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Posted 11/10/2005 3:25 PM (GMT 0)
I wonder if anyone could help me.

I am 27 and have had type 1 diabetes for just over a year.  I have been taking 2 injections a day and my sugars were well controlled for the first few months.  More recently I have found my levels to be harder to control - more high readings and more hypos.

I am now considering going to the doctors to discuss going onto 4 injections a day as I have heard this makes sugar control easier.  However I don't like the thought of two more daily injections and being relatively young I still want to be able to go out at the weekend to a club and don't really want to have to be taking an injection and eating while I am on a night out.

Can anyone who has switched from 2 to 4 injections give me their story an how it affects social life.

Thanks

Kevin 

Posted 11/10/2005 8:47 PM (GMT 0)
Kevin,

Im a type 2 that is using injectibles and Im not here to tell you whether 2 or 4 is right for you; thats up to your doctor.  What I can do is give you some advice that might make 4 inections more palatible.  Go to a 31g 3/16's inch needle for your injections.  These needles are Soooooo tiny that you don't have to pinch the skin and go in sideways, you can just go straight in.  I use the B&D ultrafine needles and the have some sort of micro lubrication on the surgical steel needles and I swear you can't feel them go in most of the time.   As for social situations, its not big deal.  Look into a FRIO wallet to carry your insulin and syringes and then ducking into a bathroom for 2 minutes to do an injection is no big deal.  The Frio wallet is supposed to keep insulin at a non spoilable temp for up to 45 hours so that might be your ticket.

I know it doesn't answer your original question, but I hope maybe this helps with the mechanics of being someone on injections.

scool   Warren

Posted 11/10/2005 9:24 PM (GMT 0)

Hi Kevin,

I'm 26 and type 1 for about 14 years.  I was first on 2 injections and after a couple of years I went to 4.  I've never regretted it and I've found that, although I have to do injections when I am out, it actually gives me more freedom.  If I am eating late then I can do my injection later - I don't have to eat at exactly the same time each day.  I've been told at the hospital that if I really want I can miss a meal (and therefore an injection) but not to do it too often!  Perfect if you are going out and really can't eat a meal.  The only injection I make sure is the same time each and every day is the long acting insulin which I take around 10 pm (I usually try to eat at similar times each day but I'm not tied into it, so on a weekend when I get up later I can eat breakfast a bit later).  I've actually heard that some people eat smaller meals and more often and have about 6 injections a day.  I personally would seriously consider this as I sometimes need more than 4 a day anyway.  I really do think that 4 injections really do give better control and also more freedom, but it's best to discuss with your doctor.  Diabetes seems to affect everyone differently so it really is what suits you best.

Claire x

Posted 11/11/2005 9:15 AM (GMT 0)
Thanks Claire and Warren for your advice. Going to 4 injections certainly sounds alot easier to manage and I think I will have to seriously consider that. I have no problems with needles, the only thing putting me off is having to take the ten pm injection as when I am out I would rather relax and enjoy myself without clock watching. To begin with my sugar control was excellent on 2 injections - I think I am still coming to terms with the fact that is no longer the case.

Cheers for the great advice.
Posted 11/11/2005 11:17 AM (GMT 0)

Do you have a mobile phone?  Set the alarm on it for the time you need your injection, then you have no need to clock watch!  And also, if you go to 4 injections you are more likely to be using insulin pens (this is what I use and I guess if you are taking 2 injections you'll be mixing insulins and therefore using a syringe, though I may be wrong although I do have to use a syringe for the long acting one as I found the pen for that particular insulin painful but that's a different story!) and so you don't have to mess around with using syringes.  Just click to how much you need and inject (I usually can get away with doing it at the table in my tummy and no one ever notices, as long as it's discreet).  It's not the end of the world if you occasionally give yourself the long acting insulin a little later than usual.  The whole point of using 4 injections a day is that you don't become a slave to your diabetes.  I hope you find what's best for you.

Claire x

Posted 11/11/2005 11:24 AM (GMT 0)

Hi Claire

I have never used syringes, I am on a novomix flex pen that has 30% fast acting and 70% slow acting insulin.

For first 5 months my sugars were good morning, noon, evening and night but now my sugars are high at night and in the morning.  Also I started excercising every night and eating a chocolate bar to avoid hypos but sometimes my sugars went to high and other times I had a hypo so just trying to find the right balance.

I'll discuss it all the next time I go for a diabetes check-up

Thanks for taking an interest.

