# Multiple injections versus twice daily injections



## Kerrie (Feb 8, 2009)

My daughter was diagnosed when she was 3 years old and she has been on twice daily insulin injections.  

She is now 5 years old and we are debating whether to change to multiple injections to give her better blood sugar control and us some quality of life.

At school she is regularly having hypo's in the morning and despite changing the doses of her insulins the hypo's still happen regularly on a daily basis.  Then she has a high kickback and ends up in the 18 to 20 range.

We also have to stick to a very strict timetable for snacks and meals and it is so stressful, always watching the clock, trying to get meals prepared in time.

Can anyone give me their experience on the pro's and con's of changing from a twice daily mix of insulin to mulitple injections by pen?  Have their been any problems with schools assisting with this?

I have discussed this with her Diabetes Specialist Nurse and her Consultant but I would really value hearing the opinions of anyone with a child who has changed to this.


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## Adrienne (Feb 8, 2009)

Hi

I would say absolutely yes change to MDI without a shadow of a doubt.  There is only 1 boy who is about 12 now out of about 200 diabetic children I know that is ok on twice daily.   You cannot get good control on twice daily (I know people will argue with me here).   The best thing is a pump but unless you can carb count you can't pump.

MDI gives you so much more freedom than twice daily, the control is better but you definitely need to carb count when on MDI.  Some medical teams say no don't need to carb count.  They are wrong, very very wrong.   Carb counting is easy.  It seems daunting speaking about it or even just starting it but it is easy.  Most packets have carb values on them and there are books that you can get which tell you the carb values of things.   You then give the right amount of novorapid to cover the amount of carbs you have eaten.  Obviously it is not perfect but it is 100% better than mixes.  

If you lived in any other country in Europe or in the USA or Australia you would automatically be put on MDI or a pump, there is no mixes.  Here you are put on mixes because of cost (!) and the medical teams say it is easier for schools to deal with as they don't have to provide someone to give an injection.   It may be easier for the schools but it is not better for the child.   What is your child's HbA1c?   If it is an ok level which is 7.5% and under then I would say it was due to the fact there are lots of hypos and then lots of highs.    

I hope I have helped.  If you want to ask any questions I will try to answer otherwise I will ask my friends the questions for you.    

Take a look at www.childrenwithdiabetesuk.org there is some great info on there.   It is honest info, no-one is making any money with this site (in case you wonder why I keep plugging it  it is written by parents who all have children with diabetes.   The web designer even has a child with type 1.

Take care
Adrienne


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## grahams mum (Feb 8, 2009)

*multiple injection*

graham was 3 as well and started on 2 injection but after 6 month  was alwayshigh after lunch he always had a good appetite so we changed to 3+1  at night and is much better  i do not know  why  nurses do not say about multiple injection as well  as double and somebody can choose what is best for theirlifestyle


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## wendyh (Mar 24, 2009)

We are still on 2 injections a day and it is working for us ok - some days are good some days are not so good - i give packed lunches and have found that the control that way is far better than school lunches.

I dread the day we have to go onto MDI as my daughter is still not so keen to change her routine she is still in.

We have been on 2 a day for 3 years although very rarely do we give novorapid to sort out those bad days.

Hope this helps

Wendy


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## Admin (Mar 25, 2009)

Gosh! I am so surprised they still do this - 2 injections a day. It seems such an archaic way of treating diabetes with the knowledge we have today - I am someone who used glass syringes, surgical spirits and one injection a day as a child! They did not introduce MDI until I was 19 - and it revolutionised my life. I understand - that that was an adult. But I always carb counted even on 1 injection a day - throughout my entire childhood. Also I was a rebellious teenager (down the sweet shop with my non-diabetic friends!) and could have rebelled safely with added bolus! LOL!!
Not sure this helps - but thought it might help to hear from someone who has lived with diabetes her entire life!


