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Medical Forum / Diseases and Disorders / Diabetes / March 2006Insuilin Poll - Dosing?
Kurt's poll has been fascinating reading. But one question that was left out, which is of great interest to me right now is this: If you are using insulin How much basal are you using, what kind, and how many units to you use? b. When you cover meals, what is the carbohydrate/insulin ratio you use? --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > Kurt's poll has been fascinating reading. But one question that was left > out, which is of great interest to me right now is this: > > If you are using insulin > > How much basal are you using, what kind, and how many units to you use? I pump, so I use a basal rate [with Humalog], not a basal insulin preparation. And it is set at a rate of 0.6 per hour, but 0.7 during the period of 3:00 a.m to 7:00 am to stop the dawn phenomenon, which in my case is not caused by a sleeping hypo. > b. When you cover meals, what is the carbohydrate/insulin ratio you use? 14:1 at breakfast, 15:1 at lunch, 16:1 at evening meal. You did not ask about correction boluses, and in my case 1u of Humalog drops my bg by 60mg/dl. Remeber that Humalog is 50% more potent than Regular. Ref: Dr. Bernstein's Diabetes Solution, 2nd edition 2003, page 301. Last my weight is 130 pounds, my height 5'10", and with being newly-married [second time around] I get lots and lots of enjoyable exercise >>>vbg<<< > --Jenny > > http://www.phlaunt.com/diabetes Diabetes Info > > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control > Kurt's poll has been fascinating reading. But one question that was left > out, which is of great interest to me right now is this: [quoted text clipped - 11 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control basal 16u/day ratio 10:1 except at breakfast, which is 8:1 Dave "How much basal are you using, what kind, and how many units to you use?" None "When you cover meals, what is the carbohydrate/insulin ratio you use?" lunch and dinner is 22:1 breakfast is like 8:1 or 10:1 (This is to avoid a spike; I have to eat again in an hour to avoid going hypo.) If I was ok with a big spike after breakfast and coming back to normal in 2 hours, I could get by with 15:1. -Tina > Kurt's poll has been fascinating reading. But one question that was left > out, which is of great interest to me right now is this: > > If you are using insulin > > How much basal are you using, what kind, and how many units to you use? 4 Units of Lantus, once per day > b. When you cover meals, what is the carbohydrate/insulin ratio you use? Will vary depending on my exercise and activity levels. And also time of day, but if I had to give an average it would be...20:1 Best, Kurt > Kurt's poll has been fascinating reading. But one question that was left > out, which is of great interest to me right now is this: > > If you are using insulin > > How much basal are you using, what kind, and how many units to you use? Humalog in a pump. 5 different rates ranging from .6 u/h to .85 u/h. Total basal = 17.2 units although I usually miss about 1/4 of a unit while I'm disconnected for my shower. > b. When you cover meals, what is the carbohydrate/insulin ratio you use? Breakfast - 1:12 Lunch - 1:17 Dinner - 1:13 I generally average just under 30 units a day for basal + bolus combined.  SignatureLiz Type 1 dx 4/1987 MM Paradigm 5/2005 : If you are using insulin : : How much basal are you using, what kind, and how many units to you use? Pumping Humalog, 1.75 u/hr : b. When you cover meals, what is the carbohydrate/insulin ratio you use? 1:10 which is 50% reduction of my normal because of taking Symlin > : If you are using insulin > : [quoted text clipped - 5 lines] > > 1:10 which is 50% reduction of my normal because of taking Symlin That's great news that Symlin made such a huge improvement in your insulin resistance! I'm curious, does it cause the same nausea as Byetta? --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control No nausea yet, Jenny, but I didn't have it with the Byetta either. Only a queasy feeling the first day was all. Not everyone has the nausea with Byetta, and it is only the rare ones that continue to have it. Some with the continued nausea said that it was worth it for the results they were getting from it, and by that I mean BG results. I do not pay much attention to those taking it off label for weight reduction only without concern for BG, and doing *their* share of the control by diet and exercise. Some bug me with their *free to eat as I please* attitudes. That gives the drug a bad rap, and not an accurate picture of its effectiveness. Many in our group have been able to go off other meds AND insulin, though it is meant to be used in conjunction with Metformin or another oral drug. I'm holding my breath that this is going to continue to work. I have had NO spikes today at all, nor have I had a low, which can occur with Symlin. The 50% reduction in insulin automatically goes with taking the Symlin, not that my resistance has improved. Billie, an Amylin (Symlin) research guinea pig.... :o) : That's great news that Symlin made such a huge improvement in your : insulin resistance! : : I'm curious, does it cause the same nausea as Byetta? : : --Jenny > Kurt's poll has been fascinating reading. But one question that was left > out, which is of great interest to me right now is this: [quoted text clipped - 6 lines] > > --Jenny Basal - Lantus 22 units bedtime Bolus - Breakfast & Lunch - Starlix (30 carb limit) Dinner - Novolog 4.5:1 Anon T2 Jenny wrote in message ... >Kurt's poll has been fascinating reading. But one question that was left >out, which is of great interest to me right now is this: [quoted text clipped - 6 lines] > >--Jenny I am using 24 units (0.245 units/day-kg) of Levemir as 10 units a.m., 14 units p.m. I find that shooting the Levemir as late in the evening as possible is best. I shoot 1 unit per 10 gram carb except for breakfast which is 1 unit per 5 gram. Regards Old Al >Kurt's poll has been fascinating reading. But one question that was left >out, which is of great interest to me right now is this: [quoted text clipped - 11 lines] >http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood >Sugar Under Control custom tailored to my individual needs. of absolutely no use to anyone else. SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. DISCLAIMER If you find a posting or message from me offensive, inappropriate, or disruptive, please ignore it. If you don't know how to ignore a posting, complain to me and I will be only too happy to demonstrate... . > custom tailored to my individual needs. of absolutely no use to > anyone else. The "use" is to display the great variability in people's insulin needs even among those with similar diagnoses. I have been hearing very conflicting information about what a "normal" type 1 and type 2 dose is from several sources, and was curious to see what the people here who are very involved with their own care had come up with. I suspect that type 1s whose dosing has to be a lot more carefully worked out don't realize just how generic the treatment of type 2s on basal insulin can be. Reading other diabetes boards I'm always struck at how many type 2s of all different sizes are taking doses that are either 30 or 100 units which seems to ignore human variability. I suspect a lot of the weight gain caused by insulin IS, as Dr. Biggs explained on m.h.d. due to patients having to eat to feed the generic insulin dose they are prescribed rather than having a dose tailored to their actual needs. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > > custom tailored to my individual needs. of absolutely no use to > > anyone else. [quoted text clipped - 16 lines] > they are prescribed rather than having a dose tailored to their actual > needs. That's exactly what my daughter's boyfriend has been doing for 12 years. He shoots a set amount, if he goes to high he does nothing, if he is too low he drinks a lot of real Coke or a lot of sugary food. I haven't had any feed back from him after his first visit to a diabetic clinic (in 12 years) last week. >I suspect that type 1s whose dosing has to be a lot more carefully >worked out don't realize just how generic the treatment of type 2s on >basal insulin can be. Reading other diabetes boards I'm always struck at >how many type 2s of all different sizes are taking doses that are either >30 or 100 units which seems to ignore human variability. Or maybe such dosages are dictated by human variability. I've been T2 since '72, on insulin since '99. Almost immediately, I discarded the recommended doses and experimented to find out that I routinely needed up to 30-50 times the recommended dose of Humalog. I've taken up to 300 units of Humalog over a two hour period to bring down a spike of 250, yet from '99 to '06 virtually never had a hypo. (I use no basal, just Humalog.) I gained 60 pounds the first year, and there was no additional caloric intake because there were no hypos that needed attention. >>I suspect that type 1s whose dosing has to be a lot more carefully >>worked out don't realize just how generic the treatment of type 2s on [quoted text clipped - 12 lines] > I gained 60 pounds the first year, and there was no additional caloric > intake because there were no hypos that needed attention. Richard, I just had a hypo for you, imagining a 300 unit dose!! I'm Type 1 and I remember talking to a co-worker not long after I was diagnosed. He mentioned that his father took 60 units of NPH at a time and I kept telling him that he must be wrong; nobody could possibly need that much insulin all at once. At the time I still had no clue about diabetes in general or Type 2 at all. I assumed that if his father was taking insulin he must be like me, Type 1 (although I don't know if my doctors were even calling it Type 1 when I was diagnosed). I don't even remember what my dose was then but it was nowhere near 60 units. SignatureLiz Type 1 dx 4/1987 Minimed Paradigm 715 5/2005 >I just had a hypo for you, imagining a 300 unit dose!! I'm Type 1 and I >remember talking to a co-worker not long after I was diagnosed. He >mentioned that his father took 60 units of NPH at a time and I kept telling >him that he must be wrong; nobody could possibly need that much insulin all >at once. I used to take NPH at bedtime in an effort to control dawn phenomenon, but I was up to 100 units without significant effect, so I stopped the NPH. I'm usually up several times during the night anyway, so now I test through the night and shoot Humalog as required. In February, I started using Symlin in addition to insulin and my per shot dosage is markedly reduced, commonly 40 - 60 units, unlike the 60-80 units common before the Symlin. >>I suspect that type 1s whose dosing has to be a lot more carefully >>worked out don't realize just how generic the treatment of type 2s on [quoted text clipped - 9 lines] >250, yet from '99 to '06 virtually never had a hypo. (I use no basal, >just Humalog.) Your IR has to be beyond comprehension, or your beta cells have to be totally dead to use such an amount of insulin. Any idea why so high? I didn't know there was a recommended dose of humalog. Where is this stated? Did your endo/cardiologist/GP ever run a complete blood workup to determine the effects of 300u/2hr period? I can't imagine the physical/metabolic state where 300u would do anything but saturate the blood supply. Done often enough, it has to have a detrimental effect on your entire cardio system. What is the state of your cardio system? Has your medical team investigated this need to use massive amounts of insulin? Something is out of the norms in your case. >I gained 60 pounds the first year, and there was no additional caloric >intake because there were no hypos that needed attention. I packed 15# on my butt a couple years ago in about a six week period using NPH/R in much smaller quantities. >Your IR has to be beyond comprehension, or your beta cells have to be >totally dead to use such an amount of insulin. Any idea why so high? Nope. I have several chronic ailments and they are all eccentric, running to higher than normal doses of meds. Fortunately, I have good doctors who are willing to do what works for me and not force fit me into some one-size-fits-all regimen. >I didn't know there was a recommended dose of humalog. Where is this >stated? I'm talking about the dosage my doctor originally recommended when I started on insulin. It was something like three units and I was supposed to increase it by not more than three units per day. >Did your endo/cardiologist/GP ever run a complete blood >workup to determine the effects of 300u/2hr period? No. I only took that much one time, and it was between 4:00 am and 6:00 am. >I can't imagine >the physical/metabolic state where 300u would do anything but saturate >the blood supply. Done often enough, it has to have a detrimental >effect on your entire cardio system. What is the state of your cardio >system? Excellent. I have the heart and arteries of a 20 year old (I'm sneaking up on 60.) Initially, I was on a basal of 100 units of Lantus, but when my endo saw the amount, he took me off basal entirely to protect against hyperinsulimia (and damage to my heart). The Humalog, even in huge quantities doesn't stay in my system long. >Has your medical team investigated this need to use massive amounts of >insulin? Something is out of the norms in your case. As I said, I'm out of the norms in many ways. >> Your IR has to be beyond comprehension, or your beta cells have to be >> totally dead to use such an amount of insulin. Any idea why so high? [quoted text clipped - 33 lines] > > As I said, I'm out of the norms in many ways. I read a case history online where someone had the same kind of response to insulin you report. The explanation was that they had developed antibodies to insulin. If I recall correctly they were taking 500 units! Over time, however, the antibodies faded away. Is it possible you have a condition that would cause your body to overproduce antibodies in that way? --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >I read a case history online where someone had the same kind of response >to insulin you report. The explanation was that they had developed [quoted text clipped - 3 lines] >Is it possible you have a condition that would cause your body to >overproduce antibodies in that way? I suppose, but I have so many chronic ailments (all more or less autoimmune disorders) that demand so much effort to just keep up with that I have no inclination to pursue it. Jenny, Wonder if it would be an autoimmune condition? It is the autoimmune diseases that has led me to this point. With the autoimmune diseases, and the meds required to *try* to control them as much as is possible, it is a real struggle to get a handle on the BG. You'll be interested to know that *so far* with the Symlin my insulin requirement has dropped considerably, though I still do not have my bolusing worked out exactly yet, to cover any later spikes. Seems like all I have to do now is to figure out when my carbs hit. This is so much easier to do with the pump than the DMI. It's almost like have a pancreas, albeit a little sick one right now until I figure it all out. :o) : I read a case history online where someone had the same kind of response : to insulin you report. The explanation was that they had developed [quoted text clipped - 3 lines] : overproduce antibodies in that way? : : --Jenny >>Your IR has to be beyond comprehension, or your beta cells have to be >>totally dead to use such an amount of insulin. Any idea why so high? [quoted text clipped - 28 lines] >to protect against hyperinsulimia (and damage to my heart). The >Humalog, even in huge quantities doesn't stay in my system long. I was just wondering how far your doctors investigated the reason why you were able to safely use 300u humalog. Humalog is potent stuff, and there has to be something unique about you that is preventing the insulin from putting you on the floor or hospital. Maybe Jenny's antibody idea exists, but I would think something is errant why your medical team did not look deeply into why you could use 300u and be around to tell us about it. >I was just wondering how far your doctors investigated the reason why >you were able to safely use 300u humalog. Not at all. > Humalog is potent stuff, >and there has to be something unique about you that is preventing the >insulin from putting you on the floor or hospital. Maybe Jenny's >antibody idea exists, but I would think something is errant why your >medical team did not look deeply into why you could use 300u and be >around to tell us about it. I find doctors don't generally have an abundance of curiosity. My endo knows from years of experience that I tolerate huge dosages, so doesn't really care why. He says it's just part of my unique condition. > I find doctors don't generally have an abundance of curiosity. My endo > knows from years of experience that I tolerate huge dosages, so > doesn't really care why. He says it's just part of my unique > condition. Have you ever thought about using U-500 insulin? I know it's only a Regular formula and therefore not as fast as Humalog, but you'd be injecting a much smaller volume. SignatureLiz Type 1 dx 4/1987 Minimed Paradigm 715 5/2005 >> I find doctors don't generally have an abundance of curiosity. My endo >> knows from years of experience that I tolerate huge dosages, so [quoted text clipped - 4 lines] >formula and therefore not as fast as Humalog, but you'd be injecting a much >smaller volume. In the last several months, three new treatments have appeared: Apidra as a substitute for Humalog, Symlin as an adjunct, and Byetta as a substitute. I was on Apidra for three months and found I used a lot less, but at the end of three months my A1C was unchanged at 6.9, where it's been for years. I'm now two months into using Symlin and again am seeing dramatically lower insulin usage. In another month, I'll get another A1C. Regardless of what that says, I'll probably try Byetta for three months, then decide which to use on a regular basis. On Sat, 25 Mar 2006 00:53:48 GMT, Richard Evans <infodex@mindspring.com> Huffed and Puffed the following into the madness of usenet: >>I suspect that type 1s whose dosing has to be a lot more carefully >>worked out don't realize just how generic the treatment of type 2s on [quoted text clipped - 12 lines] >I gained 60 pounds the first year, and there was no additional caloric >intake because there were no hypos that needed attention. no oral anti resistance meds? SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. DISCLAIMER If you find a posting or message from me offensive, inappropriate, or disruptive, please ignore it. If you don't know how to ignore a posting, complain to me and I will be only too happy to demonstrate... . >>I gained 60 pounds the first year, and there was no additional caloric >>intake because there were no hypos that needed attention. > >no oral anti resistance meds? Glucophage. Possibly one other back then. I don't recall >> custom tailored to my individual needs. of absolutely no use to >> anyone else. > >The "use" is to display the great variability in people's insulin needs >even among those with similar diagnoses. remember the sazki or whatever spelling of the idiots name, who self prescribed and misdeed their insulin? >I have been hearing very conflicting information about what a "normal" >type 1 and type 2 dose is from several sources, and was curious to see [quoted text clipped - 11 lines] >needs. >--Jenny I don't doubt Dr Biggs on this one. What gets me is that so many non-endos will prescribe a type 2 insulin and at the same time take them off of the anti resistance meds they were taking. The resistance does not go away simply because they started insulin or because they have lost some or all insulin production and must inject insulin. SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. DISCLAIMER If you find a posting or message from me offensive, inappropriate, or disruptive, please ignore it. If you don't know how to ignore a posting, complain to me and I will be only too happy to demonstrate... . > What gets me is that so many > non-endos will prescribe a type 2 insulin and at the same time take > them off of the anti resistance meds they were taking. The resistance > does not go away simply because they started insulin or because they > have lost some or all insulin production and must inject insulin. DH doesn't do computers so I monitor this group for him. His endo recently took him off his orals because metformin is contra to congestive heart failure. He was severely insulin resistant after 24 years of T2. He also is a cardiac patient having had bypass surgery twice (1981 double and 1994 triple). His heart functions at about 35%. It was rough going until the basal doses kicked in (took about 3 days to circulate) but he is in the best control he's ever been. (Special thanks to Jenny of this group who gave me much needed support when we were frightened. ) He is on Lantus and Novalog. He is doing so well that he's just been approved for a pump. There are some T2s that simply can't take the orals because of other considerations. (It is not unusual to have a T2 with attendant cardiac issues.) It was Avandia, prescribed by an ignorant GP, that put him into CHF a few years ago. We work closely with the Endo, Educator and Cardio. The Cardio thinks the pump is ideal for cardio patients and feels it will help protect him. I still keep in touch with his former dietitian and just sent her a URL for a complete listing of vitamin K content of foods. (He's on blood thinners, too) She is a great source of support. Sometimes there are attenuating circumstances. Signature----------- Janet Wilder the basal doses kicked in (took about 3 days > to circulate) but he is in the best control he's ever been. That is wonderful news! I am so glad to hear he finally got the basal working and is doing so well! --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > I don't doubt Dr Biggs on this one. What gets me is that so many > non-endos will prescribe a type 2 insulin and at the same time take > them off of the anti resistance meds they were taking. The resistance > does not go away simply because they started insulin or because they > have lost some or all insulin production and must inject insulin. Taking type 2s off their IR meds makes no sense! If that is happening it must be because family doctors are so used to prescribing sulfonylureas, which you should quit when you go on insulin, that they don't understand that the newer Type 2 drugs work differently. My experience with docs has been that quite a few are painfully ignorant about how the meds they prescribe actually work. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > My experience with docs > has been that quite a few are painfully ignorant about how the meds they > prescribe actually work. > > --Jenny And with your non-qualifications you think you know better? >> My experience with docs has been that quite a few are painfully >> ignorant about how the meds they prescribe actually work. >> > And with your non-qualifications you think you know better? Given her focus - OF COURSE! How much time do you think a medical student gets devoted to diabetes and diabetes drugs, and how much time they can devote to keeping up to date once they've qualified? I'm damned sure I know more than my GP about T2 diabetes. I've spent a considerable amount of time reading up on it since dx! Nicky. SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg >How much basal are you using, what kind, and how many units to you use? 30 units of Lantus >b. When you cover meals, what is the carbohydrate/insulin ratio you use? 2-5 carbs per unit Apidra Hans, T2 since 1990, Germany Apidra & Lantus > How much basal are you using, what kind, and how many units to you use? > > b. When you cover meals, what is the carbohydrate/insulin ratio you use? Basal: NPH 14/7 (soon changing to Levimir - will be 60% or so of NPH dose QD) For meals: Novolog 15:1, usually. But if numbers are low and I'm having a low carb meal, I'll exercise a bit more or have a shot of scotch to cover the carbs. (Haven't quite got medical clearance for my homeopathic single malt diabetes prophylactic treatment, but I sure have been happier since adopting it!) (Haven't quite got medical clearance for my > homeopathic single malt diabetes prophylactic treatment, but I sure > have been happier since adopting it!) If you can find a way to get your insurer to pay for the single malt diabetes prophylactic treatment, do let me know. SMDPT costs about the same as most of the drugs they will pay for and has quite a few mental health benefits the others do not. <g> --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control |
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