Thanks for taking your time and give us newcomers the benefit of your wisdom, it is appreciated.
Hey Joe & Friends here
Good morning from Lahore, Pakistan!!!
Thanks a lot Joe for your highly informative response. It really cleared few confusions exist in my mind.
Though u r not a healthcare professional but still you are quite knowledgeable & it is wonderful that u r really doing well by helping others like me.
I request you if u can please comments in some details about few confusions as below:
I had been pre-diabetic from 1996 – 2002.
Finally diagnosed as T2D in july 2002.
First 3 years on diet control & little workouts & taking metformin.
Then next 7 years on sulphonyl urea & metformin.
Since March 2012, surviving on humulin 30/70. Untill 6 weeks back, mostly dependent on two shots.
It was very good in the beginning as BG level remain within ranges much better than on pills.
It was so friendly that soon after (probably after 6 months) I quit to monitor BG levels & rely that it would be OK. No need to worry too much. All went well. During these 5 years, I tested the HbA1C rarely (less than 5 times) & found it less than 7%. Eye check couple of times & found OK.
It was 6 weeks back, suddenly I started feeling unusual tiredness & problem with the vision. I started again checking BG level & surprised to see the high swings ( from 300 to more than 400), I was shocked.
I decided to follow the healthcare professional advise, given 5 years back to adjust the doses in case of BG irregularities.
Unfortunately, here in our region, going to healthcare professionals frequently is of little use, as I had been tried during the initial stage & had several bitter experiences. Though healthcare professionals are respected but here situation is too much different. It is quite an uphill task to find a genuine specialist here. Lots of them claims that they are expert in treating DM but they are not in actual. Therefore, i decided to take awareness from sites and in the process found this wonderful site.
So, what I did to adjust doses. After little hit & trial & awareness taken from sites, I concluded that most probably insulin doses in the morning and then in the late evening are wearing out too quickly now, leaving a huge gap in between to cover. SO, I decided to inject 3 times. In morning, mid day & then in late evening by trying to adjust timing properly if not all equal exactly. Results beginning to appear good as BG level started remaining to lower side, sometime hit a HYPO condition after 5-6 hour of limited meal (restricting carbs to 50-60 gram per meal with slight variations). Now I get used to HYPO in these 6 weeks which I do correct by taking 30-40 ml of juice containing rapid acting carb and it does well in 15-20 minutes time. Apparently all is looking well as last A1c a month back was 6.8%.
But still feeling awkward like:
1) whether I am taking correct steps?
2) whether it is OK to take insulin (humulin 30/70) thrice a day?
3) whether doses (20 units per injection) which I have done at my own are really OK?
4) whether injecting insulin again say after 6 – 7 hours, while previous insulin may be there & may still be working there is OK & not harmful?
5) is it OK to go with higher dose even not required really & only as to avoid high BG and if it is followed by HYPO then correct it by taking fast acting carb as to neutralize the effect of excess units of insulin?
Could you please help me ?
(Lahore 35C 1100 Hours)
hi this is really a new topic, I might split this one to start a new one – for now we should leave it here.
No one should give medical advice, and by no means should anyone take advice read here or elsewhere online and implement without understanding that insulin is a dangerous medicine and careful adjustments have to be made because consequences can be very bad. I try to give the best practical information I have with my 30+ years of experience, but you should know that everything I say is an opinion and not medical advice. Diabetics must learn to be their own doctors at some point.
1) regardless of “correct” you are taking steps which shows your seriousness and your self care. which is great. hypos are more immediately dangerous than highs, you must always have fast acting carbs around and if you change things, take good notes and test more.
2) you are “stacking” the “70” which can lead to lows, because your mix has long acting insulin, and that long acting can stay in your body from 12-24 hours, overlapping, potentially 3x overlapping at some point of the day (I would think at supper) the long acting can lead to hypos at various times of the day. any change you make to long acting insulin can take 3 days to a week to show up as a “trend”. there are too many strategies to discuss here so I strongly recommend you purchase and read the book “Think Like a Pancreas” by Gary Scheiner.
3) I take 50 units per day, total. This is not wrong or right, this is what I typically need. There are days when I need less that 25 units (total) and days I need 100+. With insulin resistance, it is possible to need 300 units per day. The amount of injection to meet needs is right, not the number of units. Once I decided to eat a full-on (US based) Chinese dinner with all the gravy and sauces, rice, salt, etc. I needed over 40 units. I choose to not do that a lot! Pizza can be over 100g carbohydrates but the carbs absorb over 8 hours for me… needs a special dose and requires me to test every hour for the first 4, then every other for the next 4 hours, if I have any hope to control my blood sugar.