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## Mand (May 27, 2009)

When my son swapped from 2 a day to multiple (usually 4) a day it improved his quality of life considerably. Of course, the big down side is the number of injections but there were so many advantages eg eat to appetite, eat at chosen time, better control overall, lie-ins at the weekends etc etc. I would highly recommend swapping. We carb count. We are now awaiting an answer from our application to our local health authority for a pump and we hope that a pump will be yet another improvement in quality of life and long term health.
Good luck if you decide to change!


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## sasha1 (May 27, 2009)

Hi,
When Nathan was diagnosed, he automatically went on to MDI, so personally he has know no different. How ever at the clinic there is a small child on twice daily injections. Until this was mentioned, I didnt think the twice daily approach was still practiced. Good look if and when you change over to MDI.
Heidi


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## ruthelliot (Jun 13, 2009)

Hi , my little boy was diagnosed 6 mths ago at 18mths old and started on MDI. While not having experience of anything else it is easy to see that this regime gives much more freedom but I would say that there is still a lot of clock watching and the need for a fairly strict routine. The flexibility is more with what he eats rather than when. His bloods can be hugely unpredictable which i think is common at this age but MDI allows quick correction of the highs at least. We're considering trying a pump soon as i'm told its the way to go.
good luck.


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## ZoZo (Feb 20, 2010)

Hi All, 

I am new here and this is my very first post!! 

This subject really interests me, and I see lots of debate about this. 

My son was diagnosed last year, June 09. From the word go, we were told about carb counting and he has always done 4 injections a day -  3 novorapid before each meal and lantus at night. Carb counting takes a bit of practice, and sometimes is based on a bit of guesswork, but you do get the hang of it, and thanks to practically everything being labelled it does get easier. 
I was surprised how easily we have adapted to having the dreaded D in our world, and I firmly believe this is because of this regime. We do everything we have always done, we eat out, have our weekend lie-ins, he goes for sleepovers , does his after-school clubs, and we have all our normal days out etc.  Of course, because of his age (12) he has always done his own blood tests and injections so school lunchtimes have never been an issue. 
He eats what he wants, when he wants ( within reason of course, he still eats the same diet he always did, which was never that bad anyway! I do try to encourage him to snack less but he's a growing boy! ) and he counts his carbs and has enough insulin to cover that.  If he gets home from school starving hungry and wants a huge bowl of cereal (common occurance) he does an injection for it and he's away. 

It does make him think a bit, and a common phrase we use is ''is it worth the injection???'' Sometimes he wont bother becuase he doesn't want the extra injection, and he will save sweets etc for after dinner and count them in his 'dinner' injection - which to be honest is not a bad thing, cos aren't we always telling kids not to eat sweets between meals! 
Another beauty of this regime is that if things go a bit awry, there is the correction dose! Hurrah! 
Anyway, his HBA1C 4 weeks after diagnosis was 12.1, the next one was 9.6, the next one was 5.6(!) and last weeks was 6.1 ( bloody christmas!!), so we must be doing something right. 
We have our ups and downs ( or highs and lows!) but not quite as often it seems as those people who are the 2 injections a day regime. 
I honestly think that this really seems the way forward in treating diabetes, and I know I am a bit of a newbie to this thing, and I have a lot to learn, but it works for us and our lifestyle ( I'm a single parent who works full time) and in these modern, busy times - every little helps!!! 

xxx


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## Northerner (Feb 21, 2010)

Hi Zozo, welcome to the forum Agree with everything you say - I was started on MDI and can't imagine how difficult it would be on two injections a day. I'm not a child (diagnosed at 49!), but I do think this regime offers me enough flexibility to more or less live life as I did before. Like your son, I also 'think' about snacks and whether they are worth the extra injection! I used to be munching constantly, now I rarely eat outside meals - but I do eat regular meals, which I didn't before. A pump would be even more flexible, of course, but I'm not yet ready for a 24/7 attachment (not that they'd give me one!)

We have lots of parents, and a few with children your son's age, so I'm sure you can help each other out on things!


