Really low doses of insulin

#21

Fat deposits (lipohypertrophy) at insulin injection sites can occur with MDI or with a pump. A good rotation schedule in either case can reduce the chances. It's one of the reasons that the infusion site is recommended to be changed at least every 3 days.

#22

Within one month of going on my first pump, I met John Walsh (author of "Pumping Insulin") in person at an International Diabetic Athletes Association meeting. At the time, I had so little body fat it was hard to find a place to insert the cannula. John took one look at me and informed me I would end up with fat pods at the insertion sites. I have viewed it as the price I had to pay, and I don't know if it happens to everyone (they may not be visible on those with more fat). So I completely get "not wanting to sign up too soon" but I would say it has been totally worth it to me to be on the pump. BTW, John Walsh also gave me some great advice and basically solved a basal rate pump problem I was having--the man is a genius when it comes to pumps!

#23

I'm 6 weeks into being a type 1, my doses have been reduced nearly every week, humalog is now at 4 units in morning and lunch and 5 units at dinner, lantus has increased from 12 units to 16 units. I'm basically eating what i want within reason which is great. no idea how long this honeymoon will last but I'm making the most of it. going for my 1st endo visit in a week so will hopefully have a better understanding of whats going on

#24

Thanks for responding! It's always a comfort to hear a 'real life' example that supports the 'science' doctors/books offer. Minus the pregnancies, my situation seems similar - I also need more basal than bolus and a year after diagnosis/starting insulin I use about 10 units a day (moderately low carb) with no observable progression out of the 'honeymoon' at this point.

#25

Strictly from outside, I would say your pancras is doing a great job kicking but and only requires a small boost.

#26

How did you come up with your ratios? Mine are still off since November 2012, my DX. I’ve counted TDD with 10 sums and it seems to be 1:21, but that according to 500 rule. Since I am honeymooning this is not an exact. I need to count TGA as well because protein and fat set me off. I don’t get this. So frustrating.
Mine dosages are 4 at night Humulin NhP, 4 nhp +4 novorapid morning, 3-4 lunch and 4 novorapid at dinner. This what I came up with myself. Hospital sent me home with 12 8 8 8 based on the food they’ve served :-(. Next day I had many lows.

#27

After 50 years, my total basal per day on the pump is7.95 and my IC ratio is 1/18. I average about 10-12 total units per day. Not much, but I maintain A1Cs of 5.1. Every body is different. When I was diagnosed, I took well over 100 units per day....different insulin and regimens. But stability and diabetes are not two words that go together in my experience.

#28

Well when I was diagnosed (back in January of 2012) I wasn't even on insulin for the first five months...until I got a C-Peptide and a GAD antibodies test. Basically, within that time frame (or sooner) my pancreas was completely dead (no insulin no nothin). I was total T1 in a very short period. So my doctor put me on 15 units of Lantus per night and started me on a bolus regimen (I use pens so I just adjust my whole I:C ratio according to meals)...
Recently, I went down on my Basal (11 units now)due to my being very insulin sensitive and dropping too low in the night. Again, I'm not honey mooning at all.
So I guess it depends on the person and how you react to insulin. I'm a physically smaller fellow (I'm around 5'6 and 128 pounds) so injected insulin goes through me really fast.

#29

I was diagnosed November 11, 2008 with an A1c of 11.9. I was put one Levemir pen, 10 units 1xdaily; I:C of 1:15g. I had hit a couple lows, so I:C changed to 1:30g. I kept hitting lows, so I quit insulin altogether! I managed my diabetes with diet (basically no bread, pasta, rice, etc) and exercise (just went for walks and things like that). Fast forward to present day…I am now on the t:slim pump. My A1c prior to being put on the pump was 6.8. Since being put on the pump in February, my last A1c was 7.2! My endo says it’s normal for an A1c to spike a little when starting on the pump. My insulin sensitivity has not changed. My basal is set to .23u per hour (that’s like 5.5u per day!). My I:C is set to 1:30g (endo wants it at 1:20g, but no thank you). I actually don’t bolus for food. I keep my carb intake at a maximum of 30g per day, if that. My endo suspects that I still make my own insulin. I do test positive for GAD65, so that puts me in the type 1 category, although I don’t feel like a ‘real’ diabetic.

#30

Hi,

Talking about diabetes, pregnancy, and honeymoon.
My experience is that the ‘honeymoon’ resumes after the high insulin requirements of pregnancy.
Got diagnosed in first weeks of my first pregnancy (about 8 years ago now). Up to about 80 units/day during that pregnancy. Down to about 6 - 12 units after that pregnancy. Then up to a total of about 100 units per day with second pregnancy, after which down to about 20 units / day (that’s about 4 1/2 years ago).

Currently things fluctuate quite a bit. Guess it depends on the time of the month and what my body is doing at any particular time. This month I’ve gone from 20 - 50 units a day - Beginning of this cycle was about 20 units a day - now end of the cycle at about 50 units a day. The only rational explanation for this big a change should be pregnancy - but all my tests are negative - so who knows… I am hoping it drops in the next day or two… This is nearly all basal insulin… I chase my fasting blood sugar levels up and down all month, though not typically to this extent…

Christina, I don’t feel like a ‘real diabetic’ either, as my diabetes seems far too easy to manage, and not typical at all…

#31

I really don’t know if I had a honeymoon or not. With an A1c of 11.5 I was misdiagnosed at age 70 as a type 2. I had to starve myself and lost 17 pounds I couldn’t afford to lose trying to get my A1c under 7.0. I was treated as a type 2 on oral drugs that didn’t do all that much good for a year and a half before finally being referred to an endo. He diagnosed me with type 1 (LADA) and started me on 8 units of Lantus and an I:C ratio of 1:20. I quickly discovered that 8 units Lantus was far too much - I had to get up in the night and eat to prevent hypos. So within a few weeks I dropped that to 6 units. A year later I was able to drop my Lantus to 5 units for the summer only, during a period I was getting a lot more exercise. Three years later I’m up to 8 units daily.

While the endo’s starting dose of Lantus was too high, the ratios for food was far too low. It isn’t that I’m so insulin resistant – my correction factor is 42 on Apidra and 34 on Humalog. But my BG is extra sensitive to carbs, far more so than the charts suggest for my weight. The result is an I:C ratio of 1:3.5 for breakfast and 1:7 the rest of the day on Humalog or 1:4 for breakfast and 1:8 the rest of the day on Apidra. These ratios haven’t changed over the three years I’ve been on insulin.

#32

I have to say, I am surprised that there isn’t more use of diluted insulin. While none of the basal insulins can be diluted (except NPH which you don’t want to use), you can dilute both
Novolog and Humalog
. And you can dilute them as much as you want allowing you to give much more accurate smaller correction and mealtime doses. If you dilute insulin 10:1 then you can accurate give 0.1 unit doses with a normal syringe, you just have to adjust your math.

Here is Bernstein on diluting insulin:

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Sugars way out of wack this morning
#33

Utterly dangerous irresponsibility. Insulin producers produce our insulin under very careful conditions to get the mix correct. Insulin isn’t a cocktail we’ll just throw up a mix, it’s exceedingly dangerous. For those of us who are exceedingly sensitive to insulin a variation in mix even when from a normal vile is bad enough, let alone the mess something like this could cause.

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#34

The insulin manufacturers themselves make the dilution solution and the vials for mixing that Dr. Bernstein is talking about, so I don’t know that it’s that dangerous if done correctly. Small children and very insulin sensitive adults sometimes require diluted insulin in order to safely take bolus insulin.

#35

There’s a lot of if’s when it comes to getting in a contaminant, or even being fractionally off. Shouldn’t ever be considered, and this is yet again more questionable advice from Bernstein. Depending on what I’m doing my sensitivity can fluctuate from 1u:25g to 1u:250g so yes I’m not “very” sensitive. But doing something like this simply shouldn’t be done, or even advised on a forum such as this due to the inherent dangers.

#36

It is kind of shocking to hear you say this. Certainly you should only undertake dilution under your doctors guidance, but it isn’t a misuse. Dilution is right there on the prescribing information, an appropriate and supported practice from the manufacturer. They sell you the stuff to do it. The steps to do this are straightforward and sterile.

Here is what the prescribing information for Humalog says:

16.3 Preparation and Handling

Diluted HUMALOG U-100 for Subcutaneous Injection — HUMALOG may be diluted with Sterile Diluent for HUMALOG for subcutaneous injection. Diluting one part HUMALOG to nine parts diluent will yield a concentration one-tenth that of HUMALOG (equivalent to U-10). Diluting one part HUMALOG to one part diluent will yield a concentration one-half that of HUMALOG (equivalent to U-50)

And I don’t understand your concerns about contamination. You use a syringe and vials of insulin and sterile diluent. If you don’t trust these devices you shouldn’t trust a regular syringe and vial or a pen or even a pump. These delivery and dilution methods have been designed and tested to maintain sterility, I’m sorry you don’t trust them.

So if you don’t feel comfortable with diluting insulin yourself you can ask you pharmacist to do this or even take it a step further and order diluted insulin from a compounding pharmacist whose job is “exactly” that, to mix custom medications per doctors orders. If you hung out over ChildrenwithDiabetes you would see that dilution is a not uncommon practice. I understand you don’t like Bernstein, but your comments are not supported by the manufacturers nor others in the diabetes and health communities.

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#37

I started out with ultra low doses like yours and over time have required more and more. I still use less basal than many but my carb ratios have crept up from similar to yours to as much as 4:1 depending on the time of day. One thing you can count on with diabetes is that it is ever evolving. At first I felt like it was a defeat every time it became apparent I was going to need more insulin… In hindsight that was just my reality…

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#38

Have to agree this is a bad idea for most… more practical to eat a few more or few less carbs to match the available dose.

There’s a reason why so many diabetics out there are on ‘primitive’ sliding scale or fixed dosage regimens… It’s not always because their doctors are foolish, it’s often because not all patients are as methodical, motivated, educated, alert, etc as someone like you might be

So while I have no doubt that you could perfectly well mix and adjust your own insulin dilution to whatever extent you possibly wanted, I don’t think it’s generally a good plan for diabetic joes nationwide.

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#39

You need to coin that term “diabetic joes nationwide” (meaning = not your average, more intelligent, educated, and tightly managed PWD who is also a TuD member).

Once coined, may I use this term?

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#40

Consider it done. It may also be abreviated DJNs or just DJs. Access granted.

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