Dr Young: There are several options. We can do basal plus one dose [of insulin] before the biggest meal, or we can do basal plus three, meaning [one dose before] three meals. According to the 2017 American Diabetes Association guidelines,[1] there are different ways to start the initial dose [of insulin]. We can start with 4 U, or 0.1 U/kg, or 10% of the basal dose. A newer class of medications, glucagon-like peptide-1 (GLP-1) receptor agonists, is another alternative that can also be added to basal insulin.So, what all these talks about? It is about diabetes developed by wrong eating. That's right, it is discussions how to use insulin, see, there is no type of diabetes, type 1 or type 2, just insulin and how to use it, and meal. Dose of insulin connected with amount of meal times. They are doctors, and they talk about diabetes, meal and insulin. Now let me ask those doctors, what was first, insulin deficit or meal? What id diabetes, regardless it is type 1, type 2, LADA, MODY, or any one type it can be? It is deficit of insulin in blood. This is why insulin must be added in injections.
Now there is another question right from this statement, what dose of insulin must be injected? What doctors discuss?
We can start with 4 U, or 0.1 U/kg, or 10% of the basal dose.4 units of insulin will not make any difference for diabetic with A1c>6.5%. Dr, Banting and his assistant injected 10 units into each other arms before they started to inject insulin in diabetics patient. Nether one of them was diabetic. For doctors it must be very well known. So, 4 units can be injected, but question still stand, what dose of insulin to inject, and how to determine dose of insulin diabetic need? I tried to find it in discussion, and there is no answer to this very simple and most important question.
Authors of discussion jumped to the testing, meal account, and to discuss GLP-1, looks like they have paid to promote this medicine, still, it is not insulin, and the point of discussion simple avoided. Bother authors do not know what to say, but do know very well how to get money from the empty air.
Dr Shubrook: You have mentioned many options, which make me a little nervous and confused. That is part of the problem—there are so many choices. Let's talk about basal plus one [dose of] insulin. For the insulin at one meal, we can choose a fixed dose of 4 U or a weight-based dose of 0.1 U/kg. What kinds of insulins can we use for basal plus one?I am very interesting to find out how doctors choose dose of insulin for any amount of meals, any body weight. So, what is the dose? There is no any discussion how to dose insulin injections. It was left for patient, diabetic or to those who care for diabetic, parents for child or loved one for adults. Most complicated part of therapy, the dose of insulin which changing all the time, out of any discussions.
Dr Young: Two subclasses of insulin are available: rapid insulin and short-acting insulin. For rapid-acting insulin, there are three options: aspart (NovoLog®), lispro (Humalog®), or glulisine (Apidra®). Regular insulin is a subclass as well.
Let us try to get the picture what is insulin therapy and how it looks from the point when needle go into belly every day a few times. Fixed dose based on weight? Try it. Level of sugar different every time we take readings. Insulin is real therapy. After injection level of sugar dropping. But the drop going differently if it is one type of insulin or another. Short acting type of insulin or rapid acting insulin dosing are not based on the weight but on the meal one planning to eat, carbs count. I do not use this accounting, so I am not going to discuss how to dose this type of insulin. I tried many times, I used to take all of them, and all what did I have just riding on the high-low swing. I lost my patience. Also I mixed a few times types of insulin. It is OK if Lantus Solo Star taken instead of Novolog. The dose of Novolog is smaller, and actin time of Lantus is longer. But if instead of Novolog I took Novolog, the dose of which is less then Lantus Solo Star, and I took higher dose then I needed, I am in big mess. Lantus Solo Star is type of insulin to cover needs between meals.
On the flip side, patients were taking doses of insulin for something that is not a real meal, like a cup of coffee, and then they are at risk for higher rates of hypoglycemia. What I heard is that the basal-plus-one algorithm is as good as basal plus bolus, with less hypoglycemia. What a game changer. Would you use the same dose for basal plus one as you would for basal-bolus?I try all the time to get this game, basal, bolus, rapid, short, and so so on, and I never was able to find it out, which one to take at any time my sugar above the sky. What I see, no one of them do know what they are educate diabetic to do.If insulin taken to get rid of sugar after meal, then what is the reason in it? This is why most people do accept that meal is our enemy. This is why professor tylor is so popular that his theory of starvation diet will cure diabetes. Say me how?
Diabetes is disease of pancreas. If so then all testing, all treatment must be addressed to treat pancreas and test if pancreas started to recovery or not. In contrary, no one remember that pancreas is the key, that all therapy must be about health and well being of pancreas. Not at all. All discussions how to get rid of sugar from blood: carb limiting in meal, starvation, insulin to reduce sugar right after meal, and so so on. How all these effected pancreas? There is no one test, no one every discussed the condition of pancreas after any therapy, GLP-1 including.
All this discussions can be seen as therapy for those who has pneumonia. This patients have high temperature of the body, right? It is inflammation. So, best treatment to get rid of high temperature is to put victim of barbarism into ice water. Would body get cold after these therapy? I bet it will. So, let us thereat diabetics type 2 with starvation diet, and they will not have any sugar in blood, right? Perfect cure!
Dr Young: Initially, we would use the same dose because the guidelines[1] recommend that when we use one dose or three doses, we start at the same dose. The only difference would be the frequency of injection because we would assume that they would eat about the same amount of food. Starting with different amounts will lead to a higher chance of hypoglycemia.It is perfectly wrong, D. Young. The amount of injections and dose of injection is very important. If all dose of insulin, Apridra, injected with one meal, then what is going to be? Low blood sugar, of cause, if dose of insulin was counted for full day use. The dose of insulin divided fro three or two or four injections depending on dose of injection, let treatment to be done smooth and nicely. It is easy to see with every not medical mind, and not possible to see with medical highly washed mind. Also it is very easy to see that Dr. Young simple replace one point of discussion with another, less uncomfortable for him. We do not ask what dose of insulin to start. The point of discussion, the dosing of insulin, and it is far away from being the same. Of cause we can start all and every one with the same dose, but then we go into differences, and very very wide range of them.
Your diabetics type 1 take 7 units of Apidra, and they do not have low blood sugar. I take 300 units of Lantus Solo Star, and low blood sugar is constant my companion, regardless what dose I started, and in how many injections I take my dose of 300 units.
Dr Young: That is a very good question. GLP-1 receptor agonists are glucose dependent, meaning that they work better when [blood] sugar is higher but do not work as well when sugar is slowly going down. The advantage is that they significantly reduce the hypoglycemia risk by being a glucose-dependent medication. In terms of dosing, there are three once-weekly GLP-1 receptor agonists out there, and patients love them.So, what is this about? That GLP-1 simple do not work to reduce level of sugar. In every one diabetic level of sugar in blood elevated, it is fact, and GLP-1 does not work when blood sugar going down, even slowly. so, before we will take this medicine into belly, what is the benefits I will have? No one. No low blood sugar? Simple, do not take insulin, and there is no low blood sugar, only high. The problem with low blood sugar solved. There is another problem also solved, dosing. GLP-1 taken all the time in the same dose, so, there are no one problem with question how to dose this medicine. The question is only, how it suppose to work? I do not see it so far. There is why there are Black Box. This medicine is potentially danger. Most important, it has all side effects it is listed, and no one will escape them, and has no one benefit, medicine promised. Why DO I Need It?
Of cause, to closer up any discussions, it is Diabetics who are behave unproperly. We do not test as we have to. At the same time all the time the Rx to glucose strips is on the discussion, that we do have overuse them. Now I am lost. If it is possible I do something right? Or because of I am diabetic I do all wrong?
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Complexities of Basal-Plus Insulin Therapy
via Ravenvoron
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