New to insulin

Type 2
1

I was diagnosed diabetic over 25yrs ago. I never really worried about my glucose over the years, just did Adkins and had good A1Cs most of the time. Finally, about 5 years ago, I had to go onto metformin to help me control the glucose levels. Then, last winter I became ill with the flu, and was put on dexamethasone for wheezing. Since then my sugars sky-rocketed to 450-550+. I finally decided to ask my doctor to put me on insulin because I was throwing up so much, and my eyes were so blurry so often. Plus I had constant fungus issues on my body, and repeated UIs due to sugar in the urine. In May my A1C was 8.8 for the first time. It was just time to go onto insulin to help me control sugar levels a bit.

Then, suddenly, my doctor was dismissed from the clinic, so I have no doctor. I'm on Lantus, and she wanted me on 36u every night. I honestly don't do that much. I am really afraid of insulin because one of my friends died from insulin-induced hypoglycemia a couple of years ago. Anyway, I am using 10-12u of Lantus, and my morning readings are running 170-200 most days. It is still high, but not 350 or more. I'm happy with it at this point.

On the other hand, my husband became insulin dependent diabetic recently after a bout of pancreatitis. His sugars are still running really high even though he is on Lantus and humalog. I mean really high, like 350 or 400. They just keep giving him more and more insulin every couple of hours to try to keep it down, but it shoots back up so easily. I really believe Janumet caused his problems, but I can't prove it, of course. And he has complications like wounds on his legs that don't heal, constant retching and vomiting, inflamed pancreas, etc. I don't know why he has so many more issues than I ever had. He has only been diabetic for a couple of years.

I hope to learn from all of you. Are you afraid of your insulin? I know when my friend died it made me really fearful of the drug.
Do you have complications? And why do some people do ok for dozens of years, but others have bad issues so soon after diagnosis? Do you use Pens or vials? I love the pens, but they do cost more. And how many times do you really use your pen needles or other needles. I know they say once, but many people seem to use them again and again.
Do you really throw away your pens after 28 days? I haven't. Mine is about 32 days old now, and I'm going to use it until it is empty. It costs too much to just toss in my opinion. But that is just my opinion. I just have questions, and there is just so much I am curious about. Thank you for all your input.

2

Hello Mekamom,

I would find a good doctor and educator asap who can help you to better use the insulin to get lower bg. Those are bad fasting numbers. I'm really sorry about your friend.

I'm type 1 diagnosed last year in dka. I am cautious with insulin because people do die from hypos. They also die from high bg and complications too, so you need to better control your bg. I'm not sure about hypo events statistics between the types on this point- but this article says that type 2 seem to have less hypo events overall. Usually they say not to bolus a fast acting insulin more than every three hours when it wears off.. depends on your insulin. It's also recommended to go to sleep with a certain bg around 90-100, and to have a snack when taking basal insulin if it's at night. Exercise and other things need to be monitored also when on insulin.

http://clinical.diabetesjournals.org/content/24/3/115.full

I'm not sure why your husband is so much worse, maybe due to the pancreatitis kicking things off. It's really hard to say, diabetes is very complicated and it hits each person differently. I hope you can get him to a doctor who can get him some help.

I use pens and syringes and I re-use them now. A few times until it hurts usually then I know the needle is dull. It's just too time consuming to change them each time and I have had no problems with infection. I keep my pens in frios, all year round, and in the fridge and I never throw any insulin out now.

For hypos I have glucose tabs/candy all over the place, in the car, in my purse etc. as well as juice and glucose drinks since the liquid works better for me. you should also have a glucagon kit and and id.

3

I have a healthy respect for insulin but I do not fear it. I fear the complications of high blood glucose much more.

Your profile does not say which type diabetes you have but it sounds like you and your husband are T2. I'm also T2 and find that I can control my bg with insulin. Anyone taking insulin can experience low bg but with the proper training they can usually be limited in severity. I strongly recommend that you see an endocrinologist. I would never trust a regular doctor to administer insulin treatment. Regular doctors are usually not well trained in insulin use.