4) stacking insulin can be very dangerous, see 2), I would be most afraid of the dangerous overlap of your mid day shot of 70-30 and the “double long acting” in your system at 2 AM. There are other insulin formulations. There is straight fast acting (no long acting mix) there are different long acting insulin as well. I use a pump but technically I “inject” 6x a day. When I was on shots I was injecting at least 5 times a day.
5) you are describing the “roller-coaster” and I personally HATE the roller-coaster. it is not incorrect. I say it that way because it is a very personal decision. You can make almost anything work, but for me, it depends on how I feel and if I can “keep it up forever”. hbA1c of 6.8% is in target range for T1 diabetes, so in the world of “right and wrong”, your control is “right” it is the effort to get there that needs evaluation. the best way is the way that keeps you alive. even better if you can be both alive and happy, better still if you can be alive, happy, and learn or grow everyday. If you tolerate the roller-coaster then that’s ok, if you want control but no highs and no lows, you will need other insulin formulations (not 70/30) available to you and you need to learn how to use them. by overdosing insulin and having to add carbs, your calorie intake and total insulin is higher than “just enough”. Controlling your weight may become a factor.
The “poor man’s pump” (sorry I didn’t make it up) is a shot (or 2 shots) of pure long acting, such as “insulin glargine”. then every time you want to eat and anytime your blood sugar is a little bit high, you inject separately fast acting “Regular” or very fast acting “Insulin Lispro”. The fast acting is active for only 4 hours and does not affect the long acting. multiple short acting shots is ok for blood sugar “corrections” or eating. You can eat whenever you want. You can test to see how much 1 unit of fast acting lowers your blood sugar and use that as a reference: example for me, 1 unit reduces blood sugar by 30 mg/dl. if I have a blood sugar of 180 mg/dl I can inject 3 units to “correct” (actually in the pump I can deliver 2.66 units). there are tests you can use to find out how many carbs for 1 unit of fast acting and use that as a reference for eating: example for me 1 unit for each 12 grams of carbs. if I eat a small apple (~15g carbs) I inject 1 unit of fast acting (actually with a pump, I can deliver 1.25 units). this method is called carb counting and is explained fully, along with testing long acting, in the book “Think Like a Pancreas”. Best of luck to you always.
Good morning from Lahore, Pakistan.
At the first place I am surprised to find your great response which is far rather very far away from my own expectations.
I really have no words to praise your great & superlative remarks & comments. I am surprise in terms of the fact that can a person be so generous, kind and sincere like you to help out someone like me in such a brilliant way?
Though, I am more than 100% agree with your comments regarding healthcare advises which are too valid in a realistic world but believe me from your above response, if it doesn’t look like that you are more than that but, atleast, & based on the above marvelous response you are not too far behind from any regular healthcare professional. I am highly impressed & highly obliged.
The beauty of your response is that you have covered almost all the requested information brilliantly and also in concise way by giving some outstanding practically observed example from real daily diabetic life.
Your guesswork findings are almost true. For example, you have anticipated HYPO during & around 2AM, it is highly true as I have faced atleast 3- 4 HYPO episodes during the time 3AM & 4AM in the last 6 week. Suddenly, I woke up from sleep and feeling uncomfortable like weakness in legs, cold sweating, heart rate feeling like sinking & strange anxiety. I took at once chilled juice (about 50ml) every time and in all cases got better within 20 minutes.
From your highly informative content which is a blend of deep practical experience & knowledge, I understand, fixation of insulin daily doses as fixed units have no importance rather it may be changing everyday accordingly the situation on that specific day & time. For example, If i m taking 20 units routinely then I may adjust it as many times as needed. Right?
2nd thing I understand is, instead of premix insulin (like humulin 30/70), rapid acting insulin in combination with long acting give us more flexibility in terms of meal schedule & control on BG. Right?
It also provides freedom to eat to a certain level. Right?
I will try to find your recommended book from local market & will update you accordingly please.
If not get from local market then I will try to use few contacts to get one from UK.
Now few more questions please, if u don’t mind please:
1- From few crude testing (not too much accurate), I have seen that during morning & breakfast same amount of insulin ( 20 units of humulin 30/70) produce less good results in comparsion to the same amount as stated above in the afternoon & lunch. Let me put it in this way, If I consume 50g of carb in morning during breakfast then BG first went skyhigh (around 300 or 350) in about 75 minutes while premeal (breakfast) reading was 110 or 95, then after 3-4 hours it came down to 170 – 190 & after 6-7 hours of breakfast it came inside 100. Then before lunch I took another dose of 20 units & consume same 50g of carbs but this time found different result from morning, though BG went high enough but didn’t stay there too much and came down inside 170 in less than 3 hours. Can u help me please?
