Am trying to gather info to present. Right now, my understanding of using dextrose IV is minimal. Have to admit that I didn't have glucagon on hand when my low hit. I kept refilling the Rx & throwing glucagon out when it expired. It's expensive & doesn't last long & didn't get around to refilling it. If learning to safely inject IV isn't a problem, I want something that works instantly now that I've experienced a life-threatening low. Can't tuck a bag of dextrose in your pocket, but something helpful to keep at home.
Interesting about the Glucagon expiration issue. Just getting ready to buy some for the first time. May have to rethink it. It is expensive and if it's just going to have to be constantly replaced . . . now I'm really looking forward to the outcome of this discussion.
I don’t bother with Glucagon because you’re really not supposed to use it if you can take anything by mouth. I have heard of people self-injecting Glucagon, but that’s not something I see myself doing. My husband would never in a million years inject me, but he would call 911 immediately.
The only time I think that I would buy Glucagon would be if I went camping or on an international trip where I couldn’t count on rapid 911 service.
I used to buy Glucagon, but never used it and always threw it away. If you can’t count on having someone with you who will use it, it’s really a waste IMO.
Glad you’re doing better. It’s always scary when diabetes totally kicks your butt.
Gerri, two weeks on... how're you doing?
So sweet of you to ask. Am doing fine & have had no scary episodes, kocking loudly on wood. I've lowered daytime basal & am testing a lot. Thanks.
Gerry,
It's very good to know that you're doing well and haven't had any more nasty incidents. I know we were all anxiously hoping for that news.
I found something in Bernstein that is sort of interesting. From the description he gives, I'm sure this is not what happened to you -- he says the effect is very minor -- but it's interesting for closely related reasons:
"For Routine Use, Avoid Insulins That Contain Protamine . . .The one remaining intermediate-acting insulin, called NPH, is modified with an animal protein called protamine. Insulins that contain protamine may stimulate the immune system to make antibodies to insulin. These antibodies can temporarily bind to some of the insulin, rendering it inactive. Then, unpredictably, they can release the insulin at a time when it's not necessarily needed. This effect, though small, impairs the meticulous control of blood sugars that we seek."
Now, it sounds as though you would have to use huge doses of NPH to see an effect like this. But it begs the question, what other, similar -- undocumented! -- phenomena may be lurking somewhere else? The manufacturers and educators certainly do not tell us everything. They don't (for example) mention the fact that fast-acting analogs and long-acting basal insulins don't all have the same BG-lowering result. Some are significantly more powerful than others and that's not in the literature anywhere that I can see, except for Bernstein.
So you have to wonder, what other rare sporadic potential surprises might be out there? (FYI, I have just begun using insulin, so my interest is more than simply academic.)
Yep, that was my first thought,too, Natalie. I had concluded during my own bout with crazy numbers (plunging blood sugar hours after bolus) that it was an absorption thing. I think it is more likely with pumps, but certainly could happen with shots. Whenever I've felt a little knot under my skin I've rubbed it to encourage absorption, but that may just be D-superstition! (Anybody ever think how many things we pass along here may fit in that category?)
Interesting point that we may be uninformed regarding similar effects with other insulin. NPH was a nightmare for many. People had/have to eat on a very regular schedule & stories of NPH lows are infamous.
Very grateful I've had no repeats of my experiences, at least so far. I'd hate to go back to Lantus because I had terrible lows on it. I'm testing more than usual to catch any downward spirals. Has made me paranoid.
For reasons unrelated to our present discussion, Bernstein recommends avoiding Lantus and using Levemir instead anyway.
Yes, he does. I had a terrible time on Lantus. It peaks, for one thing, & isn't level. There's been allegations of a cancer connection. Weight gain has been linked to Lantus as well. Because it's acidic, it stings. Lantus also loses potency quickly. Yet, it appears to be the basal of choice with doctors. Their pharm reps must have shorter skirts.
I just saw a nurse/CDE and asked whether it made sense to change my backup insulin from Lantus to Levemir. She said that if I was on MDI they probably would switch me but for a backup pen she didn't think it was necessary. Maybe the tide is turning.
... and yes, doctors are still stuck on Lantus. I have had a couple of conversations where this surfaced. My boss is on a Lantus pen because that's what his doctor told him to use and he doesn't question it. He thinks I'm foolish for not using a pen, but I'm a precise control freak, like Bernstein. Probably because we both come from engineering backgrounds.
I used pens for a bit & didn't care for them. I had bad bruising. They're huge & more expensive. A vial & couple of syringes fit in my meter case. In hot weather, I use a Frio wallet.
Gerri --
I've not heard any of this stuff you bring up about Lantus (except the stinging, which is sorta obvious...). Can you point me at some documentation? I know I could do a google search, but I'd like to read what you've been reading, please.
I got onto Lantus five years or so ago precisely because NPH seemed to have some of the same exact issues you bring up about Lantus!
Thanks in advance,
/\/\
Michael,
In addition to the feedback you get from others in this community, read chapter 17, Important Information About Various Insulins, in Bernstein's book. Better still, read the whole book! :)
David
Hi Gerri, another late entry here. A few years ago, I started passing out a lot – I had never passed out before and all of a sudden I was passing out about every 10 days. I live alone so was pretty lucky that I woke back up every time. Even though I had been on my thyroid meds for years, the bottom kind of fell out and my thyroid was really out of whack. My TPO was over 3,000 at the time with a lab range of 0-9. I always suspected that my thyroid was the cause. After that started, I saw an interview Dr. B gave talking about inflammatory diseases (and Hashimotos is an inflammatory disease) and its effect on blood sugar – he confirmed what I suspected was going on with me. Once my thyroid leveled out, things came back to normal.
The other thought, I have noticed an inconsistency lately between boxes of Levemir. I just went thru a box that seemed super potent and the next box was box to normal.
Does everyone usually find Levemir inconsistent? I actually felt Lantus was more inconsistent in comparison to Levemir.
Hopefully they figure out your aunts problem. I am guessing she never bothered to check her BS when it happened.
I started using Levemir late 2007 and prior to this year, only ever had one problem with it before. I had 2 bad boxes from my pharmacy in Jan, then a box that seemed very potent. You couldn't pay me enough money to switch back to Lantus.
Hey Michael,
The news about a potential Lantus cancer connection hit the news several years ago. Yep, you can Google "Lantus Cancer." Lots on the web & on Tu about weight gain with Lantus. It's been referred to as Fat Lantus:) Afraid I didn't keep the sources--sorry. I had them when I was arguing with my doctor to change to Levemir. Doesn't matter what a patient reports as her experience. Docs read the pharm literature & are trained by pharm reps, unfortunately.
I think Holger posted a graph about Lantus peaks & valleys, if you want to contact him.
I had bad lows on Lantus. I lowered doses, used split doses (Lantus doesn't last 24 hours as claimed) & changed timing. Didn't make a difference. I still had lows during the day & morning highs. Others reported that Lantus wasn't level for them either. I also hated how Lantus lost potency quickly & I saw a decided potency drop by day 26. I use Levemir with no problem for 6-7 weeks. Cost saving for me for a superior basal because I never use a whole vial.
Great if you're not having issues after 5 years.