Diabetes Talking

Question:

i just have to support every word that OldAl just stated here i was initially put on a Regular/NPH regime…… then i was moved to Humalog/NPH regime that meant 911 lunch breaks, and groping in the dark for my juice box and emergency glucose at 2:30 am every night failing that, after an adjustment to the NPH i was left with bg levels of 14 to 25…… with no rhyme or reason to the whole mess told me about the same ‘low points’ and the same problems that i had with NPH i highly suspect this fellow will find new freedom with Levemir insulin (however he will also find that he has to shoot for lunch) word from Novo is that they applied for Levemir in Dec/2001 thru Health Canada…. and they HOPE to hear back in the neighbourhood of Dec /2005 kate — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

– Hide quoted text — Show quoted text – Hi all . . .(snip). . . Couple of things he said struck me as a bit odd.  He told me that he only takes one dose of basal and two of bolus, said he doesn’t need any bolus with lunch.  When we were discussing Hba1c’s and I said mine was 5.7 he said he’d be hypoing at that level. Second thing was that he was a brittle diabetic with BGs of 20 one minute and 5 the next.  I didn’t think it was my place to say anything to him as after all, he’s been diabetic most of his life.  Anyway, I wasn’t sure what *brittle meant but I’d have thought that was just a roller coaster syndrome. . . .(snip). . . Patti    You are touching upon one of my pet peeves,  perhaps one worth a rant or two which I will try to minimize. We happen to have a 20-ish lady with that kind of erratic control in my T1 support group but because her doctor has laid down her insulin regime in stone,   there doesn’t seem to be much anybody can do to help her. She is taking our version of Insulatard (NPH) as a basal,  and attempting to get by with two shots of basal a day.   With Insulatard,  that means:     a.   You go low,  sometimes very, very low when the 4-6 hour peak hits you    b.   You tend to experience a basal fade at 10 hours or so and spike up to 16 or so    c.  If you try to increase either of the two daily Insulatard doses to try an extend its activity and avoid the basal fade spike,   you go lower into a hypo at the 4-6 hour peak.   d.  Every now and then,   you experience an anomalous "quick-absorb" from the Insulatard and the peak hits at 2-4 hours and may result in an Emergency Ambulance run to wherever you are when you pass out. That means you’re jumping all over the place every day.   This of course is your fault because you obviously must be one of those  "non-compliant" diabetics. I made our Insulatard work without all of that nonsense but it took splitting my daily into 4 shots per day.   You hardly ever hear of a T1 splitting their Insulatard that way,   though the better docs can prove that it’s necessary, http://www.medscape.com/viewarticle/440106 ". . . . .Dr. Bolli has used NPH . . . . as a basal insulin in combination with the rapid-acting insulin lispro at mealtime. Since clamp studies revealed a peak effect of NPH at 4-6 hours, Dr. Bolli instituted a 4-times-daily regimen of NPH in combination with insulin lispro. . . ." Again,  if you want a low HbA1c and are seriously insulin deficient,  you have to manage your shots very closely.  If you try to minimize the number of daily shots,  that means you will be taking all or most of your daily needs as a few shots.   That’s a recipe for daily hypos. Many doctors and many insulin-using diabetics prefer the minimum shot routines since they are very convenient.   However,  they are trading convenience for power and paying a price in HbA1c. Food for Thought:    The Insulin Pump is the best way to handle a basal. The pump I am familiar with splits the daily basal into 24 shots,  taken once per hour. I went surfing a few times trying to find out exactly what is going on with "brittle diabetics".    Never could find a good explanation though the ones I found were invariably discussing Insulatard and minimimun shot routines which in my mind disqualifies the explanation. Regards   Old Al

Response:

- Hide quoted text — Show quoted text – Hi all Today went for annual eye test/retinopathy test at Specsavers. Thankfully all was well.  The optician asked me to take a seat in the waiting area whilst he put the drops in for the retinopathy.  When he’d finished the guy sitting next to me asked if I was diabetic.  He told me he’d been diabetic for 47 years, so without thinking I said ‘Oh, you’re a T1 then?’ and continued to ask ‘What insulin are you on?’.  In retrospect it was slightly mad, and I suppose a bit personal (after all, we *are British).  Upon which he told me he’d been on Levemir for a week and I said what a coincidence I’d been on it for 3 days…. after which the conversation took off as to merits of split doses etc etc and  his wife rolled her eyes and went off for her eye test.  By the time she came back we were merrily discussing flights to Nigeria where he’d worked and I’d worked on the flights… Great guy with a great sense of humour…. Couple of things he said struck me as a bit odd.  He told me that he only takes one dose of basal and two of bolus, said he doesn’t need any bolus with lunch.