Kev

Posted 11/11/2005 12:54 PM (GMT 0)
Hi Kev,

I use the Novorapid Flexpen during the day and then Glargine for the long acting insulin (the long acting one lasts 24 hours so it acts as a background constantly). This works for me better than the 2 injections, but as I said it's up to each individual. Are you in the UK? If so, you are most likely going to the hospital every 6ish months for checkups. Discuss it there as opposed to your GP as they are specialists in diabetes where your GP isn't. They can always contact your GP to advise. When I changed insulins I noticed a difference in how my body felt and it took a little while to adjust as the quick acting insulin acts a lot quicker than the one I was on before, but as long as you eat properly you adjust to it.

I really hope this helps you make an informed decision as you are the one who's diabetic and you have to be happy with your own control - you don't have to have 4 injections if you aren't happy with it.

Claire x
Posted 11/11/2005 1:01 PM (GMT 0)

Hi Claire

Yeah I am in Scotland.  I have a diabetes centre in my local town but due to strain on the NHS I get a checkup every two years rather than every 6 months.  In between times I go to my gp for a check.

I will see how things go for the next wee while then i will make an appointment at the hospital if I think I need to speak to diabetes specialist.

How do you get on with exercise - do you have many hypos?

Kev

Posted 11/11/2005 1:29 PM (GMT 0)
I'm down south - I'm a lot luckier as I've been going to the hospital every 3 months lately as my control went a bit (decided I'd slightly ignore the fact I'm diabetic for a while, which is really stupid) but I'm getting a lot better again and I'm to go back every 6 months now. I'm fortunate enough to have a telephone number for one nurse or another at the hospital if I need it. I'm starting to realise how lucky I am with the care I receive!

I'm very naughty as I don't do a lot of exercise at the moment (apart from walking to the bus stop -only joking). I find any reason not to - my weight is fine and I have no complications (touch wood so far!) but I must admit that's something I need to improve on. What kind of exercise do you do? Where I live there's actually a lot of walking around to do so I'm not sitting around all day, and my job can sometimes be quite active, but that's not really a proper subsitute.

I can't give any advice on what best to do if you are exercising to be honest, it really is something you need to adapt to what suits you with good advice from specialists (which is what I need to also do - maybe whoever gets advice first can share?) :)

I was getting a lot of hypos at one stage, every day near enough, but they have rarely been severe. I usually get good warning signs.

Claire x
Posted 11/11/2005 1:41 PM (GMT 0)

I was playing some golf in the summer and taking a chocolate bar at the start of a round and that worked pretty well.  Now the golfing season is over I have started the exercise bike and weights but that is causing hypos. 

In the main I recognise hypos and deal with them effectively but occasionally I don't realise I have one till my sugars go very low and I've had a couple scares.

I lost alot of weight when I as first diagnosed and the diabetic nurse said I would put it back on once I started insulin.  I never did but my diabetes coincided with a really stressful time in my life and I am naturally tall and lean so that prob explains why I never regained much weight.

Light exercise accompanied with a choc bar seems to work for me but I've been to scared to try anything really exhausting like five a side football etc.

Kev

Posted 11/11/2005 1:43 PM (GMT 0)

Hi Claire

Just one more question about 4 injections a day.

Could I take the long lasting one during the day rather than late at night.  That would mean I could take that at dinner time and then if I had a night out I could just skip the short lasting one?

Kev

Posted 11/11/2005 1:57 PM (GMT 0)
Do you follow the GI diet? If you don't I'll roughly explain and if you do sorry for the extra reading!

There is a points system for foods (sugar is roughly 100, eggs and some meat are 0). Chocolate has a lot of sugar but it's still not that high on the index. I think a mars bar is 55, whereas some potatoes are in the 90s. I think it has to do with how much fat it has as well. If sport is higher impact I'm guessing you would need something a bit quicker acting than chocolate? I may be wrong, though, but this might explain why a snack that's not that quick acting on your blood sugar would be good for a sport that's not high impact, but wouldn't be very good for football where there's more bursts of energy being used. Again, this is something to see a specialist about! Ha ha, sorry to keep saying that but I'd really hate for you to follow my advice and for me to be wrong! I did see a dietician today before work and I'm using the GI way of eating so I have a relatively good understanding of how it works. Does this make sense to you, though?

I know what you mean about the scares. I ended up being taken to hospital in an ambulance a couple of months back as my blood sugars just went crazy. They didn't hit too low, but they were falling and falling even though I had eaten. I had lucozade and the levels kept falling. This is the wake up call I needed to look after myself a lot better than I had been previously. I must stress, this was because I wasn't looking after myself though.

