Started insulin, please comment the regime I've been prescribed


first of all, thank you all who helped me through my panicky times.
So I had my endo appointment on 1st and my new a1c is 6,6% (as expected). I told my endo I'm not comfortable having such high sugars regulary (as high as 18,5mmol (333mg) - my new record, it was rising for 5h until slowly dropping to 10mmol so I could finally went to sleep, no ketones- and I'm ready to try insulin. She reluctantly decided for it and sent me to have quick education (I will have more of it in two weeks).
I was also just diagnosed (one day prior) with Hashimoto's (my TSH is barely above limit, T3 and T4 are ok for now, but I was nonetheless prescribed with levotyhroxine) and my endo told me this could be a cause for my random high sugars and she wants me to start my meds ASAP (I did yesterday) and my sugars will probably be much more normal then. She doubted that I'll even need insulin after that, at least for some time...

Ok, so, my presricption for now: 4 units long acting in the evening, 4 units before each meal only if my sugars are above 7mmol/126mg (6/108 in the morning). No count carbing for now, only rising/lowing the dose next day according to the sugars I had the day before..

What do you think about that?
I have my next appointment in a month already...

The insulin regime you are on is a super simplified version of "sliding scale" with a heavy heavy emphasis on avoiding hypos. Nobody would be surprised that eating a meal without taking required insulin results in high bg's. If this is just a baby step on the way to a real insulin regime (maybe accompanied by classes on you adjusting your dose yourself?) then do whatever you can to get "qualified" for adjusting your dose yourself.

Thyroid levels are not as strongly related to bg's as your endo suggests. At the fine tuning level, yes. You are nowhere near the fine tuning level.

Seeing the units you use... are you in England? There they tend to call the insulin regime where bolus insulin dose is determined by carbe count, "DAFNE" or Dose Adjusted For Normal Eating. I think other countries have their own brand name for the (pretty dang obvious) concept that bolus dose is based on carb count and is taken before the of meal.

hi krisa. i think you need to start using an insulin:carb ratio and begin carb counting. its the best way to control your blood sugars. the method of the sliding scale-what youre doing right now for meals, or close to it-is really random!
walsh´s book "using nsulin" might be a good place to start.
good luck!

Hi Krisa,

I'm glad you started insulin because it appears your Blood Glucose control deteriorated quickly. Did you restrict carbs before the appointment? I agree with the other posts that you should still keep carbs lower because it will help you avoid lows while using insulin. I'm sorry to hear about the hashimotos, did you test positive for antibodies? I have been on thyroid meds since 2010 (antibody negative) and it had really no effect on my blood sugar levels, Good luck with the treatment and keep us posted!

I agree with what others have said and would strongly urge you to look into carb counting. Have you started taking the insulin yet? If you are in the beginning stages of LADA like I was when first diagnosed, you might find that the regime prescribed is far too much insulin. I needed no long acting for 18 months and only tiny amounts of fast acting, about 1 unit per 20 grams of carb in the beginning.

no, I'm from Slovenia.. they haven't mentioned any special name, but my endo did give very specific instructions to my nurse educator, so I guess that's it..
I guess I'm gonna see what they're gonna teach me next time.. If not, I'm gonna learn carb counting myself.. I once tested how much does 10g of carb raise my sugar, but I forgot..

I'm going to look into this book, thank you!

No, I did not, not that much. I was careful not to consume too much carbs with one meal, but I guess I was still above 100g per day. I've been having some hectic weeks, plus illness (viral infection and bacterial bladder infection), that must have done it's job, too.
I actually did not test positive for antibodies either! Are you doing well with your hashimoto treatment?
Thank you so much.

I've just started today. 4 units was too much for breakfast, probably because I have small breakfasts, but it seemed to be okay for lunch. I already seem to have dawn phenomenon so I might benefit with long acting, which I'm injecting this evening firs time..
I really must look into carb counting and maybe try 1 unit for 20 carbs too, too see how I do with it.

I would agree with others, you have been given a set regimen but carb counting is better. I would say that 4 units before each meal is probably too much, in my opinion. When you are newly diagnosed/newly on insulin, you typically require less fast-acting insulin. Even so, I rarely take 4 units prior to any meal, I take much less than that.

Finally, congrats on starting insulin! It is a good step.

I was told it was just hypothyroidism, because I didn't have antibodies detected although the radiologist who did my uptake scan said it looked like Hashimoto particularly since I was presenting as hyperthyroid, but was actually the reverse. They called it acute thyroiditis and I started taking Armour and have been stable since.

Oh, I see, well, my tyhrologist checked my thyroid with ultrasound and said the structure of it is consistant with autoimmune attack... checked my autoantibodies later on and they were negative, but my TSH was once again slightly above the range (like half a year ago) so she prescribed synthetic hormones, I hope they'll help since it's nearly impossible to get natural ones here..

Thank you!

Yes, I think it might be too much, too.. I think I'll start learning to carb count on my own

krisa, this is really up to you. You need to be in control, decide what your goals are. Then gather information and educate yourself as much as possible to be a strong advocate for your goals and plans with your health care team.

As Tim said, seeing 18mmol/dl after eating with no insulin for a full-on diabetic isn't surprising. What it does mean is that, absent some other confounding factor causing high BG (other than frank diabetes), insulin is pretty much the only way to get tight control (i.e. as close to non-diabetic), absent a nearly impossibly restrictive diet that most people don't find liberating in their lives.

I'm type 2, and am on the Omnipod pump and the G4 CGM now for about 15 months. It has enabled me to get my A1c down to 6, and my goal is <5.5. This tight control has only been possible with carb counting, constant monitoring, and multiple corrections every day. If you want to be more agressive with your control, demonstrate to your team that you are highly motivated, knowlegable, seek knowlege and advice pro-actively, and therefore can be trusted with calculating dosing. Best of luck!

Yeah, the fixed-dose / sliding scale approach is, in my opinion, far more prone to hypos than learning to do carb counting well. It's ironic, because for some reasons doctors think this "simpler" approach is safer in terms of hypos. Go figure.

Carb counting does mean you man potentially be injecting more than 4U -- sometimes a lot more. But that's actually a good thing -- it means you have much more flexibility in your diet, your life, your social life. Yeah, most of the time 2-6 units per meal will match what you count, but then there's that special occasion, celebration, whatever, where 10U, followed and hour later by another 5U are needed because of all that delicious crap you're grazing from the hors'devours table at the party.

I have great insulin envy for T1's :-)

4 units? That's a glass of milk for me. 20g. IR's a biotch!

I also really like the book Think Like a Pancreas by Gary Scheiner for helping to balance carbs and insulin.

dave, yesterday, high at 205, took half a unit, walk dog for 45 minutes. 96. wanted to take a nap but thought, ooh that half a unit still has three hours to work its magic. had two squares of choccy and a biscuit. woke up 45 minutes later, putting in my contacts with my hands shakin, thinkin, god, its sooo hot! 54. blech! t1s on mdi need quarter units! ;)

Yeah... rub it in, pancreaswanted. Rub it in :-)

By way of contrast, I completely lost it last night and ate two Skinny Cow ice-cream cones (30g each, total 60). Bolused properly for it -- 15U.

Still woke up this morning 250. Bolused 20U. Here I am in the office 4 hours later still 130, adding a bit more correction.

My insulin use would kill you, my friend -- or make you VERY fat with proper carb to balance.

BTW, fell off the wagon last night because I had one of those awful weekends with my 16yo daughter making all kinds of trouble. Needed some getaway, and Calgon just doesn't work for a burly country man like me :-) :-)

t1s on mdi need quarter units!
Or 60U insulin in the analog formulations.

It's always puzzled me why they don't offer that formulation. I read way too often here about T1s having dosing difficulties on MDI because of the lack of sub-unit dosing. 60U insulin would help that alot, I would think.

And hey, they could charge the same per bottle for it, and make a killing! What are these manufacturers thinking of? :-)

Or 60U insulin in the analog formulations.
It's always puzzled me why they don't offer that formulation. I read way too often here about T1s having dosing difficulties on MDI because of the lack of sub-unit dosing. 60U insulin would help that alot, I would think.

I've met a couple folks who regularly diluted insulin.

I suspect that given the problems (fatalities) that have happened on U-500, that the trend away from color-coded insulin/syringes in the past decade or so has made the insulin manufacturers scared of different dilutions.

When I was diagnosed they really thoroughly drilled into me "orange=U-100, red = U-40, green = U-80", and then a couple years ago they put purple (not orange) on U-100 humalog. Go figure.