He might not – depends on his lunch. I don’t take bolus with breakfast. As for basal, if you need it twice a day, I would call it ‘intermediate’, basal IS once a day. JMO When we were discussing Hba1c’s and I said mine was 5.7 he said he’d be hypoing at that level.

Clinically he would not be hypo — though he might well feel that way. Second thing was that he was a brittle diabetic with BGs of 20 one minute and 5 the next.  I didn’t think it was my place to say anything to him as after all, he’s been diabetic most of his life.  Anyway, I wasn’t sure what *brittle meant but I’d have thought that was just a roller coaster syndrome.

*Brittle* is claimed by some endocrinologists not to exist except in the mind of someone who is having difficulties with control. The reasons might be deliberate malingering (very unlikely), unresolved denial (surprisingly common), or wrong type of insulin (might need to change species). What still keeps making me chuckle was the end of the conversation when he said ‘Lovely talking to you, perhaps we’ll see each other in the diabetic clinic’ and I replied (quite seriously) ‘Oh, I don’t go there, I’m managed by the practice nurse and a bunch of people on an internet  newsgroup’

That is a wonderful compliment! Thank you. Alan — de gustibus non disputandum est – Hide quoted text — Show quoted text – Patti

Response:

x-no-archive: yes Just read the abstract of Bolli’s research and you seem to have got the wrong end of the stick about it Oldal. Bolli is using Humalog pre-mixes and he is not trying to demonstrate the effectiveness of splitting NPH doses into 4 but the use of premixes with T1s ! Humalog is rapid acting and some T1s using it as bolus find its run out of steam 4 to 7 hours later – hence a bit of NPH to cover that in the premix ( Mix 25 or whatever ). http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd=Retrieve&db=pubmed&d…

stract&list_uids=15189747 besides which Bolli, in the ref you provided, also compared splitting NPH into four doses to one glargine basal with humalog bolus. he found glargine basal and humalog bolus better than NPH x 4 so if anyone is using NPH and contemplating switching to x 4, better just to switch to Lantus anyway ??

    My interpretation is that he is talking about a variety of things,  one of which is a    "Since. . .therefore"  cause and effect relationship on number of NPH doses,  ie.  :  ". . . .Since clamp studies revealed a peak effect of NPH at 4-6 hours, Dr. Bolli instituted a 4-times-daily regimen of NPH. . ." ". . .Since glargine is not widely available outside the United States and Germany, an available option is the use of NPH (ideally in 4 doses) supplemented with the rapid-acting insulin analogs at mealtime. . ." Especially since part of the speech lamented the peakiness and hypoglycemia tendencies of NPH. He is writing for an audience,  many of whom,  prescribe twice a day NPH. He flat-out says 4-times and tells why  (clamp studies). Basal-fade will spike you anytime,  day or night.  If the Humalog runs out of steam,  you can spike.    It became more of a problem when folks stopped using  ActaRapid type insulins with their long tails. The Lantus recommendation is more subtle than it looks.   He is presenting the docs with an option. . .1 Lantus/day or 4 NPH/day.   Since most patients are horrified at the thought of extra shots,   that is no choice at all. It’s almost Reducto ad absurdem He is advising other doctors who are little kings in their castles.  Herding cats is easy by comparison. Of course,  I admit this is am IMO so your interpretation is equally valid. Regards   Old Al

Response:

i highly suspect this fellow will find new freedom with Levemir insulin (however he will also find that he has to shoot for lunch)

