Too soon to give up on basal and bolus insulin?

Type 2
1

I've been on the basal and bolus insulin for about 3 months and I want to go back to 30/70. Does that seem ridiculous? My bg is worse because I now have more shots that I can forget. I can tell the poor state of my control by the look of my feet (peeling skin) - I was testing vigilantly but I've stopped.

I'll see my endo next week and not sure what her response will be. I'll find out my A1BC then. Am I giving up too soon? The choice if 4 shots with metformin versus 2 shots with metformin (I'm not always great with the metformin either).

Sigh.

2

Was your A1C good before? Was 30/70 working for you?

3

Thanks for replying. I had finally gotten my A1C to .064 in April and was told to change for better control. Of course, that result was the best in years and been .079 the year before. The difference was that I was paying more attention to my meds after participating in a pharmacy talk about diabetes. I've always been on and off compliant but my endo has been woking with me for less than a year - and I've had diabetes for 12 years.

4

can you set alarms on your mobile phone to remind you about times for shots? leave notes on the bathroom mirror? on the fridge? everyhwere in your house? a note with your lunch at work? can you have someone remind you, someone youre with every day? is there somewhere you could put your gear so that its very in your face as a reminder? i always put my levemir with my meter before i go to bed so that when i do my test before breakfast i see the levemir pen.

when i switched from lantus to levemir, i was terrible at remembering the extra morning shot. i put a post it on the bathroom mirror and on the front door so i would see it as i was leaving for work in the morning. after a couple of weeks it was habit. there are times i might forget if im tied up doing something but i usually remember now.

i wouldnt give up on the mdi. its supposed to give much better control (when done correctly) and flexibility. i imagine it would take some getting used to after doing the 70/30 for so many years, but with time it will become routine. dont give up, start testing again and keep going! after three months of doing it right, re-evaluate, see if its worth it for you, but dont give up now, youve been unable to see the benefits because of all those forgotten shots!

good luck!!

5

Compliant. I really don't like that word. It is not like you are refusing the doctors advice, you are just making the wrong decisions.

The real issue? This is all mental. It has nothing to do with changing to MDI, it has to do with your putting your diabetes as a priority and taking care of yourself. If you really care, then you need to work on getting your head around paying attention, testing regularly, watching what you eat and using an insulin regime effectively.

So let me ask you. Do you really want to get your A1c down to a well controlled level and have the best chances for a long healthy life? Of course everyone will say yes, but you really need to mean it and mean it enough that you are willing to make some basic mental and behavioral changes.

6

Hmmm. Hadn't thought of that it is a really big shift after doing 70/30 for years and years. Thanks for the perspective. (I would hate the reminders!)

7

Yes, it has been a mental challenge for years. Something I can overcome for about 2+ months and then I fall off the "wagon." I guess I am also frustrated that I had finally got to 6.4 (and that I was finally taking all the other meds I need regularly - Lipitor, Altace, Metformin, etc) and now I know it is so much worse. It hasn't helped that I've been anemic at this time which means I am exhausted. Too many things going on!!! :)

8

And I agree - "compliant" is such a funny medical word. Turns us into "good patients" versus "bad patients."

9

You will never be called a bad person here, you are just another one of us struggling to find their path. You might find it helpful to read "Diabetes Burnout" by William Polonsky. Although this book is more than a decade old, it is really good. My public library still has copies on the shelves.

10

My allergist told me to leave my Asmanex next to my toothbrush so I'd remember to take it. I never thought it would work (and I'm terrible about remembering pills I take every day), but I never, ever forgot it.

Maybe you could stick your basal pen in your toothbrush holder? Or on your pillow so you take it before bed? Once it becomes a routine, it's routine, but until then the habits can be hard to form.

11

Thanks. I do that for my night meds and shot. Weekends are hard for lunch and dinner shots since never sure where I'll be or when I will eat. I could use my phone as reminder but... :)

12

but what??? but ill wait till i have my feet amputated!?! but what?? sorry to be so blunt, but, dude, its not that hard to set an alarm!
everyone has a social life here, everyone goes out to eat, has crazy weekends, but this is sooo important! make it part of your life, its not going to do it by itself!

13

:) I guess that is why I am here - to figure out how others do it! I am one of those people who assumed my foot won't be amputated, I guess...

I do know my coping mechanisms are poor so I try to triage. My main victory is that for the last six months I take my other meds regularly - Lipitor, Altace, synthyroid, and more - very big victory. My cholesterol has come down which is great.

I think I was switched to this system because I sometimes take my shots after my meals. (I know some of you are face palming!).

Thanks for the bluntness. So much for me to think about. So much for me to do. And fine! I will take one of the metformins I miss!

14

When you have made the commitment to do it, it will get easier. Just like we form bad habits in our lives we can form good (or necessary) ones. You'll get there and then it will be your "new normal" and you will feel so much better! And yes, I would stick with the basal bolus and find ways to work it into your routine/memory. I am home a lot so I have meds/meter, etc right on the kitchen table where I can't miss them. When I go out I throw things in my purse along with keys, money, etc. If I were still working full time I would have duplicates of everything that either stayed in my purse or in my desk at work or in my car. When I sit down to eat at a restaurant I automatically take my meter out right when I sit down so I don't get to "yacking" and forget. For meds I use med boxes with days and Am/PM slots so I can see if I missed anything. I take a lot more than just one medication.

