Hi, I’m new to this site. I’ve been type 2 for several years but cannot tolerate metformin. I’m not really willing to try any other meds so I’ve been pushing for insulin since my a1c went over 7.5. Finally getting a prescription today for Lantus only. 10units to start. I have no idea what to expect. My before bed reading is about 200-216, I wake up roughly the same. I managed to get a 3am reading this morning of 162. I’ve just bought a freestyle libre (arriving soon) to see if I can work out what my patterns are.
I can’t imagine 10u of basal is going to lower my bg at all. I have my first ever endo appt in two weeks. I’m motivated to get my a1c below 6. I want to be aggressive after mucking around trying metformin with no success for years. Any advice regarding starting insulin, what to expect, is appreciated. I’m REALLY keen not to put on weight. I’m going low carb <50g/day. I’ve never had a hypo my lowest reading is around 140.
I, too, initially swtiched to insulin after finding that I am unable to tolerate metformin. i did try a couple other meds first (with poor results), but the whole elapsed time was 4 months in my case.
It’s typical to start with around 10 units a day. It is a low enough does that it will be unlikely to be too much, so it’s a safe starting point. Remember, though, basal insulin, like Lantus, is designed to lower your background BG – NOT to compensate for food you eat. For that you’d need rapid-acting, bolus insulin like Humalog. Whatever dose you’re working with, you need to be consistent for around three days to see how well (or poorly) it’s working for you before making any changes. Also, when you do make changes (likely increase doses at this point), make SMALL changes at a time. Lantus last in your system up to 24 hours – if you take too much, you’ll be dealing with lows for a whole day. Again, when you do make changes, wait three days to see how it’s working before making additional adjustments.
I know you want to get things perfect quickly, but patience is important here to make sure you get it right - and stay safe.
I too eventually marched in and demanded insulin when the usual T2 protocols just weren’t getting the job done. We’re actually more nunerous than you might think. Welcome to the club!
Three things about basal insulin:
10u is, as Thas points out, a fairly conservative starting dose. Everyone has a different level of insulin sensitivity and you’ll probably have to tweak that dose to find the perfect point of equilibrium for you. With insulin—any insulin—the standard “best practice” rule is to start low and creep up until you reach the right level. Doing it any other way runs the risk of serious hypoglycemic episodes. There’s no rush; you’re in this for the long haul.
Changing basal dosage should be done slowly. It normally takes 3 to 4 days for a change to settle in and stabilize so you can tell what the real effect is. Changing it every day can leave you going in circles (or chasing your tail, or . . . insert favorite metaphor here).
Also as noted, basal insulin is not designed to, and won’t, deal effectively with post-meal spikes. If those are a problem, you need a fast acting bolus insulin.
Hmmm, patience is not one of my virtues but I’ll give it a go to stay safe. I don’t want hypos as I’m alone a lot. If my overnight bg levels are fairly stable (even at a high level) doesn’t that imply I have adequate background insulin? Commonsense sort of makes me think a rapid acting at dinner time might bring my bg down to a lower point and then I wouldn’t need as much basal. Even after meals I don’t spike that much (ie. I start the day around 200, after breakfast my levels drop to about 180, keep dropping to about 160 in the afternoon but rise again after dinner to 200 again). I seem to run a high baseline but don’t spike or go low that much. That seems a bit unusual. I would say I’ve got pretty good stability it’s just 100 points too high. I think I remember reading somewhere if you improve your post meal your basal might improve on its own. I want to minimise the amount of insulin I take.
For some reason I’m expecting the doc to try and use Lantus to lower my a1c resulting in me injecting huge amounts, getting fatter, ultimately failing. As you can see I might have trust issues in my care provider but as I haven’t met the endo yet I should just chill out and give them a chance.
Not really. If you’re running around 180 to 200, that’s too high, no matter how rock-steady it is. A normal fasting BG for the average non-diabetic person is in the 80-to-90 neighborhood. If you’re regularly hovering 100 points higher than that, your body is simply not keeping up, whether due to lack of insulin, high insulin resistance, or both.[quote=“PemW, post:4, topic:58261”]
I’m expecting the doc to try and use Lantus to lower my a1c resulting in me injecting huge amounts, getting fatter, ultimately failing.
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Insulin, in and of itself, need not make you fat. If it did, every healthy non-diabetic person with abundant insulin would be fat. Exogenous insulin, at correct dosages, will cause you to process food more closely to the way a non diabetic person does. The closer to normal physiological functioning you are, the more the “normal” rules apply. In other words, eat more and/or exercise less, you’ll gain weight. Eat less and/or exercise more, you’ll maintain or lose. There is, unfortunately, no magic shortcut.
