# Insulin



## MrsBoyle (May 29, 2010)

Last time i posted on here i had alot of people telling me that the insulin Dylan my 3 year old is on is rubbish and doesnt work.
So what insulin do you use and why is it so good.
He has only had it 7 months so im still new to it all and dont no anthing about insulin.


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## Freddie99 (May 29, 2010)

What insulin is Dylan on?


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## MrsBoyle (May 29, 2010)

Mixtard 30


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## Pigeon (May 29, 2010)

Hi Mrs Boyle, I can give you my pespective, but I was diagnosed age 26 so it's obviously different for adults.

I started off taking 2 injections a day, (one was insulatard, one was Mistard 30) which was fine at first to get used to injecting, and also because I didn't need a lot of insulin because of the honeymoon period.  However, once I got used to it I found it was ok for during the week at work, when I have a routine, but at weekend levels were terrible as I tended to have bigger meals and get up late. Also it was very difficult to get good control for special occasions like weddings or parties when you might eat late, or have a very large meal. If I didn't eat on time I had a hypo, then when I ate a large meal I was high and there was nothing I could do about it. Also I had to have supper before bed every night, which I hated.

So I changed to a basal bolus regime, where you take a background insulin ( I started with Lantus, then changed to Levemir) once or twice a day, and take a quick acting one at meal times (Novorapid for me). You learn to count carbohydrate content of foods and scale your quick acting insulin accordingly, so you can eat more or less and still control it. So it does mean more injections each day, which might bother a child, but I was happy to change as it gave me better control, fewer hypos and I could eat what I wanted to.

A lot of children are on pumps, which are even more flexible, I'm sure some parents will pop in to sing their praises!

There was a post a while ago where some long-term diabetics compared their childhoods to Bev's son's - try reading this http://www.diabetessupport.co.uk/boards/showthread.php?t=7488&highlight=annoyed!

Hope that helps, keep asking questions. I think educating yourself about the different options is the best approach, then you can tell your team what you want and get the best for your son.

Best of luck!


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## Freddie99 (May 29, 2010)

Ah that's one that's given twice a day. Personally I am surprised that people still give that stuff as it's no way near as good as MDI with humalog/novorapid and levemir/lantus. The reason being is that with MDI you can be very much proactive in control using MDI. With things like mixtard 30 you can't really do much other than stick the stuff in and hope that things go well. Bimodal jabs as I understand it are very restrictive (I was once on them but seeing as I was six at the time I don't remember much) and now that I am a pumper and have done MDI I'd say get Dylan off that stuff and onto MDI as soon as possible. That is of course, my own opinion.


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## aymes (May 29, 2010)

A lot of people move from the mixed insulins such as mixtard on to a combination of insulins, the system is known as mdi or multiple daily injections. In my case that is novorapid (bolus insulin, quick action) and lantus (basal insulin, long acting). On mdi the basal insulin is supposed to match the basal rate of glucose kicked out by the liver, the theory being that this should keep your blood level steady assuming you have no food or much exercise etc. The bolus insulin is then used to cope with food, so you vary the amount you have according to the carb content of the meal/snack.
A lot of people prefer mdi to the mixed insulins as it provides a greater degree of flexibility in terms of timing meals, allowing for snacks/varied meals etc.
However, I wouldn't say that one type of insulin is rubbish, it's about what works best for you and your lifestyle. I'm on mdi now and don't think I'd ever go back to mixed insulins. However I was on a mix for the first few years after diagnosis and it worked well for me for that time and suited my lifestyle then so I was pleased to have the choice.


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## MrsBoyle (May 29, 2010)

Whta is MDI and how does it work?


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## Northerner (May 29, 2010)

aymes said:


> ...
> However, I wouldn't say that one type of insulin is rubbish, it's about what works best for you and your lifestyle. I'm on mdi now and don't think I'd ever go back to mixed insulins. However I was on a mix for the first few years after diagnosis and it worked well for me for that time and suited my lifestyle then so I was pleased to have the choice.



