and see if they will pay for a CGM and supplies. Dexcom G6 is covered by many insurances. Libre is affordable if you have to go it alone (I bought one as a backup).

Lastly, you should have your doctor prescribe a fast-acting insulin like Novolog or Humalog. Lantus will cover your background basal needs (i.e. your “fasting” requirements) and the fast-acting is needed to cover your meals. You will need to learn how to count carbohydrates and then using a little math convert that into units of insulin required. After a while, you will be able to do this math in your head!

I was diagnosed as a type 2 in the early-90s. I have progressed from oral meds, adding nighttime Lantus, adding fast-acting insulin, using a CGM, and currently using a “smart” insulin pump (i.e. with a CGM and automatic adjustment of insulin).

3 Likes
8

I was never told what type of diabetes my mom’s dad had, and unsure if my mom or my mom’s mom will recall. He passed away from it I think though. At least that is what family said anyway.

My mistake, it was 11.2, not 11.5. My A1C before this recent one was 7.5 on Sept 2020. I just got my A1C checked/done this month due to how busy we were in December, and then had issues arise in our family.

Also all this high BG stuff just kinda happened, and so far I’ve been unable to check blood sugars with my One Touch Verio Flex cause insurance is being dumb about paying for the test strips… I can see about using Novolog or Humalog too, but my sugars never have extended beyond 500. I had to stop eating and drinking after midnight the day before surgery.

9

500 is very high. Don’t kid yourself into thinking you aren’t in serious condition.
If your sugars are over 170, you are overworking your kidneys, your arteries and heart.
An a1c above 7.0 is considered out of control diabetes.

There is a mixed insulin 70/30 I believe. If you don’t want to take more than one injection.
Your doctor really should work out a better schedule for you and teach you how to count carbs and all that.

I am type 1, I was hospitalized but the diabetic educator was on vacation. I watched the nurses give me injections. My doctor wrote a note my schedule. That was all the instruction I got.

Then I was on my own, I really wanted more education. I just learned on my own how to do everything and how to manage.
I was not very well controlled back then.
The only reason I kept as good control as I was , was because I felt sick when I was high, and dizzy when I was low.
Otherwise I wouldn’t have been as regular.

I hope you can take a diabetes class figure stuff out. Walking around with that much glucose in your blood is really bad for you. You want to be around a long time

4 Likes
10

The reason I asked this is because most doctors will give you a fasting glucose goal.

These are the instructions my doctor gave to me when he introduced me to insulin. Its been a while but I seem to remember my fasting blood glucose goal was between 100 and 125.

If my results were not within the set goals he instructed me to either raise or lower my daily total of long acting insulin (Lantus) by 2 units then make no change to the amount for 3 days. After three days if I still had not reached my goal I was to repeat the process, add or subtract 2 more units and wait three more days. I was to continue this process until I reached my goal. I was told to do before and after meal blood glucose checks to make sure I was not having highs or low during the day.

If you decide to take this approach you really should discuss it with your doctor first.

This is just the beginning process, there may be different adjustments as time goes by. You may find that you may have to split your daily dose in to two injections or if you are unable to achieve your goals with long acting insulin (Lantus) alone you may need fast acting insulin before meals and for corrections.

5 Likes
11

I am a t2 for 12 years my Aic goal is to be 6.0 or less.

1 Like
12

It is so important to constantly check your BG levels. Critical even when you start insulin. Maybe with the Lantus and such high numbers they will re-evaluate that?

If you have to self fund I think the cheapest route is getting a Relion meter and strips from Walmart. Maybe someone has better info on that.

2 Likes
13

I have a One Touch Verio Flex which has worked well for me. I am looking into a CGM and if my insurance would cover it etc.

1 Like
14

Your pharmacist might also be a good resource for you. Are you exercising ,watch how many carbs you eat? Keep good records. Good luck. Nancy50

15

No, but I cannot really exercise and walk super long due to low back pain. It makes it hard to move around and do stuff for me. I was told I need to watch how many carbs I eat though. Any medications like Gabapentin, etc just never really worked for me.

I have considered doing martial arts as a way to be physically active and try to walk more often.

16

I have a back issue and have found that using a recumbent exercise bike works great as long as the back of the seat has good support. Also swimming doesn’t bother my back.

1 Like
17

In the short term -

  1. 400 is too high. If your 400, then you are not managing your illness and you need additional help. 400 is not ok. I don’t want you running this high for more than a week or two. I don’t like this situation at all. If these highs came out of nowhere, then they are particularly dangerous. 200 is also too high for day to day.

  2. Check your blood sugar two or three times a day and write that down for us or the Doc or yourself.

  3. You need to go to Walmart and just spend $40 on a Relion BG machine and strips. That will cover you for a while and pull you through the immediate time period. If your on insulin, then you need to be taking blood sugars. Insulin is a hard core medication…especially because its new to you and because your sugars are uncontrolled.

QUESTION: How do you feel?

QUESTION: At what blood sugar number might you feel like you need to go to the hospital? That’s a question for the poster and the community?

QUESTION: Are we checking ketones?

5 Likes
18

How will you fix these highs?

1.) Schedule with the Doc and tell them that you need help changing your Lantus dosage because your numbers are high. Bring the blood sugar records with.

2.) They will fix this by increasing the Lantus dose (as mentioned by Gary) or by increasing the Lantus dose and adding a short term insulin that you take before you eat.

Tell them you have an a1c goal of 8. That’s still too high, but it brings you back into the world of the living.

2 Likes
19

@dogdemon Dustin, I’m sorry to hear that you are unable to deal with the gastric side effects of Metformin. Besides limiting the amount of glucose dumped by the liver it tends to increase insulin sensitivity. But if it keeps you on the toilet I can understand stopping it.

I was diagnosed T2DM in 1992 after a decade of good management with diet and exercise my blood glucose began rising again. That’s when I started Metformin. Later Lantus was added.

I too was started at 10u/day by slowly increasing the dosage 1 or 2 units with my doctor’s permission my fBG was under 100mg/dl. This worked until November/December of this year when my HbA1c jumped a full percent. I am now on a rapid insulin I take before meals along with Lantus and Metformin.

I am lucky that I have a Dexcom G6 constant glucose monitor. I can really see in near real time the effects of the insulin, food and exercise causing rises and falls of BG.

I am surprised that your doctor switched you to long insulin without any education. You should check your local hospitals if they have diabetes education classes.

A big tip on using insulin is to rotate your injection sites. Over use in one area causes localized scarring and fat deposits which will slow the absorption of the insulin.

I use syringe and vial but I am sure that the pens are much the same. If you touch the needle tip to a spot and feel pain move a centimeter or so away. I find that if I grit my teeth the pain can be tough. My thinking is that the needle is right on a pain nerve ending.

You will notice in the picture I posted the upper arms- which I do use but I probably don’t make full use of all the possible locations. I use a table edge or my knee to get a pinch. The buttocks would be great but when I tried it I bent the needle.

When using the abdomen site keep clear of the navel which is a natural scar site.

Testing is important, but strips are expensive. For years I have used a Metrix Go meter which is small and attaches on the strip vial. I buy my strips through Amazon for about 12 or 13 cents each. I cannot remember when I last used insurance provided meters and strips.

With the use of insulin testing becomes even more important. Hypoglycemia is much more likely when using insulin than orals and Metformin probably never causes hypos.

1 Like
20

Your bg and a1c are too high. I think you will need more lantus and a fast acting for meals. Keep a record of things for a while and discuss it with your doc, It will take a while to figure out what you need and it can vary depending on many factors.

2 Likes