Your assumption could be correct regarding stability, though, as you point out, the baseline is still a bit too high. Couple that with the rise in the morning that is not likely meal-related, you still might be best served by a small basal dose. Nothing short of trying it will really give you the answer to that. The thing is, it’s impossible to get the correct pre-meal dosing of rapid insulin unless you are sure that your basal needs are already adequately met. Starting with a basal is, therefore, a good idea.
Thank you both for your replies. I guess there is a reason they start by stabilising your basal first. I’d say I am insulin resistant but I’ve never had my insulin tested nor antibodies. I was just told I was type 2. One look at my apple shape most doctors assume I’m insulin resistant.
I’m assuming if I had LADA my BG levels would be a lot higher and a lot more variable. Now that I’m “on insulin” I guess it doesn’t really matter which type I have. Even type 1s, lada etc can have insulin resistance. I guess I’ll find out when I see if I respond to insulin injections.
Exactly. At the end of the day, I don’t really care whether I am type 1, type 2, or type 95. What matters is good control. Eyes on the prize.
The one practical effect of a type classification is that it can affect what is and isn’t covered by insurance. Beyond that, it’s pretty much an intellectual exercise: interesting but not useful. Whatever you have to do to achieve normal blood glucose—that’s what you do.
Yes. Eyes on the prize is my new motto. I’m weirdly excited to be on insulin. Am I a hypochondriac? I think I’ve built up insulin as my holy grail, golden ticket… it also indicates to my family that I have a genuine issue and I’m not just eating too much rubbish (as they currently think). I’m not sure here whether just being on insulin qualifies you for subsidies (Australia) or you have to be insulin DEPENDENT ie. type 1. Guess I’ll find out today.
There’s nothing the least bit weird about it. You’re excited because you finally have access to the most powerful weapon in the arsenal, one that gives you some real power to tame the beast. Anyone with sense would be excited about that.
My GP looks at me like I’m a drug addict who wants insulin to either sell to bodybuilders or murder someone with. I can’t get through to her how long I’ve wanted normal levels. She explained there is a protocol here that insulin is not given until I’ve failed triple drug therapy. She wanted me to try metformin again. I gave up and asked for another Endo referral which she gave (quite relieved to be rid of me). The last time I tried to get an endo they rejected my case as not being serious enough (my a1c was 6.9 at that stage).
My #1 complaint about traditional diabetes treatment. “Let’s not prescribe the best medication until all the others have failed and it’s almost too late to do any good.”
My first Lantus injection was a breeze. Didn’t hurt at all. I love that I can just jump on the net and watch someone demonstrate with the exact pen I have. I LOVE technology. I went for 4mm needles and I noticed a drop of insulin on my skin when I withdrew the shot. I held it there for ten seconds. I’ll see if it happens tomorrow. I’m on my way
Glad to hear that your first injection went so well! I’m curious to hear how you feel now that you’re on Lantus, although I know you’re only just getting started and it will take some time to notice a difference. Did you twist the needle as you withdrew it? We were told to do this for our kids when withdrawing the needle after doing their injections, and it’s supposed to help get rid of that little drop on the tip. However, I notice that there is still sometimes a drop there anyway!
Best of luck - and kudos to you for getting through your first shot so easily!
The Mayo Clinic Proceedings in September, 2016, published a comprehensive review and recommendations regarding insulin injections. Here’s what they have to say about insulin pens:
Proper Use of Pens
When patients use pens they usually cannot see the insulin going in as they can with a syringe. Obstruction of insulin flow with pens, although rare, can have serious consequences. When teaching patients proper pen use, HCPs should consult the instruction manual for the specific device being used.
Several basic steps are important to follow with any pen injector, but few of these are known by (or taught to) patients. For example, it is important not to accidentally push the thumb button before the pen needle tip is inserted in the SC [subcutaneous] tissue. In fact, it is best not to touch the thumb button until the needle is completely inserted. Once the thumb button is pushed, patients should keep pressure on it until the needle is completely withdrawn from the body. If the button is released while the needle is still in the skin, body fluid and cells may be aspirated into the cartridge and contaminate it.93 Another important step is to always push the button vertically (along the axis of the pen). Some patients, especially the frail or elderly, are unable to completely inject their total dose because they are pushing the button obliquely, eg, by pushing on its edge, generating excessive resistance along its glide path.94, 95
They recommend a 4mm length pen needle as sufficient for everyone, including children and adults.
I forgot to twist it. I was so nervous it was going to hurt. I was worried the button pushing bit was going to be clunky but it wasn’t too hard. I’m not sure I’d be wanting to inject much more than 10 units but I read the average is 40?!
I seemed very hungry today. Especially in the afternoon. My bg levels stayed steady overnight at around 170-180 and all day I’ve hovered between my normal range of 180 to 230 ish. My ‘low’ was 144.
I’ve had high bg for so long I feel hypo on 150 but I’d like to wake up with 120 to start with and then lower it a bit more as I get used to the lower readings.
