Can anyone offer advice?

[Sophie Martin]

Hi.

My name is Sophie and I have been type 2 for nearly eight
years with good control and no major problems. I lost weight
when I was first diagnosed and dropped my daily carb intake
right down until my bgl's were in a near normal range. Now I
am having problems, mostly because I have to take cortisone
daily, and since I started doing this my levels are all over
the place, even though I am eating the same amounts of
carbs/calories/fats at the same time every day.

My Doctor (GP not an endo - I live in a remote area) says
that he is going to put me on a pre-mixed insulin for use at
night only. It is a
70/30 slow fast mix he tells me, and I have to start with a
small dose and slowly increase until I get control. It is
in a pen (something that I have never seen before) and I
just adjust the dial.

Is this normal for a type 2? He says that it will be quicker
to make adjustments this way and he wants to stop me spiking
asap. I will probably stop this once I am able to stop the
cortisone.

Some days my fasting BGL is 6 or 7, on other days 8 to
11. In the past, before the cortisone is was always
around 5.7 / 5.9 as long as I was careful about my carbs
and kept my exercise up. It only changed if I got a cold
or stomach upset.

I am to start this regime tomorrow and I am a bit worried
about it. I expected that any supplementary medication would
have been oral, not injected. I am a bit afraid of needles.

Sophie

[Eldritch]

Sophie Martin wrote:
> Hi.
>
> My Doctor (GP not an endo - I live in a remote area) says
> that he is going to put me on a pre-mixed insulin for use
> at night only. It is a
> 70/30 slow fast mix he tells me, and I have to start with
> a small dose and slowly increase until I get control.
> It is in a pen (something that I have never seen
> before) and I just adjust the dial.
>
> Is this normal for a type 2? He says that it will be
> quicker to make adjustments this way and he wants to stop
> me spiking asap. I will probably stop this once I am able
> to stop the cortisone.
>
> I am a bit afraid of needles.

Steroids, like cortisone, make glucose control very
difficult. It makes sense to use insulin to give you
better control. Pens are commonly used. They don't
look like syringes and that makes people who are
afraid of needles less nervous. And they're
convenient.

The 70/30 mix is an insulin for people who are
afraid of needles, because it allows you to inject
only once a day. However, it's not that good for
achieving good control. Because it's premixed, you
can't change the mixture. If you need more of the
short acting insulin, you are forced to also take
more of the long acting insulin when you don't need
it. This means you may not be able to increase your
dose of the short acting insulin when you need it,
because you're already taking so much of the long
acting insulin. This insulin also has two peaks, so
you must plan to eat at those scheduled times. This
can be inconvenient if you have a flexible schedule
and can't always eat at the same time every day.
This insulin may not work well for your situation.

Since your control was good until you started the
steroid, you probably just need a short acting
insulin to help you deal with the unpredictable
glucose fluctuation it causes. Humalog or Novalog.
This would probably require more than one injection
a day, but you would only inject the insulin you
need when you needed it .... when the steroid has
driven your glucose level up.

Most people are nervous about needles, but modern
needles are very thin and are nearly painless to
use. Most people find that once they get past the
first shot, they find them easy. Testing your finger
tips is actually more painful than the syringe. Of
course, I know that's hard to believe until you
actually do it yourself. And they will help your
control a lot.

Good luck.

E

[Jefferson]

Sophie:

> My Doctor (GP not an endo - I live in a remote area) says
> that he is going to put me on a pre-mixed insulin for use
> at night only. It is a
> 70/30 slow fast mix he tells me, and I have to start with
> a small dose and slowly increase until I get control.
> It is in a pen (something that I have never seen
> before) and I just adjust the dial.
>

My last 2 HbA1c results were 5.6 and 5.5%. Nevertheless, I
opted to do insulin injections. As Eldritch mentioned, the
needles are less painful than finger sticking, i.e.,
practically no pain.

I don't know your doctor's reasoning for at night only
injections of
70/30. I could see spliting your insulin dose to before
breakfast and before dinner. This way the fasting
acting insulin would more closely approximate first
phase insulin release of a normal person and reduce
the postprandial blood glucose. Whereas the slower
acting insulin would lower your basal level of
blood glucose either by reducing post-digestive
liver (hepatic) glucose production or by increasing
the disposal of glucose from the blood to the
peripheral muscles.

