Hi all,
I wanted to see if anyone had suggestions on MDI.
I won’t be using my pump for a while. Months or maybe longer, who knows?
I have done MDI almost my whole life, so I can jump back into it without any troubles, but wanted so see if there are any suggestions anyone had.
One of the things I liked about the pump was being able to look at your bolus amounts & times easily. I know there is a thing they are working on for pens that automatically records your bolus amount and time and uploads it to your phone. It’s built into the pen! It’s called InPen, by Companion Medical. But of course, any great idea has to be slowed down by the FDA!
So since this is not available yet, what is the best way to track dosing? Any suggestions? I will be taking a lot of shots during the day (over 10), so this recording process kinda sucks for me. Any suggestions on something that is easy? I don’t need carb stuff or bolus suggestions. I just want to record how much insulin I took and when. What is the best way to record that? Some phone app maybe?
I need more basal at night. There just isn’t any way around that. In the past I have had good results using NPH to cover the higher nighttime basal needs, but was wondering if there is an alternative. Any suggestions? I don’t think regular would last long enough.
What is the SMALLEST pen available? I have used the Humalog Kwikpen because it is small, and I’ve also used the Humalog Luxura HD pen. Is the novo pen better, smaller?
Can novo pens be refilled with whatever you want to put in there? I like that the Humalog pens can be refilled in an unauthorized way (it’s cheaper to get vials and refill the pens, instead of getting the pen cartridges).
Anything else I am missing? Please share any MDI ideas, thoughts, or opinions you have!
This probably isn’t going to be much help, but for the sake of due diligence here’s my answer.
I started keeping a hard copy log using a form I designed, clear back when I started insulin a few years ago. I’ve been doing it for so long that it’s just automatic second nature now. But I’m pretty sure that’s not where you want to go.
There are apps that can track this kind of thing. I don’t use any of them so I’m not the person to ask. But they’re out there. Hopefully others experienced with them will chime in here.
As for the pen questions, I still use syringes so I can’t help much there either. My syringes have half-unit markings, so it’s no great trick to dose to within ¼ unit with just a minimum of practice.
I keep a pocket notebook and a tiny pencil for logging. Really helps with those “how many units did I take?” and “why is my BG rising/falling?” questions. The Dexcom G5 also features easy logging of both bolus and carbs on iPhone although I find it a little inconvenient to put on my reading glasses to look back at doses logged earlier in day.
For the basal question and night BG control, I tried everything I could think of with Lantus but never found a good solution. I switched to Tresiba (thanks, TuD community!) 1 month ago and have had great success so far after tweaking the basal dose for a few weeks.
I tried Tresiba for almost 2 weeks. I like it, but the problem I have with it is that I have variable basal requirement from one day to the next, based on physical activity. It’s easier to bump up or down with Lantus.
Do you find your nighttime is easier with Tresiba compared to Lantus?
I actually struggled trying to get more insulin overnight. Neither NPH or Levemir actually was a perfect solution. However Tresiba has given me the flattest overnight cover ever. Bernstein suggests that this is because insulin clearance is increased overnight and most insulins (even Lantus) have trouble sustaining levels. He says that Tresiba simply lasts consistently through the insulin clearance and that is why many people have better experiences.
Yes, for me the difference is night and day. I also have big variations in daily activities. One day drenched in sweat for hours on end and the next day “working” (staring at a computer). For me, I dialed in my Tresiba basal for the active days and adjust bolus/carbs and use corrections on bolus on the slouch days. Seems to work as long as I am at 110-120 at bedtime. Took a few weeks of tweaking the basal (i take in AM) to find a sweet spot.
When I tried this with Lantus I kept bouncing between 3AM lows or 150+ BG all night.
Thanks guys! I will work some more with the Tresiba. I have plenty left.
But so far, when I used Tresiba alone with no NPH at night, I was through the roof. There was just no way to get the balance between having no nighttime highs, and no daytime lows. But I may find a dose that lets me still supplement with NPH, but with more stability.
I have to work on this some. That is still the big advantage to me with Lantus - every day you start with a “clean slate”!
Our project www.glucosurfer.org offers a bolus wizard and will estimate the insulin on board. The calculation of the iob is very different from pumps because pumps actually keep track of the reservoir. Therefore they know exactly how many units are left. Still I would say that we come close to the pump experience. I would recommend to create the user account on the web site. Then enter your account data into our Glucosurfer app. Did I mention that our service can be used in full anonymity and is free to use - donations are welcome
I also found it very helpful to use half unit pens like the Novo Echo. This pen will also remember the last injection.