15

I have duplicates everywhere too! And I take different meds at different times placed accordingly which makes it hard to use one pill box. I probably need more stuff in my purse. Do you keep an insulin in your purse permanently?

16

Prepump when my son was on a basal/bolus MDI regime, we used an alarm for the a.m. dose and p.m. dose of levemir so that they would always be given on time, and bolus is easy, since it should be automatic following a BG test every time you eat. We have always kept the corner of the kitchen counter near the phone free for his test kit and emergency supply kit to be deposited daily whenever he is in the house. That way it would always be in sight for meals and always in sight to remember to throw in the backback as he'd head off to school or out of the house for anything else. He was diagnosed T1 at age 10, is now 20 and I could count on one hand the missed doses in the past 10 years. I could also count on one hand the number of times that his test kit has been forgotten at school or left in the car, at the end of the day. When you have a good visible place to put it everyday at home, it will rarely be forgotten. At age 19, he had to add in an ACE inhibitor as he was continually showing too much protein in random urine tests, so that has added a pill to his daily routine. Once a week I fill a seven day pill container for him, that is set on the counter, by his test kit. If you need meds at different times of the day, they also have small containers that cover 7 days, with separate slots for up-to about six different meds. It shouldn't be a struggle turning good care into a lifelong habit. You just need to figure out a system that keeps what you need to manage that, in sight.

17

Interesting responses.... but I don't agree with all of them. This disease stinks, and so whatever you can find that WORKS BEST FOR YOU is the thing you should go with. Officially, basal and bolus is a more fine-tunable treatment plan and should give you better results, but if you miss injections frequently for whatever reason, and you were doing better with the 70/30, go back to 70/30!

To that end though, there's way to make injections less trying and easier, so figuring out WHY you miss them might be a more worthwhile effort than switching routines again. If its because you just don't care or can't be bothered, that sounds like burnout to me and I'd suggest books like "The Born Again Diabetic" by Will Dubois, or "Diabetes Burnout" by William Polonsky.

If you don't like the basal/bolus routine because it seems ineffective, I'd suggest "Think like a pancreas" by Gary Schneider or "Using Insulin" by John Walsh. (I know my biggest deterrent to good care is when I feel like it isn't making a difference anyway, so why bother!) These books both offer tips on how to figure out what to adjust and when and how to make it work better.

If you miss injections because you hate doing it in public, there's a couple ways and tricks to be more discreet and finding sites that are publicly injectable without drawing attention can help too. (Back in the day before I got a pump) my go-to injection spot was the back of my arm, UNLESS we were at a restaurant and then I used my thighs because from most vantage points nobody could tell what I was doing (except whoever was sitting next to me, but that person usually doesn't care).

There have been some good suggestions about making your stuff more visible- the counter on the corner and pill boxes for organization. To that I add that you can/should mix and match cases and containers and bags until you find something that suits you better both in terms of functionality, usability and even style. I throw away the cases that most glucometers come with and I keep stuff in camera cases, altoids tins, lunch boxes, electronic cases, toiletry bags... anything but what the manufacturer provides! I'm a lot more likely to carry around what I should be carrying around when I get to pick how its carried.

Where my main departure from everyone else's thinking though is that I don't agree that you have to choose to take care of yourself. Its a choice you get to make every day, multiple times a day, and you don't have to choose to take injections you don't like or pills that taste bad.... You don't have to choose to test before every meal, or 2 hours after, or even just once a day if you don't want to. The catch though is that you have to recognize that in making those decisions not to care, or even in failing to make a decision (which is a form of decision in and of itself), that you are choosing to die a long, slow, ugly death and you need to be able to (in my opinion) tell your close friends and family that this is your decision, you're tired of dealing with it and you're consciously choosing the painful but easy way out; you're sorry for the pain it will cause them, but you just need to be done with this. Then stop making appointments with your endo, and don't start new treatments and don't submit insurance claims for upcoming problems.

I believe 110% that people should be allowed to make whatever choices they want, but with that choice comes responsibility and acceptance for any consequences thereof. No one else can or should make you feel bad about making your choices, but you have be certain that you accept the consequences, even if those consequences aren't what you expected or anticipated. If you can't do that, then you're making the wrong choice and you need to reconsider what it is you think you want....

18

I'm on a pump, so insulin is always with me! When I was using pens, yes, I threw them in my purse when I left the house. I wouldn't leave insulin in my purse permanently as it could get too hot and it expires, but you could certainly keep extras say in a fridge at work so you wouldn't get caught without if you forgot to throw yours in your purse when you left.

The pill boxes I use (mine are two times a day, but there are definitely 4 times a day boxes) can be taken apart so you can take say Tuesday with you if you'll be gone all day, but then you reattach it. I wouldn't use different pill boxes as that would lead to forgetting or duplicating, but just take what I need when I go.

19

This is a game played by way too many T2's. I played it very successfully for many many years, the funny thing is that no matter how successful I was at the game I was never a winner. Contrary to popular belief amongst some of the T2 crowd T2 is not a disease that you can ignore.

I was the worst ever, if you read this blog post Ten Rules For Screwing Up Your T2 you will realize just how bad I was. But I turned myself around and you can too. If I can anyone can, its just a matter of making your T2 treatment a priority in your life.

I know you can do it, come on and join me.

20

Not available at my public library but I will keep looking - thanks.