I would agree with aymes - no insulin is rubbish if it works for you, it is a life-saver! If you need extra flexibility, though it is good to know that there are other options where the trade off is relatively minor, just a few more injections. I also think a lot depends on what you are used to. I was never on mixes, and find MDI quite restrictive at times, so in my case people would be saying MDI isn't very good and I should get a pump! It's all to do with increasing levels of sophistication, each level requiring a little more work and input, but with greater rewards for the extra work.


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## Pigeon (May 29, 2010)

Sorry, MDI was what I described as basal-bolus - it's the same thing, just a different name. Two types of insulin, one to deal with glucose released from food, and one to deal with back ground glucose released by your liver, as Aymes explained.


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## Gemma444 (May 29, 2010)

hya Becca

I wouldnt say mixard 30 is rubbish as no insulin is rubbish. With mixed insulin you chase the insulin all day with food, this is why 9 times out of 10 you probably have not been told to correct high blood sugars (like myself didnt) It worked ok at first for us but then i started to see that jacks would always go hypo mid-morning no matter what he ate or what insulin dose went down or upto. Then after that jacks blood sugars were very variable and the wonderful mums from here told me about MDI which you give 1 injection of long lasting insulin usually lantus or similair (not a mix though). Jack has just started this and has it in the evening and then you inject novorapid at breakfast, dinner and tea. This insulin is fasting acting and usually stays in the system for 4 hours. But if mixes are working for you then its working dont worry about it but its nice to know that you have options for Dylan if things dont work out. There are plenty of mums on here who can provide you with lots of info on MDI or a pump if need be. 

Gem x


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## MrsBoyle (May 29, 2010)

7 out of 10 times Dylan will have a hypo before lunch like today and now his levels are 20+
Will the nurses still help me out if i decided to change


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## Gemma444 (May 29, 2010)

Of course they would. What have dylan hbA1c's been when you have been to clinic? My sons bloods were variable and Hba1c's were 9.4% then 8.9% then 9.0% I just spoke to  the nurse and said that i was worried about jack levels and they weren't settling down at all and there was no pattern and also hypo before lunch like your sons are no matter what we did. They were very helpful 

Gem x


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## MrsBoyle (May 29, 2010)

he was 13 somthing when he went to hospital and the last time he went he was on 9 somthing im at the clinic on thursay and they want him down to 7%

I just want him to settle down its not fair for him to be like this.


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## Gemma444 (May 29, 2010)

no of course not it isnt fair on him at all he must feel awful. If you did want him to change regime you only have to ask them. We are 9 months in and just changing regime now.


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## gewatts (May 29, 2010)

We're under the same hospital as Gemma. Our move to MDI has been great. After 3 1/2 years of mixes and rubbish blood levels, we finally have pretty good readings. I am annoyed however, that our hospital let us stay on mixes for so long with poor control. The hospital are now moving all the children on to MDI - about time too.  If you decide to request to go on to MDI then your hospital must surely support you. At the end of the day, it is your child's health and you need to have a say in how it is dealt with. If you join the email group , you will be able to get loads of advice.  BUT - it is your decision. Don't feel pressured into changing if you don't feel it's for the best.


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## MrsBoyle (May 29, 2010)

today his readings have been terrible
Breakfast was 5.8 lunch 2.7 dinner was 17.6 and now its 25.6


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## gewatts (May 29, 2010)

I'm afraid that was pretty much what Katie was like on mixes. Things are loads better now - before , we would consider 12 to be  good reading but now she's on MDI we'd see 12 as being on the high side.


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## MrsBoyle (May 29, 2010)

Im in hospital on thursday with him and deff going to have a word with them.8pm he got up and now he is HI.