Claire x
Posted 11/11/2005 1:59 PM (GMT 0)
Oops missed that! I've been told that you can take the long lasting insulin in the morning before breakfast so that would mean you don't have to carry it around with you on a night out - so yes, you should be able to. I don't know if it gives you a different affect than doing the insulin at night as I've always done my insulin at night time.
Posted 11/11/2005 2:06 PM (GMT 0)

Thats great Claire - Im def gonna talk to the doctor about this because 4 inj a day with the longer lasting one in the morning could be the answer for me!  Dont worry about giving advice cos I would always check with the specialist as I am sure you would aswell.

As for eating I have not been given any information about GI diets.  I basically follow as healthy and balanced diet as I can. I prepared my own diet sheet I could maybe email you that.  My email address is [email protected]

Cheers

K

Posted 11/11/2005 2:17 PM (GMT 0)
I forgot to say that the rating on the GI diet corresponds to how quickly it affects your blood sugar! Below 55 is low, I think around 55-70 is intermediate and above that is high. I really do recommend the GI diet as it seems so good for diabetes. Some people would disagree with me, especially type2s I think, but even the dietician I saw today said it's a really good plan as long as you don't solely rely in it (it would be too restrictive if you did). If you want to eat something from the high side combine it with something from the low side - your blood sugar level would just rise as though you'd eaten something intermediate.

That would be great to see your diet sheet - I'll send you a quick e-mail.

Claire x
Posted 11/11/2005 2:56 PM (GMT 0)

Hi Claire and Kevin,

I used to use the Lantus or long acting insulin and the graph for its efficacy shows it at a constant level in your blood for 24 hours (basically a flat line from injection out 24 hours).  My Endocronologist said when I take it is really a matter of preference as long as I do it the same time each day.  So, ask your diabetes doc, but mornings should not be a problems as the release and effect on your blood sugar is the same all day long!

scool Warren
Posted 11/11/2005 3:09 PM (GMT 0)
Thanks Warren, I might mention it the next time I'm at hospital - I think I'd also probably find it a lot more convenient to do the long acting insulin in the morning! I tend to leave it at home if I think I'm not going out (as I use a syringe and vial for the long acting insulin) and so if I'm unexpectedly invited out I have to limit my time. Thanks for bringing this up Kevin!

Warren, you mention you used to use Lantus - what do you use now?

Claire x
Posted 11/11/2005 4:15 PM (GMT 0)

Hi Claire,

Well as I mentioned earlier I am a type 2 for about 6 years.  I maxed out on oral meds and still wasn't under control (8mg Avandia, 2000mg Metformin, 20 mg Glucotrol/glipizide, and numbers still in the 200's).  My Endo guy put me on Lantus and bingo, my numbers all came into the normal range.  One of the problems was I was having spikes after meals...big spikes, into the 200's.  Well Lantus wasn't designed to handle the spikes, but my fasting BS in the mornings was great.

Then my Endo put me on 5mcg of Byetta and did away with the Lantus. Voila!!  postprandials are now sub 100's and fasting is normal.  In fact I've had enough hypoglycemic incidents after meals that I've just cut my oral meds in half to see what the overall effect will be.  Now I know as a Type 1 this isn't much help for you as Byetta was designed for type 2's.  But for me it seems to be doing the trick.  Next week I see the Endo guy and hopefully we'll check the A1C and see where I am.

Incidently, I think that Lantus is a wonderful drug, and if you have to take insulin, it provides a really stable baseline to work off!  My goal is to get off the orals all together before they destroy my kidneys, and hopefully just use the BYETTA.

AND, after reading the article on Cinnamon, Im going to introduce that to my regemin next week and see what doses affect my BS in what ways.  After a couple of weeks I'll leave some feedback on that!

scool  Warren

Posted 11/11/2005 5:18 PM (GMT 0)
Hi kevin,

I dont know if this helps or not,but I have been diabetic for 16 years

and been on insulin for 14, when I first started injecting I too was

like you, in my early 20's and taking 3 shots a day, I also enjoyed

going out alot and it was such a bother too always excuse myself

to go into the bathroom to either inject or take my sugar to make sure

it was'nt dropping, so after about 4 years of that I switched to 2 shots

of 70/30 a day one at breakfast and one at dinner. I also take a low

dose of lantus a lunch which balances out the rest of my 24 hrs. I

tried taking lantus at bedtime but had way to many lows. I also have

2 very sports oriented boys who take up most of my time and when I

excersise with them I hardly ever have any lows like I did when I was

only on fast acting insulin. Just talk everything over with youre doctor

thats the most important thing and take care of yourself!!

Allison Rose

Posted 11/14/2005 10:14 AM (GMT 0)
Many thanks to everyone who replied to my message.  You have all given me some optimism and something to talk to the doctors about.

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