2 – Is it possible or there is some possibility exist to use rapid & long acting combination & go on to fast?
This would be your extra ordinary help as fasting month has been expected to start here in next 8 days. Fasting duration will be around 3: 15Am to 7:03 PM (almost 16 hours). I have been unable to keep fast since the year 2011 or 2012. I tried in the past but resulted in high BG after taking pre dawn meal, and after that too much urination resulted in severe dehyration within 4- 6 hours after pre-meal so I couldn’t go on. Then I tried different things like adjusting doses in terms of units but everytime ended up either too low or too high followed by too much urination within 5-6 hours. Then I decided to give up since then.
But after reading above specially rapid + long acting formula, I am thinking, may be there exist some hope? I mean, there may be a way there to apply to keep fast while keeping BG level nicely during entire fasting period?
May be there a possibility exist to take & adjust rapid in such a way that it may cover pre-dawn meal perfectly without too high BG spike for too long and then long acting keep the routine BG under check through out the day till sunset?
GOD BLESS you & stay healthy,
(Lahore 36C, 1150 Hours)
You can have MUCH better control using both a very fast acting analog insulin, which in the USA would be Humalog, Novolog or Apidra (names may vary in your country) with a long acting insulin such as Basaglar, Lantus, Toujeo, Levemir, or Tresiba will definitely help. If analog insulins aren’t available in your area it gets harder, since human insulin, known here as Humulin or Novolin (R or N of either) takes longer to be effective and lasts longer than the last meal, so you would tend to go high soon after eating, then go low shortly before the next meal. Those insulins need to be taken 30 to 45 minutes before the meal, and may require a snack in between meals.
The other thing I notice is that you are eating very high carbs. For instance 50 grams of carb for breakfast is a large problem, since it requires so much insulin to balance it…. and ANY irregularity in exactly how much you’ve eaten, since many times food will be as much as 10% more or less grams of carb believed to be in it will change your results tremendously. Eating lower carbs makes control so much simpler.
Also taking pre-mixed insulins such as 70/30 is always risky, since the shot you take for breakfast is affecting you into the afternoon. It sounds like you go somewhat lower in the afternoon as a result. Taking a larger dose of JUST rapid acting insulin, with a lower amount of long acting insulin before breakfast should improve your results, as well as lower carbs reducing ALL insulin levels, as above.70/30 locks you into a system of frustration, rather than good treatment of this affliction we share here.
61 years of Type 1 and doing well
Hey tedquick & Friends!!
Good evening from Lahore, Pakistan.
Yes, u r perfectly correct about the limitations of premixed insulin & advantage of rapid & long action combination.
For the last 6 weeks or so, I have been gathering all the possible info about the diabetes & insulin.
I will make an appointment with diabetilogist in the coming week & will share the results here.
I am also convinced to move on to fast + long action combination but just need to validate it from a diabetelogist please.
your finding about carbs consumption is also correct. But in our region things are quite different & may be strange for you guys there.
ACtually cultural foods are very high in carbs content. Like our one bread (we call it NAAN or Paratha here) contain around /about 100gm or even more of flour. It is a tradition here to eat atleast one of them during BF, at least 2 each of them during lunch & dinner along with some side dishes which may also contain Carbs, starch & neat sugar. So, psychlogically what will be outcome? I mean, if someone develop DM & cutdown at least 50% of the above stated food then he/she is considered to be too much cautious in eating, while in real he/she like me still consuming relatively high carbs. Sometime family members or love ones even encourages to eat more in a fear of get weaker.
In my case, I m still struggling despite some awareness is due to the above eating habits in the past. I had been a pre-diabetic from 1996 to 2002. But didn’t care & bother too much and keep on eating like before. Then at 40, during 2002, finally diagnosed as T2D. Fear enforced to take some care. Survived 3 years (till 2005) on metformin, diet control, Then next 7 years on sulphonyl urea. Sometime cared too much & sometime not. Now on insulin since 2012. Recently (6-7 week back), I developed an urge to fight it seriously as my inner is telling me that u r almost 55 now so become serious now. So, I m trying and taking help from friends here as to understand the facts more clearly & boost up the fighting spirit.
I wish to thank all the friends here who have responded to my querries with their own experiences and shared some highly informative content.