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## Gemma444 (Feb 21, 2010)

Hi Kerrie and all 

My son J is 8 and was dx in August 09. He is also on 2 injections a day and my sons b/s are the same as your little ones Kerrie. Hypo mid-morning and too high after lunch. my sons b/s end to go very high before supper sometimes aswell from 18 upwards. 

The very strick meal time never works for us aswell as me and J's dad both work so tea is always later then it should be. This is the routine we should stick too.

Breakfast - has his at 7am 
Mid-morning snack - 10am at home but later when at school (hypo happens here)
Lunch - 12:30
Mid- afternoon snack 3:15 
Tea - should be a 5:30 but that rarely happens
Supper 7:45



Gem x


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## ZoZo (Feb 21, 2010)

Northerner said:


> Hi Zozo, welcome to the forum Agree with everything you say - I was started on MDI and can't imagine how difficult it would be on two injections a day. I'm not a child (diagnosed at 49!), but I do think this regime offers me enough flexibility to more or less live life as I did before. Like your son, I also 'think' about snacks and whether they are worth the extra injection! I used to be munching constantly, now I rarely eat outside meals - but I do eat regular meals, which I didn't before. A pump would be even more flexible, of course, but I'm not yet ready for a 24/7 attachment (not that they'd give me one!)
> 
> We have lots of parents, and a few with children your son's age, so I'm sure you can help each other out on things!



Thanks Northerner.
Absolutely - This regime means diabetes fits in around our life and not the other way round. I cant imagine having to stick to rigid mealtimes, that would drive me mad.  
He can still snack a bit, as long as the snack is under or around 10g of carbs...so a couple of biscuits or an apple is usually the norm. 

We have talked about pumping but I dont think we would be considered as his control is good at the moment, and it seems that most PCT's giove them to people who are struggling with control. Also, my Son doesn't seem keen anyway. Having seen one on another child, he said he wouldn't want to be attached to it all the time, and at least this way once his pen has been put away, he can forget about it till next mealtime.  So we will stick to what we are doing for now. 
I would urge anyone who is on 2 injections a day to think about changing to MDI and speak with their team about it. If your kids are doing own injections thats a start, and as for the carb counting...well kids are like little sponges anyway when it comes to new information, and O is better at it than most of the adults around him!!!


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## gewatts (Feb 21, 2010)

Hi

My daughter was diagnosed when she was 2. We (why do I automatically say "we" and not "she"?!)  were put on 2 injections a day. Her bloods have always been all over the place and HbA1C results high (around 9). On Monday we moved to 3 injections a day - still Humalog 25 at breakfast, novorapid at teatime and carb counting, and Lantus at bedtime. We are still trying to get the ratio of insulin to carbs right but carb counting is getting easier. Def recommend Salter Scales that work out how many carbs are in the food. Hopefully we'll be moving to 4 injections a day soon. She can do her own injections so will make it easier at school when we do. Though school should provide someone to do it if she couldn't.Katie is certainly enjoying the carb counting as it means she can have some more interesting puddings with her tea!  Because we've only just moved I can't comment on how it's affected her blood sugar levels, esp as she seems to be coming down with a bug and is high today!


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## Kei (Feb 21, 2010)

wendyh said:


> We are still on 2 injections a day and it is working for us ok - some days are good some days are not so good - i give packed lunches and have found that the control that way is far better than school lunches.
> 
> I dread the day we have to go onto MDI as my daughter is still not so keen to change her routine she is still in.



Ditto, although I now have the problem squared, with two type 1s in the house.


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## Monica (Mar 24, 2010)

My daughter was put on 2 injections of Mixtard a day when first diagnosed. That worked fine, but when we changed to pens, we also changed the insulin to Novomix, which didn't work as well. She had hypos in the morning and then high at teatime. We tried to counteract it by giving her more morning snacks. The doc then put her on 3 injections a day, novomix in the morning, novorapid at dinner/teatime and levemir at bedtime. We did this as she wouldn't do her own injections. As soon as she mastered those injections, she went on 4 injections a day. What a difference, our lives have gone almost back to normal (within limits). Carb counting isn't all that difficult anymore. I just need to get C to learn it too. A regular phrase from her is : How much do I need mum?

