It is, in many respects. But with time and practice you will become a really skilled juggler. Trust me (and the thousands who have been down this road).
One caution, though: with basal insulin especially, rapid changes are problematical. For most people, it takes three or four days for a change in basal dosage to stabilize and give trustworthy results. Changes too close together will simply cause greater confusion. A change needs time to settle down and reveal the true outcome.
I think you have gotten very good advice here. The reason you were not able to post is that the settings on the site âthrottleâ new users as a way of reducing âspam.â And while it works, it can be a hassle. Quickly, once you have over time read and posted and been on the site all those limits are gone. A spammer will come onto the site and immediately try to spam.
As to your questions. I am T2 and started insulin in 2010. I started with NPH and Regular. Your âMixâ is similar, it is Humalog protomine and Humalog. You generally start at a modest dose (as you did) and then increase the dosing until you see an effect. That would either be a lowering of your fasting blood sugars to a target range or a restoration of your after meal blood sugars at 2 hours to a target range. Unfortunately with a mix you canât generally reach both fasting and after meal targets.
This is why I chose to start back in 2010 with separate doses of NPH and Regular. The disadvantage is that I had to use vials and syringes. And this will be a trade-off. You were likely started on the mix because it is available with a pen, you could do just 2 or 3 injections a day and it is simple. But it is just not capable of being finely tuned to what you will need. Eventually you will want an upgrade.
And I would echo what @David_dns has said. You should record your results over a couple of days and then make a change to dosing. And a conservative approach is to change by 5%, maybe 10% each time. It is important to understand that the insulin will have no effect until you reach what is called a physiological dose. Your external insulin is to a certain degree âoffsettingâ your remaining insulin and will only have a visible effect once you reach that physiological dose. Once you reach that dose you will likely see a clear lowering of your blood sugar. So donât take big jumps in dosing because once you reach that point you do not want a bad hypo (low blood sugar). So I would encourage you to be conservative and check in with your educator and doctor regularly until you are stable.
Thanks so much Brian! I really do appreciate the in depth feedback. I really hate being hyperglycemic all the time and I must admit that I am truly grateful for not requiring the ER! I am waiting on call from my GP later today and hope that all goes well.
One last thing . . . weâre sorry you had to become a member of The Club No One Asks To Join, but weâre very glad you found us. Youâve come to the right placeâwelcome to the family!
Please stay in touch and let us know how youâre doing.
Hi All
Quick updateâŚ
I chatted with my GP and he asked me to stop increasing my dosage until Thursday this week.
I am on 45 units now and had a very low carb day yesterday and my readings were as follows:
You are doing great. You see to have reach the point where the insulin is working. This likely means that the further adjustments will need to be smaller and you will have to wait several days to see how things work out. But this is really good news, donât you think?
That may take longer. Fortunately we live in a time when the psychological toll is becoming recognized as just as real and important as the physical issues. Look up the work of William Polonsky, among others.
Iâm glad you checked that out. Yes itâs 75% longer acting insulin, which is acting as your basal insulin. The 25% fast acting covers your meals. As a Type I from the Stone Age, I was on a 70/30 mix twice a day. In my unprofessional opinion, maybe you and your GP can sit down with your readings and formulate a plan on when and how to increase your insulin and how long to wait until you increase it again.
I am now up to 50 units of Humalog 75/25 - is that a lot in the grand scheme of things?
I donât seem to drop below 9mmol\L (even with fasting)âŚ
âYour body size or fat-to-muscle ratio can also make quite a difference. For a larger-than-average person, 1 unit of insulin may only cover 8 to 9 grams of carbohydrate.â
Maybe it is due to the fact that I am defintely âlarger than averageâ?
50 is not terribly high or terribly low, itâs somewhere on the bell curve. Be aware that your insulin needs may vary over time, in either direction, depending on the other steps you are taking such as diet, exercise, other meds, etc., as well as other factors in your life (stress, illness, etc.). It isnât a test; there is no ârightâ dosage, except the one that is right for you.
As several have already said, the right amount is what works for you. My Dr started me on 27-33 units/per day (which seems to be a common starting point). I saw marginal improvement on an 11% A1C until I was taking over 200 units/day of a basal and fast acting insulin. Took a few years to ramp up. Too long in retrospect and it was very discouraging until I read in âDiabetes Self Managementâ (this was 15 yrs ago) about more concentrated insulin. Found an Endo who would prescribe it. The upside is that after getting enough of a better insulin for me, Iâm back down to about 100 units/day and have very good control. So Iâm to right of that bell curve that David_dns mentions. You will find your spot too. I also had to stop being the âQueen of De Nileâ about carb counting. There is no short cut on that.
Do record your carbs, doses, and BG carefully. You will learn which foods are best for you. Carb counting does become second nature after awhile and you will feel better. Be your own advocate and bug your Dr or change Drs if you must until you see results. The fact that you are actively trying to learn all you can is your best indicator of future success!! And take advantage of a CDE if you can. They can help you personalize your action plan.