Diabetes Talking

Question:

Harsant) writes: If the UL does last about 24 hrs, then it doesn’t matter much which one you vary, since its activity level does seem to be fairly flat.

     I don’t entirely agree with the foregoing.   While the activity curve is certainly much flatter than NPH, there is some diminution of activity toward the end of the 24 hour activity curve, or, at least, there is in my case.  I take 14 units of U daily  to cover basal insulin needs.  I used to inject in 2 7 unit doses, one befopre breakfast and the other after dinner.  To deal with a distrubing tendency to go hypoglycemic at about 3 am, I first moved the evening injection to bedtime and later increased that injection to 10 units while decreasing the morning injection to 4 units.  That solved the problem which indicates to me that there is some difference in the activity level of UL over time.  (YMMV, However) IDDM, dx’d 6/72, MI (R, H & U)

Response:

You have a 1:1000000 MD, he’s smart enough to understand what diabetics are trying to get Lilly and Novo to accept.

My doc said that the old pork Ultralente actually DID last the 24 hrs or however long it was supposed to last but the Human U does not. Beanie Type 1  

Response:

[...] amount of basal is high, but I am pretty inactive right now..but am working on it.  I have been most of the summer..they eyes got pretty bad earlier in the year, and had to honestly restrict

yeah, sounds high to me.  I’m 77kg (about 170 lbs or so) and I take a single basal UL of around 30U (compared with 14  and 8 when I was using 2 shots of NPH) when not being super active.  UL supposedly takes about 6 hours to begin working, and stays in for about 24hrs after that, so if it were me I’d check my timing, but probably just reduce both a little. I’ve heard (read?) many people say that they find UL lasts significantly less for them, but for me,  I find the main variation is more along the lines of variable intensity level for the same dose.  If I have a low bg type day, it tends to last the full 24 hrs, not less. I think one of the main reasons for splitting the dose into 2 equal halves 12 hrs apart is to try to reduce the effect of apparently variable absorption.  If the UL does last about 24 hrs, then it doesn’t matter much which one you vary, since its activity level does seem to be fairly flat. Dave

Response:

- Hide quoted text — Show quoted text -Jennifer writes: ike, We have something in common…I was diagnosed in 1978 at the age of 12 (I’m 33 now). I’ve always wanted to know how other Type 1’s who are in my age bracket and diagnosed around the same time (late 1970s) are coping. I am doing very well (A1C’s always under 6.0). Have I always been adamant about taking care of myself? Well, that’s a loaded question. Actually, I’ve started to eat more like a "peasant" in the last few years. I avoid sugar at all costs today, but that wasn’t the case a few years ago. I never skipped shots or did anything to put my life in jeopardy, but I’ve come a long way. I’ve had 2 EMT experiences and the worst one was 8 yrs ago while I was shopping at the mall. I didn’t even make it out of the parking lot before I got help (BG OF 10!!!). At any rate, I’m doing much better in 1998. I’ve found that the body can be very forgiving. I would love to hear more of your thoughts and experiences. Thanks. Take care of yourself…. Jennifer

Thanks Jennifer!  In regards to your control..I don’t know you, but I am proud of ya!  You sound so much like me when I (we) were younger.  When I was in HS, I lived as though I was without diabetes, although all my friends knew I was, and didn’t mind.  I just resented the contraint the disease put on me as child, and when I got older, I was in control, and I chose to ignore the disease.  At that lengh of affliction, you don’t notice highs like you do when you’ve had it for 20 years. Now, I CANNOT tolerate a high (over 150) for anytime at all.  I feel like I imagine a period feels to a woman who has *bad* periods.  Edgy, intolerant, achy, lethargic etc.  Guess I am payin’ for the excess now.  I’m sure over time, I will get a handle on it, but it’s depressing at times, especially lately.  I tend to be hard on myself when I stray from the low carb thing that I am trying so desparatly to stay on.  Carb addiction is a real thing I am finding  I could also contribute to the overeaters thread too, as I tend to do a bit of that as well.  But my posts of late have been a bit *windy*, so I’ll stop while I’m ahead!   Take Care of U! Mike  

Response:

– Hide quoted text — Show quoted text – , but I am not sure how to adjust the U to fix it.  Due to it’s long lasting nature, Do I lower the AM, PM, both, or try 1 large does in the AM for 24 hr coverage I just saw my doc this morning about switching from NPH to U (I use Humalog for meals).  His advice was to start out with the same dosage that I  was taking of the NPH ( 20 units in the AM and 10 units in the PM).   He said that Humulin Ultralente does NOT really last the 24 hrs Lilly *says* it does.  Basically, I’m on the same amount and number of U injections as I was on NPH.  I’ve read in a few other posts on this NG that patients have lowered their Humalog dose with Ultralente.  That might be a possible solution.  This is the first day I’ve been on U so I don’t know how this is going to work out for myself.

BeanDawgs, You have a 1:1000000 MD, he’s smart enough to understand what diabetics are trying to get Lilly and Novo to accept. Dave Groves

Response:

Mike, We have something in common…I was diagnosed in 1978 at the age of 12 (I’m 33 now). I’ve always wanted to know how other Type 1’s who are in my age bracket and diagnosed around the same time (late 1970s) are coping. I am doing very well (A1C’s always under 6.0). Have I always been adamant about taking care of myself? Well, that’s a loaded question. Actually, I’ve started to eat more like a "peasant" in the last few years. I avoid sugar at all costs today, but that wasn’t the case a few years ago. I never skipped shots or did anything to put my life in jeopardy, but I’ve come a long way. I’ve had 2 EMT experiences and the worst one was 8 yrs ago while I was shopping at the mall. I didn’t even make it out of the parking lot before I got help (BG OF 10!!!). At any rate, I’m doing much better in 1998. I’ve found that the body can be very forgiving. I would love to hear more of your thoughts and experiences. Thanks. Take care of yourself…. Jennifer "We must be willing to get rid of the life we’ve planned, so as to have the life that is waiting for us."  –Joseph Campbell

Response:

Jennifer (yes, I spelled it right this time!) asked: (and I hope you don’t mind the following questions!).

NEVER mind..that’s what we are here for How long have you had diabetes and is it Type 1 or 2?

Type 1 diagnosed in mid 1976.  I’m 32. Is the retinopathy the only complication you have experienced? What is the doctor’s prognosis for your sight?

The only *major* complication, yes, however, I am showing a small amount of albumin in a 24/hr urine test.  Doctor thinks that I can keep this from getting worse anytime soon by tightening control.  The retinopathy has been pretty severe, however as I sit here, I am 20/20.  I had a Vitrectomy in November of 97, and still have trouble in that eye, and may have to have another one done, but things are stable for now.  I have had over 6000 laser spots in easch eye, so there is not much room for more.  This means that we all hope that the vessels quit growing.  My A1c’s have came down from the 9’s to the latest of 7.1.  Not the *best*, but getting better.  As Bernstein says, Normalizing bg’s will help to keep these problems at bay…I hope ‘m not trying to be a busybody. Just wondering how you cope.

Not at all!  It is easy to feel sorry for one’s self, but I try and not do that.  It is my fault I am having trouble, as I spent 20 years living as if I did not have diabetes. It is MY responsibility to turn things around.  I’m trying but it’s hard after 20 years of bad habits.  Eating is the problem with me..I like to do it!!  I’m a Micky D’s junkie!  It’s hard to get over eating like that, but I want to feel better..so the commitment is there. ooooppps…I’m rambling again..sorry!!  thanks for the question! Sincerely, Mike  

Response:

Mike, I’m curious (and I hope you don’t mind the following questions!). How long have you had diabetes and is it Type 1 or 2? Is the retinopathy the only complication you have experienced? What is the doctor’s prognosis for your sight? I’m not trying to be a busybody. Just wondering how you cope. Thanks, Jennifer

Response:

Jennifer askes: e, You’re taking a lot of NPH. Wondering if you like to snack or if you get a lot of exercise. I’m sure lifting bodies into an ambulance must get strenuous. I also assume the stress of reviving them must add to your stress level…which doesn’t help BG’s. So how do you handle it all? Jennifer

Well, right now I am on temp disability due to pretty severe retinopathy.  I don’t use NPH anymore, and have switched to Ultralente/Humalog.  I agree the amount of basal is high, but I am pretty inactive right now..but am working on it.  I have been most of the summer..they eyes got pretty bad earlier in the year, and had to honestly restrict activity untill they got the laser in, and the bleeding under control.  I am just stuck on which dose to adjust to counter the early morning lows.  And by the way..Ambulance work is kinda funny, it can be feast of famine!  Seems like either 12 hours non stop, or 12 hours sitting around watching TV  But for now, I am taking care of our 6 month old son until I can get back to work…also a bit stressfull as you parents cas vouch for.  BUT…I was only 135 2 hours after the turkey day meal!!  Not great, but considering how I ate (I deserved 1 day to indulge!) I was impressed..took 18u of Humalog to cover it, but it worked!  Thanks! Sincerely, Mike

Response:

- Hide quoted text — Show quoted text – Well, most may know that I have made the switch to U/H a month ago or so.  As a whole, things are much better, and I love the flexability I get with the U.  My dosing regimen is as such:  ~46U in the AM, and ~36U in the PM with Humalog as needed for meal coverage.  I have been doing the low carb thing, although not quite as tight as Bernstein calls for.  My problem is that in the last few days, I have been have consistant hypos in the *early* AM between 3 and 5 AM. It seems as though the longer I have been on U, the better it works, meaning that I seem to be more sensitive to it than I was when I first switched.  I think the hypos are related to basal doses, but I am not sure how to adjust the U to fix it.  Due to it’s long lasting nature, Do I lower the AM, PM, both, or try 1 large does in the AM for 24 hr coverage?  The answer would be easy if I were using NPH for basal, but with the Ultralente, I’m a bit lost as to how to adjust for hypos.  BGs are easily controlled with this regimen, but with the hypos in the AM, I end up bouncing back and forth between high and low all day after.  (Forgot the name of this effect)   I end up having 100mg/dl swings most of the day before I can get it back under control later in the day.  I know the low carb diet is part of it, I just need some direction as to how to adjust the U to eliminate the early morning hypo. Thanks in advance, and as always, Very Sincerely, Mike

Mike, You’re taking a lot of NPH. Wondering if you like to snack or if you get a lot of exercise. I’m sure lifting bodies into an ambulance must get strenuous. I also assume the stress of reviving them must add to your stress level…which doesn’t help BG’s. So how do you handle it all? Jennifer

Response:

Hi, MPompe Addtion to help from my short knowledge I tooks Double bonded chelated mineral like Chromium and Calcium and nano clustered water with 100 giga hertz vibrates resonance frequency solution to make sure to deliver to cellular level. more info please e-mail to me hope it help. Peter C. – Hide quoted text — Show quoted text – Well, most may know that I have made the switch to U/H a month ago or so. As a whole, things are much better, and I love the flexability I get with the U. My dosing regimen is as such:  ~46U in the AM, and ~36U in the PM with Humalog as needed for meal coverage.  I have been doing the low carb thing, although not quite as tight as Bernstein calls for.  My problem is that in the last few days, I have been have consistant hypos in the *early* AM between 3 and 5 AM. It seems as though the longer I have been on U, the better it works, meaning that I seem to be more sensitive to it than I was when I first switched.  I think the hypos are related to basal doses, but I am not sure how to adjust the U to fix it.  Due to it’s long lasting nature, Do I lower the AM, PM, both, or try 1 large does in the AM for 24 hr coverage?  The answer would be easy if I were using NPH for basal, but with the Ultralente, I’m a bit lost as to how to adjust for hypos.  BGs are easily controlled with this regimen, but with the hypos in the AM, I end up bouncing back and forth between high and low all day after.  (Forgot the name of this effect)   I end up having 100mg/dl swings most of the day before I can get it back under control later in the day.  I know the low carb diet is part of it, I just need some direction as to how to adjust the U to eliminate the early morning hypo. Thanks in advance, and as always, Very Sincerely, Mike

