now on insulin

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uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 6/11/2010 5:59 PM (GMT -7)   
I went to see the endo this past week...he put me on Novolin 70/30 3 times a day...and Novolin R once a day. Here is the regimen...Novolin 70/30: 50-0-50-50...Novolin R: 0-50-0-0. I was used to my blood sugar being anywhere from 220-360. sometimes it would go down to 180. Now, since I've been doing this it's been as low as 74 and the highest was 249....but mostly it's around 115. My body doesn't know how to handle this!!! I feel dizzy, and honestly kinda retarded..... THis is day 3...how long until I get used to this?

me
Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Metformin ER 500 mg. X 2 @ bedtime
Novolin 50-0-50-50
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?


LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 6/11/2010 6:24 PM (GMT -7)   
Your body was so used to the extremely high blood sugar that it may take awhile (days? a  week or more?) to get used to being at normal or near-normal blood sugar.  Please be patient.  You know that high blood sugar over a period of time can cause damage to some organs, so whatever you need to do to get it under control is important.  It's a relief that you've finally seen an endo.  And remember that you can help the numbers by a reasonable diet.  Good luck.
Lanie
 
forum moderator - diabetes
diabetes controlled so far by exercise and a low/no carb diet


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 6/12/2010 8:02 AM (GMT -7)   
Lanie hit it right on. Your body is getting used to more normal BGLs and you'll feel kinda "low" until it's levelled off. I promise you it will eventually pass and you'll find you have more energy and generally feel a lot better - it differs for all of us. Sometimes there's a bit of trial and error with meds/insulin but you'll get into the right regimen for you soon. It is a process so, patience and perseverance go a long way :-)


Good luck and I'm glad you're in the hands of an Endo now.
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 6/12/2010 11:58 AM (GMT -7)   
Thanks so much... I know that it will take time, it just is so overwhelming. I really wish I had seen this Dr. when I was first diagnosed last March, 2009. I think it would have been better. But, I'm here now. My Primary Dr. (God love him) is so Whacky...but he's a good fit for me. Or at least I thought so. It got so weird with him concerning my Diabetes that I didn't think he knew what he was talking about. So, going from all those pills to all these shots is just a bit much. But I am already noticing that I sleep better. And it is forcing me to eat on a schedule, something I didn't do before. I have to get up early take my shot, wait about 30 min. then eat breakfast. Then I have to wait a few hours take my Novolin R, wait and eat.....and so on and so on. The only thing that worries me is that at bedtime I do my shot then go to bed... I'm scared that my sugar will drop while I'm asleep and I won't know it and something bad will happen... the other night I stayed up after my shot and a few hours later my sugar was at 64.... that's the lowest in my entire life!!! I was scared and had my mom get me some yogurt...

Me.
Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Metformin ER 500 mg. X 2 @ bedtime
Novolin 50-0-50-50
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 6/13/2010 9:47 AM (GMT -7)   
When I was first diagnosed, it was as a type 2. Ever increasing meds, over the course of almost 2 years, with little to no effect on my BGLs saw me frustrated, confused, and feeling like cr*p all the time. I was following diet instructions from hand-outs and my GP and thought myself a model student for eating all the right things. I thought I was pretty knowledgeable then. In retrospect, I was pretty ignorant.

18 months later, my doctor was just as frustrated and eventually sent me to an Endo. When I saw him in Sept., he told me he thought I was a "wolf in sheep's clothing" and might actually be a type 1. Long story short, my pancreas finally went kaput and I started insulin replacement therapy that January. All meds were stopped and I started with 70/30 two times a day. A few weeks later, moved to NPH. A few weeks later I started adding Rapid insulin with meals (1 unit). Learned how to count carbs and saw a dietician. Moved from NPH to Lantus. Learned my correct basal/background insulin requirements and my insulin to carb ratios for each meal/snack, as well as how to add correction dose for high BGLs.

I also realized that I was the only one capable of managing my body. Scary thought but, I was the only one who'd be around 24/7, to do the calculations and injections and ensure that I function optimally (or at least stayed alive :-)

This is the point where I started to read forums and "experiences" from other diabetics. I learned pretty quickly that there's a reality for diabetics and the majority of it DOESN'T come from ADA/JDRF, the Food Guide, or any recipe or diet books geared towards "diabetics". People who have the D aren't generally politically motivated like so much of the dogma that's out there so, I found them to be a great source of information. The more I read, the more I wanted to read... about diabetes, how the body functions, nutrition, you name it - I read it. The biggest revelation to me was FOOD! I digress...

It is unnerving to find yourself at a 64 when you've been so used to much higher numbers. (I understand that - still occasionally go there myself :-) Given that it was before bed, I'd have eaten a yogurt or something, too. 50 and under is considered a "hypo" (or hypoglycaemic episode) and when you want to "fix" with sugar. One thing you may want to do is test your BGL at 2,3,4 in the morning - just to see what you're at. Might give you some peace of mind, not to mention some valuable info for your log book :-)

One of the things you might want to search on is "insulin action profile". It'll give you the info of how long each takes to work, when they peak, and how long they last, relative to when injected and what the dose was. This info is invaluable for the timing of meals and snacks (and when a potential low could happen overnight). I do hope you're keeping a logbook :-)

All this just to say.... hang in there. We're here for ya:-)

Cheers,
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 6/14/2010 8:31 PM (GMT -7)   
Wow, Thanks for the info. Being as high as I was and then going to 62 is a sobering experience to say the least. When I went to the Endo he said that even though I was DX'ed March 09 I may have been Diabetic for as long as 10 years before that. He also said that having Diabetes isn't just a numbers game, that it effects the kidneys, liver, heart, and other organs... he is concerned and will be running many tests over the next few weeks. I am more scared now then I was before.

I was taking Metformin ER and Glipizide along with Lantus at night. They did nothing but make me sick...never changed my levels at all. Now I went from that to this and I am so scared... The insulin I take (Novolin 70/30, Novolin R) really dropped it. I take the Novolin 70/30 before breakfast, before dinner, and before bedtime...and the Novolin R (fast acting) before lunch. It really hits me about an hour and a half after I take it...my hands start shaking, my heart starts beating in my throat, and I feel loopy...mostly when I take the R shot. I've tried eating lifesavers and drinking soda but that seems to take forever....then I panic and it makes it worse.

Tomorrow night I have my Citizens Police Academy Class (a firearms simulator) and it will be the first time I have to worry about taking my insulin while I'm out. It is from 5:30 to 8:30...so I'll have to take the shot then eat. Since I've only been doing this for a week I don't have a routine yet. This is the one time that I Do Not Know What I am doing. How do I get a routine? What should I carry with me? Should I get a "bracelet", a kit to carry my supplies with me? I need advice and I need to hear from everyones experiences.

Me.
Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Metformin ER 500 mg. X 2 @ bedtime
Novolin 50-0-50-50
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?


Chaul22
Regular Member


Date Joined May 2010
Total Posts : 200
   Posted 6/14/2010 10:15 PM (GMT -7)   
I'm type 1, but I can tell you about some of my habits.

Measure your blood glucose when your hands are shaking like that. The doctor might tell you to lower the dose a little bit. It's better than going wildly up and down with blood glucose. The optimal situation would be a predictable curve during the day with some target values.

A bracelet would be good to carry with you if you go to a place where no one knows. It's tricky when going to a restaurant as you don't really know how quickly the food arrives or how big it is, so you don't know when to take the insulin. I used to go to a toilet to take the insulin just when the food arrives or during the eating. Somehow it's easier for me to inject out of sight and then I would know is it safe to take the whole dose or did I somehow manage to order the salad plate again..

Personally I only a carry a rapid acting insulin pen with me during the day to work. I put it in a coat pocket, back bag or a small waist bag depending on where I go. I heard these bags are "unfashionable" but I don't care, they are practical. If you have the space, a blood glucose meter helps, especially when you are new with this. I only take the other insulin pen with me if I stay overnight. You might also consider taking some sort of snack bar or two with you, or just glucose tablets, if you get the shakes you mentioned and they are because of lows. Extra needle or two for the pen for safety - it's not fun if you have the pen, but you can't get anything out of it because the first needle clipped or something.

I can't think of anything else to take with you and it depends on what you need. The pen with a new needle is minimum of course. Extra needle, bracelet, snacks. Maybe a glucose meter, if you think it's necessary. A pocket, bag or purse to carry that stuff in.

I haven't really had big problems as the restaurant sized portions are usually big enough. Typically, they also tempt you with desserts, but I don't what kind of meal you are having there.

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 6/17/2010 9:52 PM (GMT -7)   
Thank you Chaul22,
When I was taking the Lantus at night I used a pen...But with this insulin I use syringes. I had my first "Oh what do I do" moment. I was going on a ride a long with the police...I am in a Citizens Police Academy class and we have to do it for an 8 hr. shift. I knew I was going to be gone all day and I brought both insulins (Novolinand Novoilin R) and several syringes, cokes, water, yogurt, a banana, some life savers)...all of this along with my meter in a little cooler with ice things to keep it all cool.... I was scared...It ended up that they needed me to re schedule so I licked out. But I think I was prepared.....ha ha

The bracelet thing I think I need. I'm scared now that my numbers are getting lower.

I have a question....I have been on this insulin for a little over a week..at first my numbers dropped like a rock. Now not so much....Will I need to go UP on the dose? Will I get used to it? Will I have to increase?

Me.
Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Metformin ER 500 mg. X 2 @ bedtime
Novolin 50-0-50-50
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?


Chaul22
Regular Member


Date Joined May 2010
Total Posts : 200
   Posted 6/18/2010 6:48 AM (GMT -7)   
Not knowing much about your insulin (all brand names are a little different over here), there shouldn't exist any factor that lowers effectiveness over time with insulin like maybe with some other drugs to my knowledge.

What can happen is that the absorption rate or something is lowered because of injecting in the same spot over and over again with possibly even a used needle (I do that all the time, bad). The skin could change, tissue would get thicker and harder in some way, making it more difficult for the insulin to get to the blood stream effectively or something like that. Another possibility is that cholesterol has gotten higher. But, neither of these things can happen within a span of one week. The point is that there are so many things affecting the blood glucose that all you can do is look at a long term average, say before and after meal, see how you did and then make a conclusion. Could be, that the next day it drops a little more again, but it may not be just the insulin. Sounds like a good thing that the levels are not dropping like a stone. Maybe it evened out a bit, but somehow I doubt it's going to become less effective as long as you change the needle and vary the spot enough.

It's true that I seem to have personally steadily increased the dose of insulin over the years, but that's because I was still growing and I gained weight. Now I'm afraid I'm having to increase the dose in my adulthood because I may have developed a little bit of insulin resistance over the years. Note, years.

Heh, banana is a good snack. Lately I've carried with me these candy bar looking things, except that there is nothing sweet or chocolatey in them. They are mostly a mix of barley, apple and raisin etc.

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 6/18/2010 10:45 AM (GMT -7)   
I'm back! (Didn't have a computer for a few days :-(

You ask some good questions, Me, unfortunately, most don't have a standard answer.

One thing about Diabetes....it's progressive. It doesn't just happen overnight (except for maybe Type 1's). The symptoms of high blood sugar aren't readily apparent and it usually takes sustained, high blood sugars to start affecting the body enough for systemic problems to show up (eyes, neuropathy, etc.). Most of us diabetics found out we were "D" because we went to the doc for something else and some common blood work showed high BGLs. Most of us find out that we've probably had a wonky metabolism (high blood sugars) for quite some time once diabetes is diagnosed. Those who catch it in the early stages (pre-diabetes) have the best chances of turning the tide in their favour with some lifestyle changes.

