Re: Have you heard about Levemir?

JasonJayhawk wrote:
Hi Tom,

Are you a Type 1 diabetic? If so, you always need to have a basal
insulin working in the background. (Lantus or Levemir).

Hello Jason

Yes, Type 1 since November 1954. My first insulin was Lente (I can't
remember the maker's name). I'm afraid in those days there were no such
things as basal insulins like Lantus or Levemir. Good grief, I used to
have to boil my glass syrynge and needle every night and those needles
were expected to last at least 10 to 14 days each.

I don't know
the insulin products in your country, but I'm going to guess you are on
something that provides 70% regular insulin and 30% NPH insulin.


My present insulin, Humulin M3 is 30% Soluble (Regular) and 70%
Isophane (NPH) and I take it twice a day. So far, it has been Ok apart
from giving me a very slight pre-breakfast rise in my sugar level (only
about 2 mmo/l). Oh, and I now need to eat and also snack at regular
times thoughout the day. I can cope with that because at my age each
day tends to be very similar and routine.
..
Gastroparesis is often a blame for slow digestion of food. You can
google it for more information. There is a simple test for it that can
be done at many hospitals. I'm not saying you have it, but it's
something to consider if your digestion is taking longer than you
remember.

Yes, this is a test result I am waiting on now. Also, they think I may
have Addison's Disease and that result I should get by Thursday.


One other trick is to take your fast-acting insulin after eating. That
gives your digestion time to start up and then the insulin will kick
in.

There may not be a magic injection for your digestion profile.

Personally, when I eat foods high in protein and fat, I will need to
inject 3 or 4 hours after the meal, too. If I inject it all in one
shot just as I start eating, I will always go hypoglycemic and have to
eat glucose, and then 3 or 4 hours later, end up needing more insulin
to cover the digestion time. Therefore, I'll inject about 2/3 of the
insulin I need now, and the other 1/3 (or sometimes, more) many hours
after eating.

The only way to beat the digestion at its own game is to test
frequently. For me, this means 10+ times a day.

Yes I understand all you say. When I was on Levemir and Novorapid I had
to be careful if eating pasta as it could have that effect on me. At
the moment I test 5 times a day.


It sounds like you are on an insulin mix of 70/30. The mix provides
you with regular insulin and NPH insulin ("pseudo-basal", and I say
that because it seems to peak more randomly). It also requires that
you to eat at a specific time three times a day.

Exactly! Fortunately, much of my diabetic life has been like that so
returning to eating at specific times hasn't been so bad. Again, I
don't now have the active life I used to so it's working out OK.


I never liked these kinds of insulins because you have to live to the
schedule of the insulin. I always preferred having a basal insulin
(like Lantus or Levemir) and then a fast-acting insulin to cover both
the glucose highs and, of course, meals, so that I could decide when
and how much I eat. Some people are very happy with the 70/30 mixes,
though, but it's generally not for T1 diabetes. (My first month of T1
treatment was on a 70/30 mix of rapid and NPH, and I hated it!)


70% fast acting and 30% slow acting? This is the opposite of my regime.
But again, my food intake is so much smaller now perhaps that is why it
seems to be workign OK for me. That said, I'd go back to Levemir plus
whatever fast(ish) acting they can find for me.

The hard part about insulin management is that it never works as a
doctor plans -- so therefore, you must be your own doctor to determine
the proper dosing. Sometimes my endocrinologist just provides the
prescription and the advice, but I'm the one who has to decide how to
do the dosing.

Oh, you are so right. I remember about 25 years ago a new doctor at my
clinic telling me he wanted to change my insulin regime and that was
immediately after he praised my tight control and subsequent results
plus not having any complications (which I still don't have). I refused
to change anything bearing in mind all the praise he had just given me.
He lowered his glasses and reminded me that he knew a lot more about
diabetes than I every would. I reminded him that he didn't know 'my'
diabetes. Needless to say I never that doctor again. He was still
consulting at the diabetes centre I attended but it was always one of
the other doctors that saw me. My regime wasn't changed for at least
another 15 years.

Tom

.

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