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## bev (May 29, 2010)

Mrs Boyle, I am so sorry that we have all made you feel that your sons insulin is rubbish - that was never the intention. We are just going on what we have experienced or what other people tell us - 99% of the time mixed insulins dont work. This is not a criticism of you - this is just fact. It seems that your little one fits the pattern of hypo before lunch and HI later in the evening - so just see this as a sign that it doesnt work for him. When you move onto MDI (which i think you will) - it will give you so much more freedom and will make life easier for you all that you will understand what we were all trying to say.Bev


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## gewatts (May 29, 2010)

Good luck at clinic. Stay strong and make sure you get your say. Do you have any one to go with you for support? I'm rubbish when I'm try to be strong and am anticipating a battle. I always end up in tears! When I fell out with Katie's school, my hubby ended up going in and putting our point of view across cos I ended up in hysterics in the head's office!!


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## Adrienne (May 30, 2010)

Hiya

Just popping in and out again I'm afraid but I think that I helped contribute to your original post above about mixed insulins being rubbish.   I would like to say that I don't think I would have said rubbish and I hope my previous emails have not upset you, I only try and explain and help.  Out of approximately 300 children that I am aware of on an email group, only one child is still on mixed insulins because it works for him, which is highly unusual.

I'm not sure anyone has said about the different insulins so I'll explain it quickly, as easily to understand as I can which is what I needed to hear when my daughter was little.

The Mixtard insulins and Novomix insulins are a mixture of long acting insulin and shorter acting insulin.   There are different degrees (some have now been stopped) but for example Mixtard 20, 30, 40 and 50 (they are not all available anymore).  I can never remember which way around it is but your Mixtard 30 contains 30 % of either long or short and 70 % of the other all mixed together.

The long acting in theory will last in the body for approx 12 hours ish and the quick acting is approx 6 to 8 hours maximum which is not that quick.  The quick acting part of it is supposed to cover what is eaten at breakfast and lunchtime and tea time especially if the injections are say at 7 am and 7 pm, for a child 7 pm is normally way to late for tea on mixed injections.

This is a hit and miss regime as the insulins work at differents speeds, there are definite peaks and troughs in both the insulins and you find you are doing what is called 'chasing the insulin' or 'feeding the insulin' because you HAVE to eat at a certain time to avoid hypos, which happen on a frequent basis on mixes.

MDI (basal/bolus or multiple daily injections) is the same sort of idea but the two insulins are not mixed and are better insulins, they are newer.   The long acting insulin will either be Lantus Glargene or Levemir (same sort of thing, different companies).   They are supposed to last in you for 24 hours.   In reality they last less but only a few hours less and there are ways around that.   So the long acting insulin is called the basal insulin (or you may hear people call it the background insulin as it is always there in the background).  It is injected and it sits beneath the skin and releases itself slowly throughout the 24 hour period (or slightly less).   There are still peaks and troughs but small ones, nothing like the mixed insulin peaks and troughs.   This is one injection daily at the same time or in some people if it really only lasts 14 to 18 hours then it is split to two smaller injections 12 hours apart (generally Levemir - most people don't have to split the Lantus).

The other insulin in MDI is a very quick one, normally Novorapid but in some instances Humalog (different company).  They peak quickly ie between 2 to 3 hours and by about 4 to 6 hours are out of the body.  This insulin is given purely when you eat carbohydrates.  This is why it is so important to learn carb counting on MDI and really really helps to get some sort of control of blood sugar levels.  For example  if for breakfast you have two weetabix and a measured amount of semi skimmed milk I know from experience that that is 32 carbs.  You will be given a ratio of insulin units to carbs so you can work out how much quick acting insulin you need to cover those 32 carbs.   To make it easy lets say your ratio is 1 : 16 which means for every 16 carbs you eat you need 1 unit of novorapid.  So if you eat the 32 carbs you will need 2 units of novorapid to cover that food, so that is what you inject.

If on the other hand you have just bacon and eggs ie no carbs then in theory you will not need insulin.  Some people get to know that they need some carbs so would add a piece of toast to the bacon and eggs and you would then need to bolus for the bread which the carbs are generally on the packet.