For the basal I am a huge fan of Levemir. But as we all know this means two injections per day to have a more evenly distributed activity profile.
I adjusted Tresiba basal every 4 days when I was getting started…be patient. Because of the long tail on Tresiba I did not think more frequent adjustments would do me any good.
First 2 weeks when my basal was too low my night BG was usually high, I was correcting many times during day and night, etc. I started a little low on the dosage because of the unknowns and not wanting to go low on super active days and adjusted upward until all was well.
I like that memory feature. That looks helpful. Is that available in the U.S.? For some reason I thought it was not available here
From a release perspective, Levemir and Lantus are essentially the same, right? Any big advantage for one over the other? Or is it akin to Humalog vs NovoLog?
Actually Lantus and Levemir are quite different beasts.
Lantus claims to cover 24 hours but in reality these are 22 to 23 hours at maximum. The gap in coverage must be covered by bolus insulin. Usually this shows with much lower “Carbs per Insulin” coverage around the injection time of the Lantus. Also a higher sentivity to carbs and a higher likelyhood of higher BG numbers around the injection time. To improve the coverage you can split the dosage and inject two times per day. The problem with this approach might be that two 22 hour dosages are now extremely overlapping. This can cause something best described as a turbulence pattern which I have experienced myself. This made the split approach very unreliable for me. Lantus binds to fatty tissue and this binding is dissolved very evenly. The problem is that people can inject at locations with less fatty tissue than normal or they might hit a blood vessel. In this situation the Lantus will not bind effectively to the tissue. As a result the Lantus can dissolve at a rapid rate into the blood stream causing a massive low.
Levemir on the other hand does only last for more than 12 hours with a huge dosage. The bigger the dosage the more uneven the activity pattern of Levemir. An even activity pattern can only be reached with two smaller injections every 12 hours. Therefore in Germany Levemir is recommended to be injected twice per day. This might sound less convenient but the better coverage is worth it. Levemir binds to albumin of the red blood cells so its release rate does not depend on the location of the injection. Even directly injected into the blood stream the albumin binding prevents that Levemir dissolves at a rapid rate.
Please ask your Endo about test vials of these basal insulins to experience the differences first hand. Because the basal coverage is fundamental for good glucose control all these effords are really worth it.
Been on MDI&P for a couple months now after 15 years of pumping. Very much enjoying not having a pump attached to me.
Have you seen the NovoPen Echo? That’s what I use and like it a lot. It’s simple and shows your latest bolus and how long ago it was taken. I used Novolog in the Echo.
A simple piece of advise is to have a wristwatch with a “dive timer”. These are pretty much standard on most men’s watches… any watch with a rotating bezel on it that you can zero when you take a bolus… then the minute hand of your watch acts like a timer… I use this every day and I’d be lost without it. Just turn the dial timer to zero when You bolus and you’ve got yourself a timer… works flawlessly
Your idea made me think of something else too. You can screen-shot your phone, and you can even do that when it’s locked. Then you could go back in your photos later and review them, and the time of the screen-shot would be visible.
EDIT:
The trick would be to figure out an easy way to get a dose amount into the screenshot easily…
The mysugr app if you have an Iphone works very well. I have a one touch verio that has bluetooth as well that you can set up to automatically record your BG’s into it. I use mysugr to record my lantus, boluses, carbs, activity, food and my endo really likes the reports it generates.
To me, it’s always easiest to change one thing at a time and examining it’s effect rather than changing a lot of things at the same time.
I started with working a bit on splitting up my NPH doses at night. The idea is to make the release curve a bit flatter. This is something I have done before, but the past week I tried different percentages of the two doses, and trying different times. I think I have it pretty good. I ended up splitting them evenly, 50%-50%, and doing them 3 hours apart.
I stayed between 65 and 120 twice with this mix. I like it. No spike in the middle of the night, and no high when I woke up.
Nobody should worry about this old man doing MDI.
So next I have a few different things to try from the recommendations. Splitting Lantus doses, spending more time investigating Tresiba, and also trying to get a Levemir sample. All based on the wonderful information shared here.
I am excited about the privilege of getting to explore these various treatment options.
I am always grateful of how people here are helpful to one another. Helping each other is what makes this such a great community. That’s what we do, we help each other. Helping someone is the best thing anybody can do. Thanks, and I sincerely always want to try my best to help others as well.
I could post a well known picture of a dive watch with a 1911 in order to showcase the dive watch and it’s benefit to bolus timing and it could reduce you to tears