I use an insulin pump now but before I was using both fast and long action insulins like your husband. The key is to know how many carbs are in the food you eat and adjust your insulin dose to match.

meee is right your fasting levels are too high and your husbands are definitely too high. You are at a much higher risk of dying of complications than you are from hypoglycemia.

I would suggest that you run not walk to your nearest endocrinologist and seek out the education required to safely use insulin. You will both feel much better for it.

4

horning in:

I am T2 and have been for 30 plus years. I used to use starlix/glyburide and now insulin.

Insulin far better and wish I had done sooner. One has way better control and ability to diet and manage without having to keep the oral pills fed to prevent lows. In addition as mention one can adjust the basil insulin using slow insulin like lantus and its versions from other manufacturers. For meal bolus; I use a fast acting insulin like humalog lispro that has a 4 hour reach and find straighforwrad to easily manage.

I really do not like the long acting mixes like 75/25 or 70/30 that have a 12 hour reach and I find hard to manage.

5

My 2 cents here:

Are you afraid of your insulin?

Actually I was diagnosed at 8 yo with T1. For that reason it's like insulin is one of my best friends. As one it deserves attention and respect (as Stemwinder said).
And why do some people do ok for dozens of years, but others have bad issues so soon after diagnosis?

I second what meee said here. Everybody has its own D. In my opinion we just have to do our best in keeping stable BG without worrying too much. Difficult to manage but we should smile not only as much as non D but much much mooooore.
Do you use Pens or vials?

Use pens with 1/2 unit (Lilly Luxura HD) cause they are really handy. If I wasn't going abroad for a few months I'd try injections (at home). Will do that when I get back!
And how many times do you really use your pen needles or other needles. I know they say once, but many people seem to use them again and again.

I use needles twice and throw them. Works pretty well in balancing dullness and usage.
Do you really throw away your pens after 28 days?

I'd say insulin lasts more than 28 days if well kept.

Mekamom, as others before me suggested, find a doctor and try to get your BG in a tighter range. I myself thought it was nearly impossible get A1C in the "normal" range. After some theory and having seen people here doing miracles now I joined the club (and improving day by day).

If you want to read some stuff I would suggest two books:
- Think Like a Pancreas
- Diabetes Solution

The former was the first book I've read. The latter was life changing, even though I'm not 100% following his method. Also, you can read some chapters here
I would read them in the same order as mine ;)

Best of luck. And abuse of TU when needed!

6

Hello, I myself am type 2 on oral medication. However, My father-in-law is type two and recently put on 70/30 insulin. We are having a hard time with his sugars. At first the hospital started him on 5units tid. But his sugars are still over 500. So, we have increased him up to 20units three times a day. This morning his sugar was 148. So, he took 20units of insulin and two hours later his sugar is 300. We are not well versed in insulin usage and the doctors at the Military hospital are horrible here. I keep telling him he also needs regular insulin to correct the high and use a sliding scale. His diet is not bad he eats three times a day and we have been keeping added sugars away from him. He just had his major toe amputated due to diabetic foot with gangrene in it. His foot will probably be amputated in my opinion. I can not express enough to his family to get his sugar under control so the foot will start to heal. So, I am here to learn from everyone like you. Insulin can be scary but in my personally opinion these high blood sugars that are not controllable are far worse.

7

Really sorry to hear that jenn.
I would suggest to find a good doctor and switch to an intensive insulinotherapy instead of the (bad) conventional one.
Also, to correct high BS it's better to use a rapid analog which is faster than rapid (regular) insulin.

Stick on TU and you will see amazing results. Plenty of inspiring people here!

8

As rick said, you can often get better control by using a basal (long acting) insulin to bring your blood sugar between meals in to normal range and then a rapid insulin to handle the blood sugar surge from meals. You may find that you have limited choices with insulin, either a mix as you have now or NPH and Regular (R). Using NPH/R will give you more flexibility.

But it is also important to get your diet in order. It is more than just avoiding sugar, it is about restricting carbohydrates. Carbohydrates are all around us, in bread, rice, potatoes, corn, legumes, etc. A simple diet of meat, seafood, dairy and non-starchy vegetables (like green veggies) can be a good way to start out.