I hope that is all ok and that I have made it easy to take it.   I know how much information thrown at you in the early days makes it so hard to get to grips with everything.  I am 10 years down the line and I still learn new things all the time.   So ask any question and it will be answered for you.

Take care and good luck on Thursday.


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## MrsBoyle (May 30, 2010)

Thank You that really has helped.
Im just not sure about his insulin now the past few days his bloods have been really up or really down. 
Do you need to eat at set times still and have snacks at set times. becuase i no he struggles eating alot of the time.
And how would i do his insulin at school.


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## gewatts (May 30, 2010)

With MDI you can be much more flexible with meal times. Katie does still have a mid morning and afternoon snack, though I know not all people on MDI do. She also has a snack before bed. If she didn't have her snacks in the day then I guess I would give less insulin. She likes to have her snacks, esp in the morning as all her classmates have mid morning fruit. Also,if she's not very hungry at meal time then she can have a small meal - we just work out the carb content and give insulin accordingly. We we fortunate in that Katie started doing her own injections just before she moved to MDI and the staff at school just have to supervise (and also work out the correction dose if there is one and add it to the dose needed to cover her lunch). There are many children on MDI who don't inject themselves. The school will hopefully provide a volunteer to do it. If no one volunteers I think that they do have to find someone else who will do it - other people will know more about this than me !!


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## Adrienne (May 30, 2010)

MrsBoyle said:


> Thank You that really has helped.
> Im just not sure about his insulin now the past few days his bloods have been really up or really down.
> Do you need to eat at set times still and have snacks at set times. becuase i no he struggles eating alot of the time.
> And how would i do his insulin at school.



No problem.

In theory you shouldn't have to eat at all as the basal should keep your levels on an even keel but we all know things don't go according to plan with diabetes.

So yes your son will need to eat.   With mixed insulins you have to eat at set times, on MDI there is a much bigger window with each meal.   For example what we did was made sure we ate between 7.30 and 9 am and for lunch between 11.30 am and 1.30 pm and for tea between 4.30 am and 6 pm
so you see the windows are much bigger. 

My daughter also still needed snacks at about 10.30 am and 3 pm ish (or just after school) but lots of children don't.

As for the injections at school never volunteer for anything, once they have you, they will use you.   None of the staff are obligated to give injections or do finger tests, however the school have a duty of care and under the Disability Discrimination Act they have to make reasonable adjustments so they have to ask for volunteers and if none come forward they will have to find someone and employ someone to give them.  Where schools are concerned you you have to be friendly but firm and work with them, it gets you a lot further that way.

Hope that helps.


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## MrsBoyle (May 30, 2010)

Today hasnt been any better all night he was HI and woke up at 4.3 then at 11.30 he was down to 1.7 

Cant see it being what he was eating because he had a tin of spagetti for breakfast and a rich tea plus some milk  and for his snack at 9.30 he had 1 chocolate cookie and a rich tea.


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## Northerner (May 30, 2010)

MrsBoyle said:


> Today hasnt been any better all night he was HI and woke up at 4.3 then at 11.30 he was down to 1.7
> 
> Cant see it being what he was eating because he had a tin of spagetti for breakfast and a rich tea plus some milk  and for his snack at 9.30 he had 1 chocolate cookie and a rich tea.



Spaghetti for breakfast! Aren't kids wonderful?  I think a good discussion with the consultant is in order. Most meters only show HI over 33, and to go from that to 1.7 is a heck of a change. I do hope that something can be sorted out, it must be awful for you all


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## Adrienne (May 30, 2010)

When Jessica was on mixed insulins before Lantus came out, she once went from HI to 2.3 in 30 minutes.   Now I know her bit of pancreas that is left is well dodgy (even dodgier back then) but this is a bit drastic even so and was purely due to the mixed insulin. We had washed hands and checked each time as it was so unbelievable.


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## Gemma444 (May 30, 2010)

Im so glad Adrienne has come in to explain things shes very good and helped me and others and are very greatful. I hope you get things sorted with the nurse on Tuesday becca. 

Are you up and running on the email list now? x


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