He was apparently on Lantus previously and doesn’t seem to have been instructed to have a different regime on Levemir.  Reading between the lines of what my nurse said and the fact that another IDDM has been changed, I gather Levemir has been seen as the new wonder drug by the West Cornwall Primary Care Trust. I’m also surprised that he didn’t have to shoot for lunch whilst on Lantus!  I blessed well did!  Actually I couldn’t care less if I have to shoot 6 times a day if it keeps things under control! word from Novo is that they applied for Levemir in Dec/2001 thru Health Canada…. and they HOPE to hear back in the neighbourhood of Dec /2005

I do hope you get it quicker than that Kate!  Though it may not be the wonder drug.  I’m monitoring it very carefully. Patti Penzance, Cornwall On 13u Levemir and Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7

Response:

That means you’re jumping all over the place every day.   This of course is your fault because you obviously must be one of those  "non-compliant" diabetics.

Al, I have no idea how this guy controls his diet.  I got the impression that he relies on his specialist.  But I also got the impression that he’s a very intelligent man and one who not only thinks but has a sense of humour.  From that I deduce that he takes what the specialist says as gospel and just tries to get on with his life. Interestingly (do these things multiply) I have just spent the evening with some friends and their friends.  The husband of the friends of friends saw me injecting and asked how long I’d been doing it.  Turns out he is a T2 on Met and gliclazide who occasionally has hypos (which I didn’t think people on met did)  but is incredibly aware of the ramifications and complications of uncontrolled DM as his father had both legs amputated, went blind and died of a heart attack at 65 due to diabetic complications.  Oh gosh… what bliss… 2 warm bodies I can talk to in one day and the 2nd frightens me to death with complications! Patti Penzance, Cornwall On 13u Levemir and Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7

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Hi all . . .(snip). . . Couple of things he said struck me as a bit odd.  He told me that he only takes one dose of basal and two of bolus, said he doesn’t need any bolus with lunch.  When we were discussing Hba1c’s and I said mine was 5.7 he said he’d be hypoing at that level. Second thing was that he was a brittle diabetic with BGs of 20 one minute and 5 the next.  I didn’t think it was my place to say anything to him as after all, he’s been diabetic most of his life.  Anyway, I wasn’t sure what *brittle meant but I’d have thought that was just a roller coaster syndrome. . . .(snip). . . Patti

   You are touching upon one of my pet peeves,  perhaps one worth a rant or two which I will try to minimize. We happen to have a 20-ish lady with that kind of erratic control in my T1 support group but because her doctor has laid down her insulin regime in stone,   there doesn’t seem to be much anybody can do to help her. She is taking our version of Insulatard (NPH) as a basal,  and attempting to get by with two shots of basal a day.   With Insulatard,  that means:     a.   You go low,  sometimes very, very low when the 4-6 hour peak hits you    b.   You tend to experience a basal fade at 10 hours or so and spike up to 16 or so    c.  If you try to increase either of the two daily Insulatard doses to try an extend its activity and avoid the basal fade spike,   you go lower into a hypo at the 4-6 hour peak.   d.  Every now and then,   you experience an anomalous "quick-absorb" from the Insulatard and the peak hits at 2-4 hours and may result in an Emergency Ambulance run to wherever you are when you pass out. That means you’re jumping all over the place every day.   This of course is your fault because you obviously must be one of those  "non-compliant" diabetics. I made our Insulatard work without all of that nonsense but it took splitting my daily into 4 shots per day.   You hardly ever hear of a T1 splitting their Insulatard that way,   though the better docs can prove that it’s necessary, http://www.medscape.com/viewarticle/440106 ". . . . .Dr. Bolli has used NPH . . . . as a basal insulin in combination with the rapid-acting insulin lispro at mealtime. Since clamp studies revealed a peak effect of NPH at 4-6 hours, Dr. Bolli instituted a 4-times-daily regimen of NPH in combination with insulin lispro. . . ." Again,  if you want a low HbA1c and are seriously insulin deficient,  you have to manage your shots very closely.  If you try to minimize the number of daily shots,  that means you will be taking all or most of your daily needs as a few shots.   That’s a recipe for daily hypos. Many doctors and many insulin-using diabetics prefer the minimum shot routines since they are very convenient.   However,  they are trading convenience for power and paying a price in HbA1c. Food for Thought:    The Insulin Pump is the best way to handle a basal. The pump I am familiar with splits the daily basal into 24 shots,  taken once per hour. I went surfing a few times trying to find out exactly what is going on with "brittle diabetics".    Never could find a good explanation though the ones I found were invariably discussing Insulatard and minimimun shot routines which in my mind disqualifies the explanation. Regards   Old Al