Frank

[Dave]

Not too unusual, upwards to 40% of type II diabetics end up
on insulin.

Dave Type II A1C 6 Low carbing

[Bj]

Even if you live in a remote area, is there some way you can
get at least a consult with an endo? Get a program that you
can then manage, with the GP as local backup (GP would have
the endo recommendations to follow too). bj

"Sophie Martin" <antispam@world.net> wrote in message news:43f1f178$08.26$1@ID671324.news.uni-
berlin.de...
>
> My Doctor (GP not an endo - I live in a remote area)

[Jonk]

Everyone here is giving you good advice.

Insulin shots with modern needle are NOTHING. At worst it's
as bad as a mosquito bite, and most of the time I don't
even feel it.

70/30 is the most common insulin prescribed by GPs and
internists. It's also obsolete.

It's easy to take but impossible to control. And it
constrains you eating schedule to absolute slavery.

Ask to see and endocrinologist or diabetologist or diabetic
educator and get on a modern MDI (multiple daily injection
regimen. It's tricky to learn at first but after that it's a
cakewalk. And you have total freedom of when to eat, and a
lot of room on what to eat.

Jon

[Dennis Rekuta]

Sophie Martin wrote:
> Hi.
>
> My name is Sophie and I have been type 2 for nearly eight
> years with good control and no major problems. I lost
> weight when I was first diagnosed and dropped my daily
> carb intake right down until my bgl's were in a near
> normal range. Now I am having problems, mostly because I
> have to take cortisone daily, and since I started doing
> this my levels are all over the place, even though I am
> eating the same amounts of carbs/calories/fats at the same
> time every day.

Are you on pills or shots? I take oral cortico-steroids (7.5
mg prednisone) daily for a kidney transplant. It is a bear
to handle.

> My Doctor (GP not an endo - I live in a remote area) says
> that he is going to put me on a pre-mixed insulin for use
> at night only. It is a
> 70/30 slow fast mix he tells me, and I have to start with
> a small dose and slowly increase until I get control.
> It is in a pen (something that I have never seen
> before) and I just adjust the dial.

I was started on a pen and wouldn't know how to use a needle
and syringe. You just load the cartridge according to
instructions and dial your dose, loosely pinch your skin
with some fat underneath, and just insert the needle.
Usually it is a lot less painful than a finger prick for
your meter. I would look for the 30 guage or 31 guage thick
needles for the pen with either 8 mm length (short) needles
or even 6 mm (shorter). Depends on how skinny you are and
how easy it is to roll up your skin.

> Is this normal for a type 2? He says that it will be
> quicker to make adjustments this way and he wants to stop
> me spiking asap. I will probably stop this once I am able
> to stop the cortisone.

I take it because of the prednisone. I could stick to oral
meds otherwise. I take NPH at night to knock down my morning
fasting BG before the prednisone starts to screw things up
after breakfast.
>
> Some days my fasting BGL is 6 or 7, on other days 8 to
> 11. In the past, before the cortisone is was always
> around 5.7 / 5.9 as long as I was careful about my carbs
> and kept my exercise up. It only changed if I got a cold
> or stomach upset.
>
> I am to start this regime tomorrow and I am a bit worried
> about it. I expected that any supplementary medication
> would have been oral, not injected. I am a bit afraid of
> needles.
>
> Sophie

I agree with the others about seeing an endo or a specialist
for better advice on what type of insulin to use. You should
ask about being put on Glucophage (metformin) to decrease
your insulin resistance, and possibly acarbose (I forget the
Brand name the Americans call it) to slow down your carb
absorption. Both can cause some gastro distress, but
everybody is different. I ramped up slowly and use 2,500 mg
metformin and 200 mg acarbose per day with few problems.
Dennis (Type 2, Kidney Transplant 1995)
--
-- "We can't help it. We're men" The Red Green Show.

