[Previous Months][Date Index][Thread Index][Join - Register][Login]
  [Message Prev][Message Next][Thread Prev][Thread Next]

[IPk] Re difficulty with glargine and humalog and Pump or new insulin

I feel your mother was right even if glycaemic values would indicate otherwise
re rice and pasta etc.  These meals are usually in the evening and my
overnight bs tend to be low normally waking bs often only just 3 but start to
rise quickly as soon as I wake ie an hour later if I have still not eaten or
taken any short acting insulin it will go up to 6.  However, if I have had the
above type of meal and don't have an extra bolus my am bs will be 6-8 on
waking.  In fact I do find splitting the humalog and having 1/2 before and
then another bolus an hour later works but its remembering as I am sitting
down to such a meal, I've often jabbed the bolus in before I've thought!!

My consultant has been lovely and fully supports me going on the pump
following me writing a detailed reasoning letter to him.  I think he has done
some reading since I last saw him.  There seems to be a bit of confusion as to
who should do the application to the PCT.  He is writing to my GP with his
full recommendation and support.  But he feels it will be the GP who needs to
put the application in.  My GP who I've now had to educate in the advantages
etc of pump therapy obviously has very little knowledge but will support the
consultant, feels it will be up to the consultant to make the application!!
I've left a letter to the Chief Executive of the PCT with my reasoning etc.
with the GP so he knows what it is all about and hope he includes it. He is
waiting to hear from the consultant so I guess I will have to wait for them to
sort it out.  My GP's knowledge on diabetes is quite dated I think but he was
willing to listen.  He did say most people in the practice have HBA1c readings
around 10% if they have IDDM and often need oral medication as well.  I
commented it seems to be a vicious circle, more insulin, more fat cells, more
insulin resistance etc.  He seemed surprised when I told him my actual
requirements of insulin and that how even with the change from insulatard bd
to daily glargine my requirements have dropped from 18 u to 10u mimicing the
more accurate basal cover and I have noticed my sensitvity increase so that my
TDD is only about 20 - 25u was about 30u.  I think it will probably be much
the same on a pump but the huge advantage will be being able to set it
differently for sleep, shift work, exercise etc.  We can't argue the case on
high HBA1c as per NICE guidelines as mine is 6.2%.  Neither requiring 3rd
party help for hypos as I eat and test all the time if I feel slighlty odd,
tired etc etc. Feeling hypo at some stage most days is something I could do
without as it does make me anxious, particularly at work and doing NHS shifts
and needing to be on the ball constantly in an intensive care situation etc
so my consultant feels he can argue my case on those  grounds.

The new long acting insulins do not have the inconsistent absorption their
predecessors had. Also, as they last for a full 24 hours, you are, in effect,
being treated the same way as if you were on a pump as the long acting
acts as basal insulin.

Using the new insulins is a good way to get used to the philosophy of pump
management as the basal bolus system of management is being used and gets you
used to recognising the different effects of the different insulin actions and
managing insulin dosing to carbohydrate intake.  According to pump info I only
need about 1u to 20 - 25 gm of carbohydrates but while on injections I  I
actually need more insulin per carbohydrate.  The basal component for me can't
be matched as precisely as a pump can as when I was on  twice daily insulatard
I needed considerably different doses eg 1/2 the dose at night as compared to
the daytime dose.  This causes problems with glargine as I find covering 24
hours with the same amount impossible.  It means I am low for much of the
night in order to maintain satisfactory basal cover during the later part of
the day and also can't keep adequate cover after breakfast without having
quite a lot of insulin to carbohydrate which seems to make me drop quickly
later in the morning and be hypo before lunch late morning when I presume I
could have a lower basal rate. Trying the new analog insulins lets you see
what works for you.  I have been on humalog for 4-5 years and glargine for 5
months.  I find humalog works well as a bolus insulin but is sometimes too
intense for slowly absorbed carbohydrate and glargine is better in some ways
than insulatard as it is predictable but it is difficult trying to make the
same basal dose cover 24hrs.
hoope this helps.
Fiona IDDM 36yrs.
for HELP or to subscribe/unsubscribe, contact: