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Derek - 18 Apr 2007 18:28 GMT

Hi everyone My first post although I think I might have posted a long time
ago.
Any advice would be welcome right please. Been on insulin for 24 years most
recently Levrmir and Novorapid. HbA1C has hovered around 8- in the past
often double figures. In the past year I have managed to lose about 35 lbs
although still over 18 stone Hoping to continue weight loss Encouraged by
my diabetes dietician have been reducing Novorapid dose from 65 x 3 a year
ago to 30 each meal now. She thinks it needs to come lower in due course as
I am eating better, exercising & have lost some weight. My BGs are still
somewhat erratic with some 11s & 12s especially before breakfast even when
before bed the BG has been fine. This makes me question the Levermir dose
which is 25 @ bedtime and 15 @ breakfast. The question is -how much of
each insulin should I be taking? Is it trial & error -responding to blood
tests? I am waiting to see Specialist Nurse but wonder what the rule of
thumb for the 2 insulins might be. I usually eat about 30- 35 gms carb @
mealtimes. I have heard that some people even take Novorapid when they have
a snack. I am hoping that I might bet better results witha higher Levermir
dose as I understand that it doesn't effect weight loss. Maybe I could
continue to lower the Novorapid Sorry if I sound confused. Your help would
be appreciated. I also take Metformin Detailed advice has not been
offered to me from hospital so far. Good health to everyone-Derek

-- Derek Savage

--------------------------------------------------------------------------------
I am persuaded by the dandelion

To take the wings of the updraught

To parachute into unknown country

To fall into the ground

To be walked on

To lose beauty

To die

And give birth to a whole generation of flyers

............................

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Beav - 20 Apr 2007 23:35 GMT

> Hi everyone My first post although I think I might have posted a long time
> ago.
[quoted text clipped - 9 lines]
> question the Levermir dose which is 25 @ bedtime and 15 @ breakfast. The
> question is -how much of each insulin should I be taking?

Dek, that's a "How long is a piece of string" question. No-one knows, they
(you) have to experiment, but your morning high BG readings indicate that
you have the problem of "Dawn Phenomenon" (as do I) so when I wake up, I
immediately tak a reading and inject a small dose of fast insulin (Humalog)
along with my usual slow insulin (Beef Lente). I use 2 units of Humalog for
every mmol/l over 5.

Taking too much Levimir at night could result in you having a hypo when you
sleep ior simply dropping low enough to trigger a response from your liver.
Both of those can result in a high morning reading (yes, even the hypo). I'd
stick with your current night time dose and do the small dose of fast
insulin in the morning thing and see how it goes. In fact, that's exactly
what I DID do :-)

Is it trial & error -responding to blood

> tests?

In a word.. :-)

I am waiting to see Specialist Nurse but wonder what the rule of

> thumb for the 2 insulins might be.

For me, the rule of thumb is roughly a 50 / 50 split. Half my insyulin is
fast, the other half slow, but taken at different times.

I usually eat about 30- 35 gms carb @

> mealtimes. I have heard that some people even take Novorapid when they
> have a snack.

I take it with a single biscuit (Marie or Ginger nut) if I have one with a
cup of tea. I even take Humalog when I eat to bring me up from hypo
territory. The food will VERY quickly lift me out of the "danger zone", but
without that extra dollop of Humalog, my sugar will keep on rising and
before I know it, I'm in doble figures and feeling like a bag of shite. The
humalog stops the excessive rise nd if it brings my back down too soon, half
a glass of milk and I'm fine for hours after.

I am hoping that I might bet better results witha higher Levermir

> dose as I understand that it doesn't effect weight loss.

I certainly wouldn't take THAT to the bank. Insulin has the effect of
interferin with fat burning, so any increase in insulin will likely bering
about a reduction in weight loss.

Maybe I could

> continue to lower the Novorapid Sorry if I sound confused. Your help would
> be appreciated. I also take Metformin Detailed advice has not been
> offered to me from hospital so far.

Don't be too ready to change too many things at the same time, you've got a
long time to live with diabetes, so one change and WAIT. If there's an
improvement, you're on the right track, so you can modifiy the same change
and wait some more. Eventually, the changes will have the opposite effect
and that's the time to sstop playing with "that" part. Move onto another
variable (slow insulin/fast insulin/Metformin dose/exercise level etc) and
do ONE change and WAIT. All repetative stuff and it all takes time, but
that's what you've got for free. Time. So don't rush things and don't change
more than ONE thing or you won't know which"thing" had the desired/unwanted
effect.

I wouldn't hold my breath that things will change either. All the useful
information on diabetes that I've ever had, has come from on here and on MHD
when that grop was a good group, not the spam magnet it's become.

Good health to everyone-Derek

Aye, that too :-)

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Beav

VN 750
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