[Oldal4865]

Sophie Martin wrote in message <43f1f178$08.26$1@ID671324.news.uni-
berlin.de>...
>Hi.
>
>My name is Sophie and I have been type 2 for nearly eight
>years with good control and no major problems. I lost
>weight when I was first diagnosed and dropped my daily
>carb intake right down until my bgl's were in a near
>normal range. Now I am having problems, mostly because I
>have to take cortisone daily, and since I started doing
>this my levels are all over the place, even though I am
>eating the same amounts of carbs/calories/fats at the same
>time every day.
>
>My Doctor (GP not an endo - I live in a remote area) says
>that he is going to put me on a pre-mixed insulin for use
>at night only. It is a
>70/30 slow fast mix he tells me, and I have to start with a
> small dose and slowly increase until I get control. It
> is in a pen (something that I have never seen before)
> and I just adjust the dial.
>
>Is this normal for a type 2? He says that it will be
>quicker to make adjustments this way and he wants to stop
>me spiking asap. I will probably stop this once I am able
>to stop the cortisone.
>
>Some days my fasting BGL is 6 or 7, on other days 8 to
>11. In the past, before the cortisone is was always
>around 5.7 / 5.9 as long as I was careful about my carbs
>and kept my exercise up. It only changed if I got a cold
>or stomach upset.
>
>I am to start this regime tomorrow and I am a bit
>worried about it. I expected that any supplementary
>medication would have been oral, not injected. I am a
>bit afraid of needles.
>
>Sophie

Cortisone "commands" your liver to manufacture and release
glucose into the blood. It can easily boost your blood
sugars above 16 mmol/L and keep them there.. Thus, insulin
shots are often recommended for Type 2 diabetics who need
to take cortisone.

However, 70/30 is a Godawful, obsolete insulin designed as a
minor supplement for folks still making a lot of their own
insulin. It is just about guaranteed to produce sustained
high blood sugars mixed with shorter periods of near-normal
sugars for folks in your situation. I suspect that you will
need a modern, "Multiple Daily Injection" regime with modern
insulins to really get a handle on your sugars.

MDI with modern insulins means taking a slow-absorbing
insulin as a "basal" to cover basal metabolism and night-
time needs and a fast-absorbing insulin to handle meals and
tweak too-high blood sugars between meals.

The best modern insulins are :

a. Lantus, Levemir and Ultratard (Ultralente) as the
slow-absorbing basal candidate insulins

b. Humalog, NovoRapid, Novolog as the fast-absorbing
bolus candidate insulins.

Some years ago, we followed the daily experiences of one of
our posters, "Tony in Mexico", who was forced to use
cortisone. His doctor let him use MDI with modern insulins
and he did very well.

If you have too, you can limp along with the two separate
components of your 70/30 mix, i.e. Human Regular Insulin and
Human NPH insulin. Use the Regular before meals and as a
tweak, and the NPH at bedtime as a basal. They won't control
as well or as easily as the modern insulins but they would
be better separate than as the 70/30 pre-mix.

Around here, the CDE (Certified Diabetes Educators) Nurses
do all the insulin training. They're better at it than
almost all of the docs.

Regards
Old Al

[Blkbear]

On Wed, 30 Jun 2004 05:06:28 GMT, Sophie Martin <antispam@world.net>
wrote:

>I am to start this regime tomorrow and I am a bit
>worried about it. I expected that any supplementary
>medication would have been oral, not injected. I am a
>bit afraid of needles.

Howdy Sophie,

Take a look at this web site, and talk to your doctor
about using a jet injector as an option to using a needle
and syringe.

http://www.mendosa.com/injector.htm

--
Type 2 - Dx'ed 11/2001
Stopped Metformin 2003
Now D&E, A1c 5.2

[Ted Rosenberg]

WHY, Jet injectors are not in general use for a LOT of
good reasons
1) They are much more likely to cause infection. Unlike
needles, they blow everything on the skin through
2) They are much more painful.
3) They are expensive.

Jet injectors have only one legitimate use, and that is
when giving large numbers of people injections in a short
period of time.

Ask any army recruit what they think of jet injectors.

Blkbear wrote:

> On Wed, 30 Jun 2004 05:06:28 GMT, Sophie Martin
> <antispam@world.net> wrote:
>
>
>>I am to start this regime tomorrow and I am a bit worried
>>about it. I expected that any supplementary medication
>>would have been oral, not injected. I am a bit afraid of
>>needles.
>
>
> Howdy Sophie,
>
> Take a look at this web site, and talk to your doctor
> about using a jet injector as an option to using a needle
> and syringe.
>
> http://www.mendosa.com/injector.htm
>
> --
> Type 2 - Dx'ed 11/2001 Stopped Metformin 2003 Now
> D&E, A1c 5.2

--
"...in addition to being foreign territory the past is, as
history, a hall of mirrors that reflect the needs of souls
observing from the present" Glen Cook