"Despite being the most powerful and complex therapeutic option for T2D, the FDA has approved all insulin formulations without providing guidance for specific regiments. Instead, the FDA recommends that the prescribe be familiar with the patient's metabolic needs, including eating habits and life style variables prior to dosing insulin. Insulin use is more complicated than swallowing a pill or even injecting a glucagon-like peptide (GLP-1) agonist." - Diabetes Management in Primary Care by Jeff Unger, MD. Second edition. copyright 2013. Page 454.It is really very interesting that FDA approved insulin to treat diabetics type 2. What Primary Care suppose to do now? Recently I read publication in medical journal, how nurse practitioner educated doctors how she treat diabetics type 2 with insulin injections. It was very nice to read all the comments, such as 'thank you' and 'nice info', and so on in this way. How nurse do know how to use insulin? She asks patient, diabetic, how one count dose of insulin every day, day after day. After she was educated by patient how to use insulin therapy, she educated doctors how to Rx insulin, and then doctors will educate patients how to use insulin. Magical word of Medical Circle.
Well, it is better to late then never. I am here to help anyone and happy to share my experience how to use insulin. I am on insulin since 2011. I take 300 units of insulin daily, with variations, of cause. When someone said that one have fasting blood sugar 101 every morning, one day after another, I trust not to this person. There is no one reading such as 101 if one is diabetic. It can be 101 one day, and another day, but day-by-day, not possible. As soon as blood sugar get stable, it starts drop, and insulin dose must be evaluated.
This is why I do not see any reason to connect dose of insulin with eating habits, of any life style. The dose of insulin is different for every one diabetic type 2. So, in stead of trying to count dose of insulin according to life style it is better simple find the dose of insulin needed for every day, one day after another, regardless if today is work out in fitness club, or flu, or Winter, or any other stress or activity. Yes, all this will effect level of sugar in blood, but dose of insulin must be effected by the number on the glucose meter rather then counted by calculator.
There is another interesting point. Since 2011 when at first time I injected insulin, I wonder, how to count dose of injections, what dose of insulin is max. after wich medicine must be adjusted, and many other questions. Now I no longer ask any of these questions.
The interesting point is that there are formulas how to count insulin dose, and every one doctor should know this formula.
http://ift.tt/2jkXfdw
If this link does not work then simple type 'formula insulin dose counting' and the link and many other links will be opened. Why doctor, who published book, so surprised that FDA does not set up any recommendations how to use insulin to every one diabetic patient? It is simple not possible. It is duty of primary care provider to know how to educate diabetic and how to calculate dose of insulin.
So sad, after almost 100 years after discovery of insulin our primary care and endo specialists have no one idea how to treat diabetes type 2. All what they do know very well how to use bathroom scale to treat diabetics. If diabetic still do not get the point of discussion, then Barking Therapy will be applied. And finally, if nothing still work, then Junk Medicine such as all but insulin developed in huge abundance for medical organization needs.
Why do not use simple strategy, observation? In this way it is very simple, start with small dose, add three units every three days, and then continue to do so till target achieved. So simple, and it was recommended at the time insulin was discovered by insulin developed, Dr. Banting. This is almost 100 years old recommendations, and still nothing more was discovered yet, nothing what works better then insulin, or the recommendations Dr. Banting provided for every one doctor.
There are many types of insulin, and this can confuse every one who never Rx it or ever used it. I tried many types, and now I take only one type, long acting insulin Lantus Solo Star. Solo Star mean it is premixed insulin in pen, very convenient to use, easy to store, very light to carry in any handbag. Lantus is the same family as Levemir Determir, but different manufacture. I think they work the same. I use Levemir and did not feel any difference. Toujeo is another type of insulin. I do not think it is about concentration that I do not can use it. It is in formula something very different between Lantus and Levemir and Toujeo. I can easy take Lantus Solo Star and Levemir, old fashioned, not probably one wich is new for me. But in no one way I can use Toujeo. For providers it must be kept in mind that diabetics are different, so we react differently on medicine.
Another point with type of insulin, I do not take any combination of insulin such as pre-mixed long acting and short acting insulin in one pen such as Humalin. Nether do I take short acting type of insulin, such as Novolog, or Humalog or Apidra. Sure right now there may be other types of insulin, and because of I no longer take any other type of insulin but Lantus Solo Star, I simple not familiar with new types of them.
I do not take short acting insulin which recommend to cover meal. I tried, it did not work for me, and probably do not work well for many other diabetics type 2. After insulin injection I have to take meal. Blood sugar drops. But insulin works only two hours or something about this time, and after there is no insulin. There is no sugar also. So, I got hungry, and have to eat. Now I have to take another shot to cover meal, and the ... return to pint number 1. Does not matter how many times I tried this regime, I still not able to control blood sugar level. I take high dose of insulin, so it is looks like I take too much meal I have to cover with insulin. It is not true. I used to take 400 units of insulin, now it is 300 units. So, my b-cells started to recovery, but the process goes slow, too slow, and this is why I need 300 units of insulin. Probably later I will need less insulin in injection, but right now it is how it is. My b-cells almost gone.
With Lantus Solo Star the level of sugar in blood going much smoother. There is no high spikes, or too low drops, and this is very important. When for any reason I need to inject more units then100 at one injection, I will take more shots, and cover my needs in multiple shots. But if the dose is less then 300 I take only three shots, or four, 80 units each and less then 80 last one before bed.
I try do not take high dose at bed time. Usually sugar drops during the night, so if I take high dose I can wake up with low blood sugar. Also I have difficulty to fall asleep if I took insulin shot at bed time. So, I try to finish all injections before 6 pm.
via Ravenvoron
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