Good Luck To all of you guys there!!!
Have a nice Sunday there!!
(Lahore 30C, 2007 Hours)
OK, glad you already understood so much. As a matter of fact it ISN’T that much different here. High carb has been the forced rule in the USA for the last 50 years or so, since the myth that cholesterol is bad for our hearts was “established” by Dr. Ansel Keyes in 1956, and it became “official” with the government if the 70s. To avoid higher cholesterol we were always told to avoid red meat, pork, eggs and full fat foods of any variety, which left carbs as the simplest solution. Problem is that cholesterol is the feedstock for roughly half of the 200+ hormones that are needed to control our bodies. His “theory” was based on wishful thinking, and was “proven” by carefully selecting where he gathered his information. He traveled the world to “prove” it, while going right past areas, such as France, that didn’t fit his model. Besides which most cholesterol is created by the body, and eating any cholesterol doesn’t matter much at all. That’s why here, your country is likely based on different assumptions.
In any case carbs are always cheaper to produce, easier to store and process than most proteins, so people everywhere that grow or process foods like to keep things simple. It’s also more profitable, so business prefers carbs too. Hard to beat, except for the fact that we, in particular, need to. I’ve been thought strange for my eating habits since 1962 when my endocrinologist put me on a relatively high protein reduced carb diet, but that’s why I’m still alive and well 55 years later. I always need to remember that MY health doesn’t rely on anyone’s opinion of my eating habits, and most people accept that I’m doing what’s necessary. That’s what you need to learn to do, too.
American health has been poorer ever since, and hopefully will be corrected by real medicine based on facts, rather than myths.There is a growing movement aimed at treating the WHOLE person, rather than just a single system or component as done today. It’s called wholistic, eastern, Ayurvedic and/or natural medicine, and likely was normal in most parts of the world outside of the USA until recently.
Of course you DO need to discuss this with your doctor, and if he’ll let you you can both learn, but his opinion IS legally defined in most countries, so don’t try any major changes without him at least knowing what you are doing and generally agreeing with it.
Hello Tedquick & friends here!!
Good afternoon from Lahore, Pakistan!!!
I forgot to congratulate you on your wonderful control & struggle on DM. It’s really nice to know that you have so far gone exceptionally well in your all efforts. It may possibly be a dream only here for a majority (probably more than 90%) of DM persons. I really appreciated your highly informative response which have increased my knowledge too. I have been trying to gather more & more information & knowledge as to go well onward seriously. I have been providing awareness to many in my social circle since long, though before 6-7 weeks, I myself was unaware of the several facts relating to insulin, previously my awareness was all about T2d without insulin. I have a colleague here which is also my close friend, who sadly developed T2D about couple of years back, but on various events he thanked me a lot every time that due to awareness given, he was lucky enough to be diagnosed at very early stage. Now he is doing very well at 41, & well controlled on exercise, reduced diet & only metformin. His numbers are almost as good as a normal person (mostly ranging between 100 – 150, maximum known peak 180, HbA1C just under 6%). The best part of it, is that, in turn he too started giving awareness in his family & social circle (he has inheritance DM in family circle) & luckily one of his relative just diagnosed at the border line of DM (GTT test , 2 hours reading was 208).
I mean to say that I am gathering all the info & knowledge to pass on to others as to be benefited as much as possible besides keeping my own numbers well, because here is almost no concept of awareness & visiting to the Doctors. If somebody have a headache then generally people take a pill or 2 of panadol to go well. Therefore, I have a objective in my mind to give awareness to others as much as possible, that’s why I am keep asking to you guys & friends there as to be more knowledgeable. I hope, friends there will be keep helping me.
From the efforts made during last 6-7 weeks, I realized that despite taking insulin regularly & reduced diet, BG still remain high for sometime after each meal which may make at least 8 – 9 hours daily out of 24 (means a full year in every 3 years), which need to be addressed & need correction.
In this context, I have a question for you & friends there:
1) Could it be possible to reduce the spike after meals ( due to carb intake) by adding some other thing rather taking the neat carbs directly?
Specifically when it is hard to reduce carbs in take too quickly. By adding some other thing rather taking the neat carb, means, to do some trick to reduce the tendency of carb to spike quickly. For example, rice do that, but if boil them & then remove water from it, then we may expect less spike for the same amount of consumption.
I will appreciate if you & friend could help please.
(Lahore 34C 1241 Hours)
To some extent you can slow down carb absorption by eating it with good fats (highest effect) and protein (second best effect). High fiber especially when it’s part of the carb (not likely an option) will also slow it down. That is to say high fiber vegetables will keep the sugar in them bound up longer in digestion so it won’t increase bg as fast, and be more moderate for a longer time. Adding fats will slow down absorption of sugar a reasonable amount and extend the higher level over a longer time. Things DO average somewhat. For instance, if you were going to eat a slice of bread or toast be SURE to put a lot of butter (not margerine) on it to slow it down.
Not that this exactly relates to your question, but I and SOME other Type 1s have found that carrots are different depending on how they are prepared. A raw carrot has quite a bit of carb in it, but it is rather heavy bound to the fiber in it, and much of it will not be released during digestion, so bg rise is minor. But when I eat a COOKED carrot the carbs have separated from the fiber to a great extent, so my bg spikes fast. This seems to vary widely, some find it affects them, some don’t. The more processed the food the more likely it is to create bg spikes.
Another separate thought for you, exercisng to lower bg ONLY works if you are below 250 mg/dl when you start the exercise: if above that it will keep on rising.
hello @Munirnara, sorry I have been away from my computer. I am glad you are getting feedback.
regarding fasting, you could fast if you knew your requirement and used a “basal” insulin such as glargine (basaglar or other as previously said). in my opinion, you will not be able to completely fast on 30/70. once your “basal” insulin is determined, and this can take testing over many months, your blood sugar can be reasonable without having to eat. I wouldn’t be able to guess if you could switch and be ok in a few weeks.
If you had a pure long acting, then you would simply not use any fast acting and not eat. of course, insulin is tricky I hope you will not find trouble if you need a little sugar during the day. my guess is you will feel better and you will not be required to eat as you are with 30/70.
regarding your first question and the data: please let me start by saying that diabetes care is an art, maybe 50% but not much more a science. any activity, even climbing stairs or walking within the 2nd hour of taking insulin can change meal blood sugar outcomes dramatically. given your mix of insulin, I say that in the morning, you have nothing “on board” there is no insulin available to help convert blood sugar, in the morning you may have higher insulin resistance as well. a small amount of carbohydrates could cause blood sugar levels to increase very high very fast. a modified strategy woudl be to take your 30/70 a little earlier, and give it time to start working before you eat. When I was on “Regular” (the 30 in the 30/70) I notices it didn’t start to work for 45 minutes. please be very careful if you try this. at lunch time, you still had working insulin when you injected. This insulin then “helped” the new shot as you started eating. this would tend to reduce the maximum spike of blood sugar after the lunch meal, again, so would any activity even mild walking. I often use a walk instead of additional insulin (when I know there is insulin in my blood) and my sugar is a little too high. exercise will not help if there is no insulin.
you can see the typical absorption of different insulin formulations if you look up “PHARMACODYNAMICS”
don’t forget your mix is a combination of “regular” and a formulation called “NPH” and that NPH is one of the more difficult to predict. I used to mix my own, instead of 30/70 I had a vial of regular and another of NPH. I could use the regular alone for corrections and mix them for a kind-of-a long acting effect. If you can’t get glargine, mixing your own, or just getting plain “R” (regular) might also be worth a look.
hello @Munirnara, one additional thought. you were asking about sugar absorption rates in your conversation with @tedquick, and I have very similar observations: example milk fat plus sugar can slow absorption for several hours, grains such as durum wheat, can also slow the absorption of the carbs for hours, when mixed with a fat such as olive oil, I have experienced up to 4 hours of delay.
the rating for carbs that absorb fast or slow is “glycemic index”. you can find a database here:
Good evening from Lahore, Pakistan.
I want to say my special thanks to both of you guys there for helping me.
I have been started learning a lot. Whatever, I have learnt in these 6-7 weeks, I haven’t before though a confirmed diabetic since 2002.
Both of you have tremendous practical experience of handling & managing diabetes which has been a great & useful for people like me who are facing problems which you had faced in the past.
The trick stated in above response (bread slice with butter) has been coincidentally verified & tested & found valid. During extensive testing during the 6-7 weeks, once it had happened that I put some lurpak brand (lighter version) butter on the slice rather to consume it with fried eggs on that particular day, & checked BG as usual & surprised to see that BG was not so high on that particular instant but I didn’t investigate the reason, but now I got the answer correctly. Similarly from your experience of real life with diabetes, your all the answers & comments are great.
I am convinced to move on to (FAST ACTING +LONG ACTING) formula, but I couldn’t get the appointment from diabetologist in this week rather expected in week after, then I will share you my results with you.
Have a nice morning there!!!
(Lahore 40C, 1700 Hours)