I would advise anyone, if possible, go on the MDI.


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## rlw890245 (Mar 24, 2010)

My daughter G whos nearly 3 was diagnosed Type 1 in november and was put on novomix 2 daily injection, her blood sugars are creeping up so quite often have to give her some novorapid after her afternoon snack, although she s not keen on this extra injection. Im on maternity leave at the moment so the injections arent an issue, but she starts school in september and ill be going back to work, im also considering asking to change her regime to MDI when we go to clinic in april. Has anyone got children of a similar age on MDI, hoe did they adjust to the extra injection if they were previously on 2 daily regime?? Should we change now or wait until shes older and can do her own injections.


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## Adrienne (Mar 24, 2010)

rlw890245 said:


> My daughter G whos nearly 3 was diagnosed Type 1 in november and was put on novomix 2 daily injection, her blood sugars are creeping up so quite often have to give her some novorapid after her afternoon snack, although she s not keen on this extra injection. Im on maternity leave at the moment so the injections arent an issue, but she starts school in september and ill be going back to work, im also considering asking to change her regime to MDI when we go to clinic in april. Has anyone got children of a similar age on MDI, hoe did they adjust to the extra injection if they were previously on 2 daily regime?? Should we change now or wait until shes older and can do her own injections.



Hi

The younger and sooner you can get onto MDI the better for long term health issues and also it is easier to 'make' a younger child have more injections with bribery than an older child.   (I do speak from experience, not just plucking this out the air by the way)

The sooner you can get your daughter used to the injections and the sooner the better she won't know any difference and won't remember the twice daily ones.     

Where school is concerned you need to be making appointments now to see the head teacher to tell them that your daughter has a lunch time injection that someone will have to do.   My one big bit of advice is do not volunteer to go in and do that injection, you will be stuck with doing it forever.   They have to ask for volunteers and they will need more than one, to cover sickness etc.    If no-one volunteers they still have a duty of care so will have to find someone who does.   

I hope that helps in any way.


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## Freddie99 (Mar 25, 2010)

I can't recall what it was like trying to get me to move from the two jabs a day to four and more that I'm on at the moment. Knowing me, it was probably a rather hard battle. In my opinion the sooner the better as you can get things sorted on MDI for longer and have a greater experience of it. That means that you can then decide whether a pump is an option as I have.


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## Adrienne (Mar 25, 2010)

Tom, thanks.  I think it means a lot more hearing it from someone of your age as to what it was like for you rather than from a mum.    From the child's point of view is hard to get.   In this instance it is positive as you say you do not remember so ever if it was hard work, the hard work paid off.   Thanks for helping.   I know it would mean a lot to me if I was asking this question.


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## jen 3 type ones at home (Apr 6, 2010)

I have been diabetic 30 years and remember moving from 1 injection to 2 to 4 to pump in feb. pump is best by far but both my girls started on 4 a day. and I say 4 a day is the way. less hypos it does not matter is luch is late. Much Much better.


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## Freddie99 (Apr 7, 2010)

jen 3 type ones at home said:


> I have been diabetic 30 years and remember moving from 1 injection to 2 to 4 to pump in feb. pump is best by far but both my girls started on 4 a day. and I say 4 a day is the way. less hypos it does not matter is luch is late. Much Much better.



Much the same here. After fourteen years of needles I've swapped, finally to pumping. I go live on Monday. Jabs are good up to a point if you're willing to live a somewhat regimented life that is controlled by the clock for your basal insulin. That's something I'm none to keen on. The sooner kids go onto MDI the better. I think that bimodal is a reasonable way to start. It gets people used to the concept of having to take or in the case of parents give injections every day. That said, they should be moved on from that after a few months as it's clearly not any good in the long run.


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