9

for some 70/30 works but i have used 75/25 and found I hate. The long reach is a right pain. Taking a 4 hour reach fast insulin like humalog lispro or equivalent is far easier to manage and one can make changes every 4 hours to suit, That long acting stuff hangs around and nails ones butt should there be a glucose fall off from gut when one least expects it making a nightmare and bad lows.

10

I agree with the others. Using the mixed 70/30 insulin may save you one or two injections a day, but using two separate insulins (rapid acting to cover meals, and basal to cover the background needs) will give you far greater control than you will achieve with a premix.

You will also need to learn about carbs. Is there a dietitian/nutritionist near you? I HIGHLY recommend seeing one. They will be able to help you find the hidden carbs/sugars in foods that you might think are ok or even healthy (like muesli, fruit juice and peas) and make informed decisions about what to eat.

11

Thanks for the reply. It is unfortunate where I live they have limited options for diabetics. Also, the doctor at the hospital told my father-in-law to take the 70/30 twice a day at 5 units before each meal. I have adjusted it to where he is taking 20twice a day. I have not seen any sugars 500 the highest was 300 in the morning. Yesterday evening he was 88 before his meal. He is 68 and so set in his ways. I have tried to explain to him the importance of counting carbs and making sure he is not drinking a huge glass of milk or eating so potatoes and things he does not realize break down quicker and spike the sugar. He has a lot of complications with his leg. He is ischemic and has had two blood clots in the one leg in the last two years. I have been doing his wound care on his foot for the last two years. I had to fight with the doctors to put him on insulin. It is a very frustration situation for me. I am American and I live in Jordan. My Arabic is weak to say the least. The hospitals and doctors here are horrible. It is like a nightmare for someone who is sick. The hospitals and doctors will not give pain medications only thing they give is anti-inflammatory drugs. He was in the hospital last week his sugar was 560, they came in gave him 20units of the 70/30 and did not even come back and check his blood sugar till the morning. That is my main point of coming to this board. I am trying to learn about insulin and help him get his sugars under control so he does not lose his toe or his life. There are not many dietitians here who deal with diabetes, our main problem with him is him being compliant with his diet. I appreciate any and all help.

12

It sounds like a nightmare there :( I would read Dr. Bernstein's book and then try to follow the diet as much as possible, no bread, no pasta, no grains, no starchy vegetables, only berries for fruit, do you think he can do that? He can switch regular milk for almond milk and so on.You really need to get him to realize that diet is going to be crucial in saving his foot and his life. Can you get to an endo there who will understand fast acting and basal insulins?

13

Yeah, for a lot of things it is a nightmare. He had gangrene in the big toe for about two months. I went with him to the one doctor who tried to say it was a abscess, I literally had to call the doctor a idiot and we went to a different hospital where they finally amputated the toe. I told them amputate the toe before he loses the leg. He feels pain now in the foot because of osteomyelitis which hopefully has not spread. I have gotten his sugars down the last two days averaging about 200. Which I know is not great but it is a start from 500. His sugar was 148 this morning that is with the 20units bid. We do not have almond milk here. I have been making him a lot of stuff with onions in it and trying to use lemon to add flavor. Seems to be working. But, when I am not there he is telling his wife to bring him cucumber and stuff. It is hard to get her to understand that I am the one administering him his insulin, I need to know what he is eating and what he will eat so we do not experience any lows. This 70/30 is a pain because I am trying to keep him on a schedule. He has health insurance at the military hospital here. I have been looking for a endo here that is knowledgeable of fast acting and basal insulin's. I will look to see if I can find a ecopy of the book thanks for the suggestion.

14

32 days will probably still work, but the only problems I ever had with an insulin pen was with a pen I was still using after 6 weeks. The recommendations are conservative, but insulin does not last forever when opened.

Keep fighting, you are in my thoughts.

15

That is wonderful that you got his bg down to 200 and lower! it will take time to get back to normal and I think it isn't good to decrease too rapidly if you're that high all the time...I think a basal/fast acting insulin regime most likely and this diet: 30g carbs per day or at most 50-70g will work wonders too. I think the other insulins will be much easier because it will be more predictable what to eat and what he needs to control things. You can try alpha lipoic acid, cinnamon and fenugreek supplements, too, they may help regulate his bg. I would just stop milk altogether, it has way too much sugar, that's why skim milk is one of the things recommended for raising bg during hypos.cucumbers should be ok.

