Just wondering

so I went to a new doctor about 2 weeks ago and he changed my insulin rx. I was on novolin n twice a day and novolog 70/30 three times a day. now I am on levemir twice a day and novolog 70/30 three times a day. well, since he changed the rx I started doing some research and everything I have read says not to take novolog 70/30 with any other insulin... I am new to this and am wondering if he made a mistake that I should bring up now or just wait till my appt. next month.... and what will happen, if anything, by taking this rx? he also lowered my doses.... and my BG are still in the mid to high 200's.... he says he will work this out and adjust my dosage a little every month until I am in normal range....is it normal for a dr. to adjust that way and not by carb ratio and all that?

This treatment is quite out of date. 70/30 is a mix of slow and fast acting insulin and so shouldn't need to be combined with another insulin. It is also not very predictable of effective and you can't use it for corrections which is an important function of fast acting insulin. I would suggest getting on a combination of long acting and rapid insulin such as levemir plus novolog. I would also suggest another doctor or better yet an endo. Finally, I recommend the book Using Insulin by John Walsh so you can learn more about managing your own insulin dosing. "adjusting a dosage a little every month" when you are in the mid to high 200s just wouldn't be ok with me!

Sounds like it should have been Levemir and Novolin. I would definitely question him, because that sounds like a big mistake. I've never heard of the combination you described.

that is what I thought.... I mean some people tell me that you don't have to count carbs so much when you are type 2 and that your insulin is usually a set dose instead of dosing according to the carb count.... but I am just learning....
I am still wondering will this rx hurt me? I mean I understand my BG can drop but I don't think it is going to go too low considering how high it is now... I mean they have lowered A LOT.... from an average of 366 to the 200s.... the only time they are even close to normal is when I exercise strenuously or walk over 5 miles.... my last A1c was 13.4.... I know TERRIBLE.... I have completely cut out sugar and try not to eat starchy foods and am trying to count carbs.... which is difficult with 2 children to cook for.... I find myself "testing" their food....

I agree with Zoe and Alan. I think you should be on novolog not the 70/30. Call him and tell him you want to try that instead so you can bolus for your meals and do corrections- hopefully he will listen, if not find someone who will. Most doctors really have no clue about good diabetes treatments. You will want to go to an endo who is knowledgeable if you haven't yet. For the carb ratio, you do a specific amount of fast acting insulin per carbs, i.e. : 1 unit novolog for anywhere from 5-30 g of carb. This is very variable for each person so you have to try and see what happens for you. I'm very carb sensitive. When I was in the hospital I ate 2 saltine crackers to treat a hypo in the 50's and I spiked to 170 in 1/2 hour or so! You have to closely watch your carbs at first, count them, measure things out and then it gets easier if you eat pretty much the same thing all the time. Exercise is really important too, walking is great, housework. shopping works for me too to lower my bg too.

Make sure to test 2 hours after meals so you can correct if you go too high. But you don't want to take too much insulin- usually 3 hours between doses is recommended for the fast acting unless you're doing a smaller correction or you're super high & need more for some reason. Another thing you can do is drink tons of water too. This will bring the sugar out in your urine and lower your bg.

I would not wait months to bring down 200 bg ranges, you need to get it down sooner, not a little each month.

I don't know if you're responding to me Samantha, I'm type 1- I don't know a lot about type 2 treatment, but controlling your carbs is really important for both types. The amount is going to vary a lot for each person no matter the type. I was at 13% at my diagnosis and in dka. I have gotten my a1c down to 5.7 and lower with a low carb diet and insulin/exercise and now symlin which helps control the hunger I feel being on insulin. You can also use metformin to help. Some people who are type 2 can lower and stop insulin after they stabilize and get their bg down from higher levels but most need to stay on insulin once they're on it I think. This varies a lot too. I would say go as low carb as you can and ask your family to help you with this. I know how hard this can be, but this your life that is at stake here so it is really important. I don't know what will happen in terms of hypos for you because if you have insulin resistance as a lot of type 2s do things can be different in terms of how insulin affects you but I think you will still have to deal with hypos once you get down to a more normal range. You will feel the symptoms and then you just take as little glucose as possible to bring yourself back up. You may need a much higher dose of insulin too, it's all trial and error because everyone is different.The most important thing is not to get discouraged and to get to a normal range and keep yourself there as much as possible.