Response:

Hi all Today went for annual eye test/retinopathy test at Specsavers. Thankfully all was well.  The optician asked me to take a seat in the waiting area whilst he put the drops in for the retinopathy.  When he’d finished the guy sitting next to me asked if I was diabetic.  He told me he’d been diabetic for 47 years, so without thinking I said ‘Oh, you’re a T1 then?’ and continued to ask ‘What insulin are you on?’.  In retrospect it was slightly mad, and I suppose a bit personal (after all, we *are British).  Upon which he told me he’d been on Levemir for a week and I said what a coincidence I’d been on it for 3 days…. after which the conversation took off as to merits of split doses etc etc and  his wife rolled her eyes and went off for her eye test.  By the time she came back we were merrily discussing flights to Nigeria where he’d worked and I’d worked on the flights… Great guy with a great sense of humour…. Couple of things he said struck me as a bit odd.  He told me that he only takes one dose of basal and two of bolus, said he doesn’t need any bolus with lunch.  When we were discussing Hba1c’s and I said mine was 5.7 he said he’d be hypoing at that level. Second thing was that he was a brittle diabetic with BGs of 20 one minute and 5 the next.  I didn’t think it was my place to say anything to him as after all, he’s been diabetic most of his life.  Anyway, I wasn’t sure what *brittle meant but I’d have thought that was just a roller coaster syndrome. What still keeps making me chuckle was the end of the conversation when he said ‘Lovely talking to you, perhaps we’ll see each other in the diabetic clinic’ and I replied (quite seriously) ‘Oh, I don’t go there, I’m managed by the practice nurse and a bunch of people on an internet  newsgroup’ Patti Penzance, Cornwall On 13u Levemir and Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7

Response:

- Hide quoted text — Show quoted text – word from Novo is that they applied for Levemir in Dec/2001 thru Health Canada…. and they HOPE to hear back in the neighbourhood of Dec /2005 I do hope you get it quicker than that Kate!  Though it may not be the wonder drug.  I’m monitoring it very carefully. Patti that is the VERY EARLIEST date they are hoping for IF THEY ARE LUCKY!!!!!!! sigh…… i bought enough UL to cover me for 8 more months…… then they ran version

First off, this entirely my own opinion. There is no wonder drug so far, and there never will be. Human physiology varies so much from one individual to another that wonder drugs are an impossibility. This bit is not an opinion. Approx 22% to 30% of autoimmune t1s become so because they are allergic to their own endogenous insulin. So using biosynthetically copied insulin (the same structure as endogenous) cannot possibly work for those people. I am one. Kate is well aware of my history concerning insulin shock and coma at the high end of bg. So, Kate, possibly you have an allergy not to Lilly, but to all endogenous and biosynthetic copies? And Patti, imo, I would never take any drug of any kind until it’s been on the market at least 5 years and half-a-dozen *independent* studies done. The only study on Levemir was done by Novo, and they make t’stuff. Surprize, surprize! They claim it’s good! Alan Please email me Kate, I lost your addy on one of the frequently required re-installs of wonderful Windows (twice in the last 3 days) a dot hardy2 at ntlworld dot com — de gustibus non disputandum est

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word from Novo is that they applied for Levemir in Dec/2001 thru Health Canada…. and they HOPE to hear back in the neighbourhood of Dec /2005 I do hope you get it quicker than that Kate!  Though it may not be the wonder drug.  I’m monitoring it very carefully. Patti

that is the VERY EARLIEST date they are hoping for IF THEY ARE LUCKY!!!!!!! sigh…… i bought enough UL to cover me for 8 more months…… then they ran out of