I'm not sure if this is the most updated version but I think there is a pdf version of the book here and some free chapters too maybe. http://www.diabetes-book.com

I hope you get to a good endo very soon :)

16

Is there anyway he could come home where he could be safer and get better care?

17

Thanks for the link. I will download them and read it. We have been using a lot of cinnamon and fenugreek. I will have to check with a pharmacy about the alpha lipoic acid, sometimes it is hard to find things like that here otherwise I might order off of ebay. The main diet here consist of Humus, rice, lamb, chicken and a lot of yogurt based foods. Right now is the holiday here also. He has been doing pretty good. I know it is hard when someone likes sweets and breads. I think they are more addicting than drugs. I have gotten him down to about 45g of carbs. I appreciate your help. I also missed typed before. The hospital had put him on the 70/30 three times a day. Which I found odd since the manufacture states that it should be used twice only. Currently I am giving him this twice. He is taking 40units a day.

18

He is from Jordan. I am American living over here. :)

19

Hi MekaMom -
Your history sounds much like mine, but my time-line is shorter. For several years my Doc sang the "loose a little weight, get some exercise, and quit smoking" song to me and then "tweaked" the meds(Metformin and then Lantus) and my glucose came back into line. I didn't change anything. About 3 years ago, after 5-6 years of ignoring it, I "progressed" to insulin before every meal - that got my attention and I got involved.

Over about 18-months my A1c dropped back to the 5.6-6.1 range and is staying there, I no longer use ANY insulin. I do still take Metformin, and test before every meal and before bed just so I can keep an eye on what is happening.

So, what do you do -
FIRST - My Doc's clinic has a FANTASTIC diabetes education and support team.
. . . YOU need a Doc and more importantly the education and support team

SECOND - I am The Boss. Managing my glucose is my responsibility and as The Boss I call upon any and all resources that I think will help me run this show.
. . . YOU need to look at Glucose Management as your job, 'cause you're The Boss, and tap every resource available. That includes the diabetes education & support team, the records you keep, this and other diabetes-oriented forums, and MOST IMPORTANTLY - don't sweat the small stuff.
You will stub your toe, and that's OK. Remember - you are The Boss - everyone else is just hired help and they will slip-up from time-to-time. When you do, walk into the bathroom, stand in front of the mirror, and talk about what happened with The Boss. THEN - because you learned something, you can "pick yourself up, dust yourself off, and start all over again".

I had to check my glucose before every meal to determine insulin dosage. I gave up trying to test 2-hours after eating 'cause I'm not disciplined enough, and I decided the test before the next meal was good enough. I held my carb.intake to 100-125 grams per day. I didn't worry about calories, fat, or anything else - JUST CARBS.
I changed eating habits as I determined the meals that left me with hi-glucose at the next pre-meal test. I started loosing weight--not because I was "dieting" but because I was reducing my carb.intake. I view that as a GOOD side-effect.
In the course of a year I dropped 40-pounds, which is a good thing except I have to admit it was there to loose. I started walking for about 30-minutes 4-7 days a week, in a treadmill and reading while I walk so I don't get bored. I also quit smoking. I did discover that a shot of bourbon has only 1-gram of carbs in it so I added that to my daily schedule (bourbon on the rocks) with no concern over the calories.
As the year progressed my insulin dosages began to reduce, I guess because my carb.intake was lower, and probably because my system was making better use of the carbs and insulin (injected and body-created) it had to work with.
When my insulin usage dropped to about 3-units of Lantus at night and 2-3 units before meals we decided I could quit using it. My last A1c was 6.1 and I'm wearing the new pants I had to buy because the old ones were too big.` Yup, I WON!

I'd be happy to share some tips on the record-keeping tools I used, if you're interested drop me a note. Most importantly REMEMBER -
1. A wise man once said - "We shall overcome!", and we shall!
2. You ARE The Boss, every body else is just a helper - take full advantage of them!
3. Don't sweat the small stuff, and 99-1/2% of it IS small stuff!
Good Luck!

20

great comments GRBernard.

Thank you for sharing.

jim snell