I also don't know what will happen if you take 70/30 with levemir. I would just call the doctor and ask to switch to novolog instead and just eat no carbs till then probably.

that is great that you have improved alot and you're cutting out sugar and starchy things.. I had to stop eating breads, starchy veggies etc. but I can still eat unsweetened yogurt and berries.

I’ve seen cases where the Dr prescribed Novolog but the pharmacy dispensed Novolog Mix 70/30 also. They’re very different insulins so it’s important to double check you’re both on the same page.

they gave me the right insulin.... my doctor told me what I was going to be taking I just don't know enough about insulin to know what questions to ask right away... I didn't know it wasn't "normal" to prescribe them together.... I am just learning the difference between insulin types and what they are used for... I do a lot of research online about how to dose and things like that.... I live in a small town and even the doctors aren't really educated in diabetes.... I don't have a diabetes care team.... the closest to that I got was a picture of what your plate should look like at dinner and my doctor telling me to test and bring in the numbers.... it didn't matter about food he would adjust doses as we go along.... LOL.... even typing this makes me think GEE ITS A DEATH SENTENCE!!!! but that is why I am here and doing some research online... to possibly get the answers I can't get there :)

Yep, I understand about the doctor's not being educated. I have learned most of what I know here and from reading books like Using Insulin by John Walsh. I would ask him to prescribe Novolog and Levemir - forget the 70/30 stuff. Then start working on figuring out your I:C ratios, basal dose and ISF (correction). It sounds like a lot to learn, and it is, but you sound like you enjoy learning and researching and one step at a time you will get there. But like the others I encourage you to start by getting the most up to date insulin. You can't learn to build a house if you don't have the right tools!

samantha, i agree with zoe and the others that you should get off that 70/30 and start on basal-bolus levemir-novo.waiting a month to change them is way too long, many people make daily or weekly changes becuase of changes in diet, activity levels, illness, alcohol consumption and the dreaded diabetes gremlins (when seemingly nothing has changed, just that the D gets bored with everything going too well). they are usually small changes, done one at a time, to observe any fluctuations they cause.
my endinosaur also does not know what shes talking about and i found the info i needed here and in the book that was mentioned and in scheiners "think like a páncreas". i had never faced such ignorance in the medical community until i developed t1. its very scary at first to know that you are going to have to know more than your doctors. however, i have come to see it as a liberation, and the people on tuD have been an invaluable source of information and inspiration to help me live well with diabetes.
good luck and i hope you can find an endo that is up to date on treatment!

Well, I know you have been advised to move to a more "modern" regime with Levemir and Novolog, but I'd also like to note that you are making a transition. You had previously been on what is called "conventional insulin therapy" which as others have noted went away with the use of bloodletting. The nice thing about conventional therapy is that the doses are fixed. Today, the standard of care is "intensive insulin therapy" which is a basal/bolus regime where you take a fixed dose of long acting insulin (like Levemir) and then adjust your mealtime rapid insulin (like Novolog) to handle your meal. But in order to do this you need to count your carbs. And I have to ask, do you know how to count carbs? If not, then it would be vital to reach out to a nearby diabetes educated or diabetes center (with doctor referral) and take a class on carb counting. You can't really dose your rapid mealtime insulin without counting carbs. In fact a big problem with conventional therapy is that most patients are required to eat the right amount of carbs for their meal but either can't or don't count and the result is blood sugar swings and poor blood sugar control.

The second thing I'd like to mention is that your use of conventional therapy and fixed doses has not worked. You have not had well controlled blood sugars and it has harmed you, that is why complications such as numbness have started. And it is wise to move you slowly towards normalized blood sugars as sudden drops can also cause problems. This may in fact be why your doctor is moving in steps to bring your blood sugar down to normal levels. These complications can likely all be stopped and even reversed with good blood sugar control, but that will take a lot of work.

So as you are aware (even more so now), these high blood sugars are really, really serious. Big time. The good news is that you can turn things around, but it isn't going to necessarily be easy. This community can help you, but it will still be up to you to ask the right questions, make good decisions and act decisively on those decisions. We have faith in you.

thanks for all the advice. and no I don't know how to count carbs. I mean I can tell you how many carbs I eat but I don't know if they are the right carbs or not... and I am not good at eating the same foods everyday.... I love to cook and I like to try new things and have something different everyday. I do have an appt. though.... the earliest they could fit me in was 2 weeks. I guess that will have to do.... my bg is coming down though.... my fasting was 175 this morning and 2 hrs ofter breakfast it was 194.... usually it is 200+ in the morning and 300+ after meals... this is the first morning they have EVER been that low...
I have been looking for an education course somewhere near me but I live very far in the country and the nearest town doesn't even have a red light.... good doctors and specialists are hard to find....

Another good reason to get on modern insulins, learn to carb count and figure out your I:C. I too like to cook and eat different things, especially at dinner. With those tools you can do that and still have good blood glucose.

This does not make any sense. How did he/she explain the rationale for this management?

This is right on! The doctors, including endocrinologist and "diabetologists", really are not very helpful for specific problem management of diabetes. The best you can expect is "general" management advice and prescriptions. We - the patients with diabetes - should be in charge of our BG destiny. All else is doomed to fail.

You are on the right track! I would suggest that you proceed gently as normal BG would feel like "low" for you at this time. You are used to high BG levels and normal will be felt by your body as a "low". You best to lower your BG gradually. Best of luck to you!

Dosing mealtime insulin (fast acting like Novolog) according to an I:C ratio is by far the most effective way, whether you are Type 1 or Type 2. Unfortunately, doctors tend imho to give Type 2's short shrift by giving them "set doses" or "sliding scales" primarily because they don't think they will "comply". Sad. I know it sounds complicated but it gets easier. If you use lots of different recipes like I do you can look up the carb counts the first time you make a recipe and then write the carb count in your cookbook. There are lots of places to get carb count lists: books, online and apps. Calorieking.com is one good one. After awhile you will know some things by heart. Like for vegies I always count 5 grams for 1/2 cup cooked and 5 for 1 cup raw. I know my salad bowls hold two cups, so unless I put something higher carb like croutons or corn in my salad I know a salad is always 10 grams. Etc.

I hear a lot of people say that normal will feel hypo when you have been at high ranges.. and although I think it is good to not lower to quickly, when I was in dka and put on iv insulin and my bg lowered rapidly, and then bounced all over the place, I don't remember feeling anything. I was at 40 at one point, but I was worried I was going to go into a coma- the nurse told me don't worry I have the magic bullet which was a huge syringe of glucose which then brought me up to 240 or so, but I didn't notice a difference then between 40 and 240 that I remember which is odd. After dka, I just felt more normal in the 80s' to 90s, more normal than I had felt in a while, I was probably at 200's to 300's for 2-3 months prior to that. I have read now the recommended dka treatment is to keep you at 200 range for a few hours and then start to lower more so that the acidosis will resolve more quickly.

Hi Samantha, I'm also T2 and on insulin. My treatment before I started with an insulin pump was what others have suggested. I used Levemir as a long acting basal insulin and Novolog to counteract the carbs I eat at each meal.

Basal insulin's such as Levemir provide a slow steady supply of insulin to cover the glucose that is released by your liver throughout the day to maintain basic body functions. Rapid acting bolus insulin's such as Novolog are used to counteract the glucose that comes from the carbs we eat. This method is call MDI (Multiple Daily Injection)

70/30 is a mix of Levemir and Novolog and is a one size fits all method. Unfortunately every persons diabetes is different. I really have no idea where your doctor is going with the combination he has prescribed to you.

The key to control is to be able to adjust the amounts of insulin you take. With basal/bolus MDI you can tailor the amounts to your needs. There are methods for determining these amounts and ratios. The key is to determine each insulin need separately.

I mention in the beginning that I now use an insulin pump. The main difference with a pump is the delivery method. A pump is designed to give a small amount of rapid insulin slowly throughout the day to cover basal needs and to also deliver a larger bolus amount of the same rapid insulin to cover you carbs at meals. The principle is the same as with MDI.

You said in one of your post that you already know how many carbs are in the food that you eat. That skill is very important to your success if you are going to start a basal/bolus treatment plan.

thank you all for the information and the advice.... I am writing down A LOT of questions to ask my doctor at my appt. my bg has pretty much leveled out at 190 in the AM and stays around 240-260 during the day..... and then before bed it is in the 190s..... I guess it lowers at night cuz I exercise late in the afternoon.... I don't know maybe my doc has a plan but he really needs to let me in on it....