If you've been following my Adventures with Insulin you might have read about how I gave up trying to make Humalog work for me. No matter how I tried to use it, I'd see surprising highs and surprising lows. The more I took it the worse it got. I concluded it either wasn't matching up with my food properly or it was sparking the growth of antibodies which were blocking its effect for an hour or so.
What a nice surprise to discover that Novolog, in contrast, does exactly what it is advertised to do. It starts to work within 5 minutes of injection, peaks between 1 hour and 1.5 hours (when my food peaks) and is mostly gone by 3 hours.
This means I can now eat a a restaurant and NOT have to inject until I see the waitress bringing the food. No more chugging smarties while no food appears and I wonder if they'll ever sober up the cook enough to get out my dinner!
For example, last week I brought some along when I went to a new restaurant that had advertised Jamaican Patties, something I adore. If I was using R I would have had to inject almost an hour before eating and if I didn't eat the patty I'd have to come up with 15-20 grams of carbs fast.
With the Novolog, I was able to order my patty and take a look at what I got before injecting. After it was served I had grave doubts about whether I would want to eat it. One bite confirmed that the crust was disgusting. Since I had no insulin in me, I could just pick out the filling (all meat), throw away the crust, and not worry about having a couple units of insulin flying around my blood stream. Three cheers for Novolog!
Though the Novolog is perfect for eating out, I still prefer R insulin for those meals that I make myself where I know what to expect and can inject 45 minutes before the food comes out of the oven.
What I like about R insulin is that I don't usually eat big meals, I like to kind of nibble at this and that through the evening. R's slower pattern of absorption lets me browse my food over a couple hours rather than eat all at once.
The other thing I like about R insulin is that it is just slow enough that a dinnertime shot will get my blood sugar to a good place when I'm done with my evening nibbling. The way my blood sugar works, if it is good at night when I stop eating, it is good first thing in the morning, too. This is a characteristic of the kind of MODY diabetes I have. This means that if I use R insulin I don't have to fool with basal insulin.
November 15, 2006
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3 comments:
Jenny,
I understand the point you are making about your BG remaining constant overnight.
Is this the case if your BG is at say 83 before bed?
I don't think its necessarily proof that you don't need a basal insulin: it could be that your beta cells are working flat out producing pulsal insulin, which adds to their stress and prevents the storage of insulin for a phase 1 response, and leads to an attenuated phase 2 response.
Among many factors that seem to be present in type 2 diabetics is a higher level of serum inuslin and defects in the way that the liver controls BG levels.
Furthermore there seems to be some evidence to support the idea that phase 1 insulin response is diminished above a level of about 110, or maybe even 100. I wonder if the phase 1 response is triggered by BG passing above a certain level, and if BG remains consistently above this level phase 1 response is effectively switched off, or dormant.
I do think that insufficient attention is paid to the role of the liver in type 2 diabetes. For most of the time it is the liver that controls BG levels - in the fasting state. Furthermore, phase 1 response should signal to the liver that it should stop pumping out sugar and should begin storing it. Regular insulin may have a similar effect as a phase 1 response here.
Paul.
Jenny,
Does your Bg stay stable overnight regardless of the level prior to bed. For example, if it is 83 prior to bed will it be 83 on awaking? Similarly does it stay high overnight?
There has been some research/anecdotal evidence to suggest that phase 1 inuslin respone is absent above a BG level of, say, 110, and is attenuated above 100. This raise the possibility that phase 1 insulin repsonse is triggered by BG rising above a particular threshold. If BG remains contstantly above this level the phase 1 inuslin response may be permananently swiched off - effectvely lying dormant. Possibly this was a factor in the Reavens study with the Biostator and with some other research. It might also back up the anecdotal obervation of some that is the BG level is lower on arising, control is easier to achieve.
I also wonder is a basal insulin helps the beta cells in two ways:
(i) By reducing the requiement for pulsal insulin, and hence enabling insulin to be stored for a phase 1 repsonse.
(ii) By enabling BG levels to stay at a lower base level, and hence triggering a better inuslin response in response to food consumption.
It seems to me that the use of insulin with meals acts in a similar way to a phase 1 response.
Another area that I feel receives insufficient attention is the role of the liver in type 2 diabetes. It seems to me that for most of the day the liver is the most significant regulator of BG levels. Furthermore some research has suggested that liver insulin resistance is a trigger for muscle and fat inuslin resistance. I believe there is a strong correlation between non alcholic fatty liver disease and type 2 diabetes. There is a need for more research in this area.
Out of interest, what sort of BG levels correlate to your hba1c of 5.6?
Best wishes,
Paul.
Paul,
Your thoughtful comments raise some interesting points. However, my situation is that I am probably not a Type 2, but seem to have MODY-1. I haven't been able to get the testing, but I have the classic history and symptoms.
MODY-1 is strange. People with it have normal fasting C-peptide levels, but still get very high post-prandial readings. They also have extremely intense responses of tiny bits of a sulfonylurea drug like Amaryl. I was hypoing on 1/8 of a 1 mg pill.
The defect here appears to be in secretion in response to a rising glucose load in the blood stream. It doesn't happen properly.
I will stay pretty much in the 80s or low 90s for a long time as long as I don't eat any more carbs.
I did pretty well on Ultralente, mostly because it is peaky and I could get the peak to cover a meal or two. Lantus was a disaster. I went surprisingly high after meals when I was on a dose low enough to keep me from hypoing which was only 3 units! At 6 units I was hypoing dramatically at night (though it took a while to figure that out). Levemir caused my blood pressure to soar.
People who do have Type 2 would probably not do as well as I do on this kind of regimen, though I do wonder whether focussing on the mealtime carb burden rather than the basal might still help some get better numbers, because the burden of 3 carb-laden meals on the insulin production is so much greater than that of the basal production.
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