Don't be worried about the tests the Endo wants to run. He wants to establish your profile and get a full set of baseline numbers. Your cholesterol, glucose/insulin, liver, kidneys, thyroid, vitamin/mineral levels... are just some of the basic things they like to know. He's put you on an insulin regimen and the only way he'll know how it's working is to keep checking these things. Get used to these levels being checked every few months; until your BGLs settle into the regimen for you. Most of us are checked for these things regularly, because we're diabetic (regardless of what type/stage we're at).

Your doctor should be accessible to you on a regular basis, while you're starting an insulin regimen. He's the one who should tell you to alter your dose(s), based on the info you provide. Like Chaul says, test yourself when you get the shakes. You could be high, you could be low. While you're on the roller coaster for a bit, you may want to get used to doing a bit more testing than usual. Is your Endo planning on keeping you on this insulin regimen? Or maybe this is your introduction (to insulin) and he plans to move you to one of the newer ones? I ask only because, in my case, I was put on the 70/30 just to get me started but, it was only until my appointment with a CDE (Diabetic Educator). I knew I would be changing my regimen. When's your next appointment? Did he ask you to keep a log book?

Try not to get too freaked out at the lower numbers. I did, too, at first and subsequently ate myself to high BGLs all the time until I was told to try not to "fix" (with 15 grams of fast-acting carbs only), until I hit 2.8/50 or lower. Kinda hard to get & keep BGLss in the normal range when I'd eat 30 grams of carbs when I hit a normal 6/106 :-) It's hard to put up with the shakes & sweats of FEELING low but, try not to fix it unless you are (test). The more you're in the normal range the less you'll feel "wierd" being in it :-)

I didn't get a bracelet right away, (maybe denial?), but I did within a couple of months. I think I went to a washroom the first couple of times I went out with my insulin but, now I inject wherever I happen to be sitting. I was conscientious the first couple of times but, quickly realized no one was even paying attention to me (this was in a food court). Just me but, I think washrooms are the worst place to inject. I don't concern myself about what other's who might see me would think. I doubt if anyone seeing you inject at a restaurant would think you were shooting something illicit into your belly.

I never go anywhere without my meter and Rockets (Smarties in the US). I only take my insulin if I'm going to need it while out. I carry my insulin case(s), meter, sugar, with extra strips & lancets in the meter case and extra pen tips in my insulin case). I carry it all in a purse or fanny pack or pocket depending on what's required.

Sorry for the novel :-)
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 6/18/2010 11:36 AM (GMT -7)   
Just wanted to add..... the reason your numbers dropped so quickly, Me, is because your body was finally getting what it needed - insulin :-) That you've been on it a week is a good thing to see that you're starting to level off. Your dose could go up, down, stay the same, sliding scale.... your Endo decides that. If you're hitting hypo (below 50), call him and let him know.

With your insulin profile, you should know (especially for the timing of food digestion - meaning, your meals should be timed and proportioned to coincide with the onset & peak of when & how much you inject)...

Novolin R: is a regular or short-acting insulin. It starts to work in your system (onset) within 30 min - 1 Hr. It peaks between 2-5 hours and lasts (duration) 5-8 hours.

Novolin 70/30: is a pre-mixed insulin with 70% of it being intermediate-acting and 30% short-acting. It works within 30 minutes, peaks at 2-12 hours and could last up to 24 hours (though usually doesn't for most).

The ranges vary so much because it depends on dose and of course, the individual :-) Again, your Endo should be explaining this stuff to you or setting up a referral to an Educator or Nurse to assist you.
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 6/18/2010 11:39 AM (GMT -7)   
Whoops... meant to share this link (Brands & Types of Insulin and their Profiles):

http://diabetes.webmd.com/diabetes-types-insulin
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 6/21/2010 6:08 PM (GMT -7)   
I would like to add that the information you have received is EXCELLENT! This is why our forum is so valuable. I'd like to hang on to this post for a while and even bump it for any new Type1's we get.

Oh, and welcome Chaul! Glad to make a new friend but sorry for the reason.
~ Jeannie
Moderator for Fibromyalgia and Diabetes

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