Response:

A word of caution: Switching to an H&U regimen is not just switching NPH for U.  U and NPH do not act the same or exhibit the same  characteristics.  U is usually used strictly for basal requirements on an MDI or FIT regimen. You usually have to feed NPH unless you have a metabolic requirement that necessitates an insulin peak at some time and that physiological requirement can offset the peak of NPH. A predominant Dawn Effect would be one such case. If you switch NPH for U, you will be creating a very high basal level of insulin which will result in unexpected lows, most often noticable at night where there is no CHO intake to cloud the fact that your basal is too high. On any H&NPH or R&NPH regimen, all of the H, R and the NPH provide some contribution to the basal levels.  Not so (ideally) when using U.  The U should be the only insulin providing basal needs.  The addition of H or R is to offset prandial intake, not supply basal requirements.  So doing a direct switch of NPH and U, unit for unit will NOT be good. To determine your basal requirement of U, you need to consider your total daily insulin intake and your total carb intake, and the U becomes a percentage of that daily total and your H or R dosage is then determined as a ratio of insulin/carb or carb/insulin as you prefer.  The split or non-split of the U requirement per day may depend again on basal fluctuations but is usually equalized in 2 injections, a.m. and p.m. Please consult your doctor again before doing what he said, so he understands completely what you are attempting to do.  I have seen this before when doctors have told patients to do an equal switch or for some strange reason use strictly sliding scale therapy with U and it leads to some very trying times for the individual. Hoping all works out! H&U and R&U or H&R&U are all great regimens that can lead to more freedom than you know what to do with, but they need to be administered correctly and monitored well.  The cost of freedom I suppose. Bruce

Response:

, but I am not sure how to adjust the U to fix it.  Due to it’s long lasting nature, Do I lower the AM, PM, both, or try 1 large does in the AM for 24 hr coverage

I just saw my doc this morning about switching from NPH to U (I use Humalog for meals).  His advice was to start out with the same dosage that I  was taking of the NPH ( 20 units in the AM and 10 units in the PM).   He said that Humulin Ultralente does NOT really last the 24 hrs Lilly *says* it does.  Basically, I’m on the same amount and number of U injections as I was on NPH.  I’ve read in a few other posts on this NG that patients have lowered their Humalog dose with Ultralente.  That might be a possible solution.  This is the first day I’ve been on U so I don’t know how this is going to work out for myself.

Response:

Well, most may know that I have made the switch to U/H a month ago or so.  As a whole, things are much better, and I love the flexability I get with the U.  My dosing regimen is as such:  ~46U in the AM, and ~36U in the PM with Humalog as needed for meal coverage.  I have been doing the low carb thing, although not quite as tight as Bernstein calls for.  My problem is that in the last few days, I have been have consistant hypos in the *early* AM between 3 and 5 AM. It seems as though the longer I have been on U, the better it works, meaning that I seem to be more sensitive to it than I was when I first switched.  I think the hypos are related to basal doses, but I am not sure how to adjust the U to fix it.  Due to it’s long lasting nature, Do I lower the AM, PM, both, or try 1 large does in the AM for 24 hr coverage?  The answer would be easy if I were using NPH for basal, but with the Ultralente, I’m a bit lost as to how to adjust for hypos.  BGs are easily controlled with this regimen, but with the hypos in the AM, I end up bouncing back and forth between high and low all day after.  (Forgot the name of this effect)   I end up having 100mg/dl swings most of the day before I can get it back under control later in the day.  I know the low carb diet is part of it, I just need some direction as to how to adjust the U to eliminate the early morning hypo.   Thanks in advance, and as always, Very Sincerely, Mike

Response: