Sub Q and other questions

Type 2
#1

I am posting to get some help with this issue. I am a 26 year old type 2 diabetic who has been on novolog and lantus for almost over a year now (also been on and off of different orals). I normally inject into my stomach area but lately that has been way to sensitive to touch so i have also been using my theighs. Lately all areas are sore and i have rotated to the back of my arms for the first time. My question is simply this. Is is normal for a Lantus injection to burn or am i injecting into the wrong area.

I did call my provider about this and her response was I can pay to go back do diabetic education classes (my insurance will not pay for them this year due to me having them already and injections areas were not covered.)

Also, my provider wants me to test 4 times a day. I try to test in the morning when i get up and when i go to bed, but the other 2 times are hit or miss due to the fact that i do not eat on a regular schedule. Does anyone have a method to remember to test the other 2 times a day? I dont wear a watch which is part of the problem.

again any thoughts are appreciated

#2

I’d test right before I’m about to eat and ive noticed it does burn sometimes when I’m injecting humalog and lantus maybe its to close to a blood vessel not sure

#3

Hi, um injection techniques...are u first of all pinching up your skin before injecting? Getting that fatty pouch of skin ensures the insulin is getting into that subcutaneous area. Also maybe there is something in the additive of Lantus that is making you sensitive to it.

As far as testing four times a day, my best advise is its just something you are going to HAVE to make habit...like going to the bathroom to pee. You dont just go twice a day, you go when you feel the need. I think it doesn't really matter so much that u may or may not be eating meals at a regular time...just more to see where your numbers are at a particular time of the day. I mean lets say you blood glucose level is 98 @ breakfast...you eat...you dont check at noon...but by the time you check again your bg level is say 111...but the Dr's don't know what it was during the noon hours...and if say you are spiking to say 200 at noon...then adjustments need to be made because you should not be spiking and maintaining a spike for a long peroid of time. So I think just make it part of your routine during the day and definately either get a watch with an alarm you can set..or a little timer you can set to remind you to go test. After a few days of doing it consistently it will become habit.

#4

Don't you need to test before each meal to determine your insulin dose?

#5

It should all pretty much be the same technique. Legs I think can be a little trickier just because they tend to be muscular in nature. When I was doing injections I'd try to go to the kinda sides, of thighs where they are a bit more fatty and less muscular.

I find it so interesting how they dose for Type 2's..and Dr's really seem almost reluctant to start carb counting and actually dosing for what you eat versus just a standard dose of insulin. I've seen other type 2's that were dosed in this same fashion, and well as being a Type 1...Im just not sure if this is kinda the standard of care for Type 2's and if it is Im not sure what the rationale behind it is. I would THINK carb counting and dosing precisely for what you eat regardless of whether you are Type 1 or Type 2 would be the ideal treatment.

#6

Really?? The standard protocol would be to move from sliding scale to carb counting rather than from a sliding scale to a fixed dose. My guess is that most people here on MDI (lantus and novolog) would test before and two hours after every meal and before bed. Once you get a handle on your blood sugars, you'll likely go low from time to time so that you will also want to test before driving and exercise.

Using insulin is a time management problem which is much more difficult if you don't give in and buy a watch.

#7

A set dose for meals, unfortunately, is no more accurate than a sliding scale. You need to figure out your I:C ratio and then bolus according to the food you are actually going to eat. A salad needs a lot less insulin than four slices of pizza!

#8

I'm pretty cynical and think the "rationale" (or lack thereof) is that they expect very little out of their Type 2 patients, which is of course, doing those Type 2's a great disservice.

#9

LOL. Never worn a watch in my life and never will. Between the time on my meter/remote and my pump, and all the clocks in my house, computer and car, I can't really lose track of time even if I try to

I agree with Maurie that before eating (to determine dose) and two hours after (to see how food affected you and if you need a correction) is pretty minimal. I have an acquaintance who is Type 2 now on insulin and his doctor told him he only needed to test twice a day because he's Type 2. Insulin is insulin and not testing is both dangerous and guaranteed to lead to poor control. As for remembering the "two hours after"? I'm a space case by nature but I've been doing it for 3 years and it's now automatic. But perhaps you can tie it to activities that are routine in your life to help until it becomes a habit

#10

I do not understand some of the type 2 standards of treatment, my endo's office seems like they are pretty aggressive in treatment but as Im not type 2...obviously I cant say for certain. But it does seem I think a lot of Endo's are reluctant to start insulin on Type 2's and when they do...it seems they put them on old standards of dosing with insulin. Philmore, I would maybe bring up the subject of dosing for carbs at a later visit. I think its an ideal way of dosing insulin.

#11

I'm new to this so I'm no expert, but I found I had much better luck with novofine 6mm needles than I did with relion 8mm. They seem to be sharper and smoother. With the 8mm I felt like I had to pinch up the skin, which I think made the injection more uncomfortable-- with the 6mm there really doesn't seem to be any need to pinch-- which I've gotten away from with the shorter needles. Try injecting in the "love handles" too, I don't seem to have much discomfort there.

#12

yes, lantus burns..I switched to levemir and NO burn at all. good luck!

#13

One thing you can do is get the book, Using Insulin by John Walsh which will help you with some of the basics of insulin use like I:C ratios. Many of us find we learn more from that book and each other than we do from our doctors.

#14

Lantus requires a subcutaneous injection. Unless you are carrying a bunch of extra bodyfat, as a guy that pretty much means an abdomenal injection. Bernstein has some good suggests on painless injection in this video. He has also written it up. I've never really been successful using alternate sites for my basal, but perhaps you can get it to work. I use Levemir as Katie does and don't experience burning either, Lantus is quite acidic and for some it does burn, but a slow injection rate may help.

In the end, as a T2, I had to fight to get insulin. And I quickly took over and "owned" my care. I bought the books "Using Insulin" by Walsh and "Think Like a Pancreas" by Scheiner. I quickly adopted carb counting and dosing my insulin for my meals and I got the best of control of my blood sugars I've ever had. You can do this too.