Response:

x-no-archive: yes

The web site you gave is a review symposium on Insulin analogues. One of the two review authors discloses this… Ashok Balasubramanyam, MD      Associate Professor of Medicine, Baylor College of Medicine; Chief, Endocrine Service, Ben Taub General Hospital, Houston, Texas       Disclosure: Ashok Balasubramanyam, MD, has disclosed that he has received grants for educational activities from Eli Lilly and Aventis. He has also disclosed that he is on the speakers’ bureau for GlaxoSmithKline. So he is working/has worked for Eli Lilly and hey presto he puffs a research report which claims to demonstrate an effective use of Lilly’s Humalog pre-mixes in T1 s. Money talks. In the webpage you cite Bolli is not speaking directly, Balasubramanyam is precising his results ( not that clearly ). Bolli, the researcher quoted, is justifying Humalog pre-mixes which perforce means splitting up the NPH dose. If you look at Bolli’s work you will see in the abstract I found that he is working for a body called "High Mix Group". He gave preprandial premixes (NPH/Humalog) and NPH at bedtime for 8 weeks. Then the patients switched to self mixed prandial Humalog and NPH and single NPH dose at bedtime. The results from the two groups were just about the same i.e. premixes do as good a job as self-mixes. Q.E.D. – Lilly will be pleased ! He measured outcomes in "late post prandial bgs" ( i.e. about 3 hours after ) and HbA1c at the end of the 16 week period. The ave late pp bgs was 8.9 and the HbA1c ave was 7.8. Would you be happy, Oldal, with bgs at 8.9 three hours after a meal and an HbA1c of 7.8 achieved by splitting the NPH dose into 4 ? It’s giving, what everyone would probably agree, was poor control. How can you possible argue the case that Bolli’s work proves that splitting the NPH dose into 4 works ? The patients in the trial in Italy and France started out with HbA1cs on average of 7.9. How has splitting the dose into 4 using pre-mixes improved that ?

Response:

- Hide quoted text — Show quoted text – x-no-archive: yes The web site you gave is a review symposium on Insulin analogues. One of the two review authors discloses this… Ashok Balasubramanyam, MD     Associate Professor of Medicine, Baylor College of Medicine; Chief, Endocrine Service, Ben Taub General Hospital, Houston, Texas      Disclosure: Ashok Balasubramanyam, MD, has disclosed that he has received grants for educational activities from Eli Lilly and Aventis. He has also disclosed that he is on the speakers’ bureau for GlaxoSmithKline. So he is working/has worked for Eli Lilly and hey presto he puffs a research report which claims to demonstrate an effective use of Lilly’s Humalog pre-mixes in T1 s. Money talks. In the webpage you cite Bolli is not speaking directly, Balasubramanyam is precising his results ( not that clearly ). Bolli, the researcher quoted, is justifying Humalog pre-mixes which perforce means splitting up the NPH dose. If you look at Bolli’s work you will see in the abstract I found that he is working for a body called "High Mix Group". He gave preprandial premixes (NPH/Humalog) and NPH at bedtime for 8 weeks. Then the patients switched to self mixed prandial Humalog and NPH and single NPH dose at bedtime. The results from the two groups were just about the same i.e. premixes do as good a job as self-mixes. Q.E.D. – Lilly will be pleased ! He measured outcomes in "late post prandial bgs" ( i.e. about 3 hours after ) and HbA1c at the end of the 16 week period. The ave late pp bgs was 8.9 and the HbA1c ave was 7.8. Would you be happy, Oldal, with bgs at 8.9 three hours after a meal and an HbA1c of 7.8 achieved by splitting the NPH dose into 4 ? It’s giving, what everyone would probably agree, was poor control. How can you possible argue the case that Bolli’s work proves that splitting the NPH dose into 4 works ? The patients in the trial in Italy and France started out with HbA1cs on average of 7.9. How has splitting the dose into 4 using pre-mixes improved that ?

I have no idea of what he was trying to do or why he was doing it.   I can make a few comments though:   1.  When you read the medical literature,  you often see that same HbA1c relationship,  i.e.   "A group of patients with lousy control were given experimental therapy and still had lousy control afterwards.   Therefore,  wonder drug X is acceptable." I have seen those same type results for Lantus which is doing quite well and generally considered to have been an advance in diabetic therapy. Lousy control is a function of the diligence and know-how of the diabetic as well as the efficacy of the med.   In any case,  two-NPH-per-day NPH folks often see 16+,  hours after the meal when the basal fade hits. He gave a scientific reason why,  if you feel you must use NPH,   multiple daily NPH is justified,   then demonstrated that it worked for his subjects. None of those sugars were acceptable to me,  but many doctors would be delighted if their patients could meet even those awful targets.   FWIW, my initial therapy was a self-mix,  4 NPH per day therapy.  It was considered modern, even advanced. When you consider that the average HbA1c measured in U.S. Hospital labs in 1998 was 9.3,   7.9 isn’t half bad.   At one time in not too distant history,  an HbA1c of 8.0 was considered "acceptable control".  There are still reputable medical organizations discussing targets as high as 7.5% (". . . .For each individual, NICE recommend that a target HbA1c (DCCT-aligned) should be set between 6.5% and 7.5%, based on the risk of macrovascular and microvascular complications. . . ."    Sept 2002) 2.  One of the big problems with diabetes is getting the patient to take the meds.   Pre-mix insulin is an abomination and is totally unsuited for T1. However,  the pre-mixes have one very important advantage:   if a patient refuses to take all of his shots,  it cuts the number of daily shots and gives the doc a better chance at getting the med into the patient.    That seems to be a ridiculous argument but in fact it  is not a trivial concern. Doctors do what they can with what they’ve got to work with. Insulatard (NPH) by itself is an abomination and unsuited for T1.    I don’t know why the docs still use it but that’s a fact of life which folks have to deal with.   (I asked my pharmacist about it once,   he still sells more NPH than any other basal insulin) 3.  Lilly sells pre-mixes,  Novo sells pre-mixes, CP sells pre-mixes.   I imagine the Indian and Chinese do also.    Why would Lilly be any "happier" than the rest of their competitors,  especially when,  AFAIK,  Lilly is about sold out,   selling just about everything they can make. Regards   Old Al

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. . .(snip). . . , I gather Levemir has been seen as the new wonder drug by the West Cornwall Primary Care Trust. . . . Patti

All of the other slow-absorbing, non-animal insulins  have problems with variable absorption patterns:  a little faster today,   a little slower tomorrow,  now and then much faster ( Insulatard),   and often very difficult to inject accurately  (Ultratard). That’s a recipe for hypos and the docs hate hypos.    They would often prefer that you run high bG and suffer the complications instead of the risks of hypos,   e.g.  patients in intensive care are often managed at 11 mmol/L,    many docs reject the 6.0% HbA1c target for T1 as too dangerous. Actually,  most of the folks I know on the pump switched to that incredibly expensive option because of the variable absorption-hypo problem. Levemir is advertised as a very uniformly acting insulin.   If it works out, that’s a tremendous advantage in many diabetics’ viewpoints. Regards   Old Al

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– Hide quoted text — Show quoted text – Hi all . . .(snip). . . Couple of things he said struck me as a bit odd.  He told me that he only takes one dose of basal and two of bolus, said he doesn’t need any bolus with lunch.  When we were discussing Hba1c’s and I said mine was 5.7 he said he’d be hypoing at that level. Second thing was that he was a brittle diabetic with BGs of 20 one minute and 5 the next.  I didn’t think it was my place to say anything to him as after all, he’s been diabetic most of his life.  Anyway, I wasn’t sure what *brittle meant but I’d have thought that was just a roller coaster syndrome. . . .(snip). . . Patti    You are touching upon one of my pet peeves,  perhaps one worth a rant or two which I will try to minimize.

What you said Old fella. Bittle diabetes is one of MY pet peeves too. "Brittle" diabetics are usually the ones who don’t think along the lines of adjusting doeses, timings, or anything else. I’ve met a few in my time and every single one thought he/she was unique. I actually don’t think there IS such a thing as "brittle" diabetes, just poorly monitored and even more poory controlled diabetes. That’s not to say some people don’t have a hell of a time with roller coastering BG’s, but they don’t seem to do much about them, they just accept that it’s "how it is" and they then call themselves "brittle" Beav

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- Hide quoted text — Show quoted text – snip Lousy control is a function of the diligence and know-how of the diabetic as well as the efficacy of the med. snip Pre-mix insulin is an abomination and is totally unsuited for T1. snip Insulatard (NPH) by itself is an abomination and unsuited for T1. snip   Old Al

On  the basis you recently gave of brilliant people being the ones who agree with you, I conclude that the above statements make you absolutely brilliant. (and your mother of course) Alan — de gustibus non disputandum est

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– Hide quoted text — Show quoted text – Hi all . . .(snip). . . Couple of things he said struck me as a bit odd.  He told me that he only takes one dose of basal and two of bolus, said he doesn’t need any bolus with lunch.  When we were discussing Hba1c’s and I said mine was 5.7 he said he’d be hypoing at that level. Second thing was that he was a brittle diabetic with BGs of 20 one minute and 5 the next.  I didn’t think it was my place to say anything to him as after all, he’s been diabetic most of his life.  Anyway, I wasn’t sure what *brittle meant but I’d have thought that was just a roller coaster syndrome. . . .(snip). . . Patti    You are touching upon one of my pet peeves,  perhaps one worth a rant or two which I will try to minimize. What you said Old fella. Bittle diabetes is one of MY pet peeves too. "Brittle" diabetics are usually the ones who don’t think along the lines of adjusting doeses, timings, or anything else. I’ve met a few in my time and every single one thought he/she was unique. I actually don’t think there IS such a thing as "brittle" diabetes, just poorly monitored and even more poory controlled diabetes. That’s not to say some people don’t have a hell of a time with roller coastering BG’s, but they don’t seem to do much about them, they just accept that it’s "how it is" and they then call themselves "brittle" Beav

It is more a lack of knowledge by the diabetic concerned and a simple answer used by the med team who should be looking after them and finding the solution. If you remember I was using Novarapid for a while and found I was having lows of 1.9 and 1.2 and was not going into a full blown hypo. I mentioned this to a Diabetic Nurse who explained that as I have had diabetes 48 years I was turning into a brittle diabetic and as the Novarapid had a shorter lifespan than Humalog, although I was going low it was burning up before I went into insulin shock. Sounded a reasonable explanation but sounded like bullshit to sceptic old me.So I got a load of test strips and really went to town testing I found after eating a normal meal (40grms of carb) within half an hour I could have a BG of 15 then it would dip to 8 within 2 hours, another time with exactly the same meal/insulin dose and test times they would be more normal the results were never near the same. After a while the insulin was acting really ridiculous I could not control my BG at all, no matter what I did. I went to see the doctor to go on animal insulin fully (after a quick chat with Al) to see if that would help but had to see a different doctor who would not take the ?risk? of giving me a script for a Beef insulin so I talked her into giving me a script for Humalog as that was on my repeat list, within 2 days I was back in control and had all my hypo feelings back. Job done. DaveT

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He might not – depends on his lunch. I don’t take bolus with breakfast. As for basal, if you need it twice a day, I would call it ‘intermediate’, basal IS once a day. JMO

I’ve been discussing splitting the basal dose and having two injections a day with oldal.  I’m not totally convinced of the need to split the dose for myself as 1 dose of lantus worked perfectly well, though now I’ve moved to Levemir I can see a fade at 22.5 hrs.  Even so, I’m only going up to 6.4 before the next dose.  So I’m kinda sitting on the fence. Clinically he would not be hypo — though he might well feel that way.

Yes, I did say that at one point I would be having hypo symptoms at 10 but that one’s hypothalamus(sp?) did condition one to have them at the lowest point you were used to.  I didn’t push it.  At the moment I am getting hypo symptoms at 3.8 but a while back I wouldn’t get them until I was 2. something.  If I get them at 3.8 I just have a small biscuit.  I don’t think that’s serious! That is a wonderful compliment! Thank you.

I said it without thinking…. which means that I really really meant it and I did!  You guys have totally changed my way of thinking and have educated me in a way that the local PCT would never do.  I may not be perfect, I may not have perfect control, I may wing it…. but I am very *aware of where I should be and how I might get there!  So yes, it’s a very sincere compliment. Patti Penzance, Cornwall On 13u Levemir and Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7

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