MDI rocks!

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This topic contains 39 replies, has 13 voices, and was last updated by  Tim 7 years, 6 months ago.

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  • #9799

    Tim
    Keymaster

    In my view pumps are the emperor’s new clothes, MDI is the way forward. In fact, one dose of mixtard a day should be fine for 99% of all diabetics. Are you all with me?

  • #10187

    Hairy Gnome
    Participant

    I’m sure I would be if I knew what you were talking about Tim… pmsl… ;-)

  • #10189

    Anonymous

    If only….

  • #10191

    Tim
    Keymaster

    @teloz – sorry, MDI is Multiple Daily Injections. A combination of slow and fast acting jabs that keeps us Type One’s alive.

  • #10192

    Tim
    Keymaster

    @aileen – I thought you, of all people, would be very pro-MDI, no? ;-)

  • #10200

    Anonymous

    Been there, done that, then got a pump.

  • #10201

    Tim
    Keymaster

    @jay451 – yup, that seems to be the general consensus. I wonder if there are any people out there who think “Yes, MDI really rocks! I’m going to give up my pump and go back to injections!”

  • #10202

    Anonymous

    I got my pump just before Christmas, and at a recent review, I was asked – did I want to keep it?- errr YES!!!

    My HbA1c is down from nearly 12 to 7.7 in three months, I have energy, don’t feel sick all the time, and actually have insulin in my body all the time/when I need it…

    Go back to MDIs? No thanks – I didn’t do them properly anyway.. so sorry Tim, but you don’t get my vote (you’re just jealous!! – and rightly so) – good luck with the wait – I’m keeping my fingers crossed for you, however, it is making testing quite difficult! ;-)

  • #10203

    Cecile
    Participant

    MDI have enabled me to maintain recent HbA1cs ranging between 5.9 and 4.9, so I’m supposed to sing songs of praise, but it also have left me stranded on hypoglycaemic rocks a trifle too often – I envy pumpers the ability to set their overnight bottom line to a mere trickle…

  • #10238

    Anonymous

    Pumps? Nope not for me I’m afraid. Much rather be able to leave my diabetic gubbins on the table between meals.

    Go go MDI :)

  • #10240

    Tim
    Keymaster

    @mike – but they look cooooool though! Gadgets are one of the few benefits of diabetes!

  • #10242

    Anonymous

    Gadgets, yes. Can someone confirm the rumour that there is a new Lantus pen that can hold it’s weight next to a Novopen?
    The Autopen24 needs to go.

  • #10243

    Tim
    Keymaster

    @alex – I use the lantus pre-filled Solostar:

    http://www.lantus.com/solostar/solostar_insulin_pen.aspx

    It’s crap – but at least it can do single units, rather than the AutoPen’s two units.

  • #10245

    Anonymous

    @tim The green Autopens do 1 unit (with a smaller max dose). Though they are still as dreadful as the 2 unit ones. I can’t understand why Lantus has virtually no refillable pens. Sanofi just don’t seem bothered.

  • #10247

    Cecile
    Participant

    @mike Sanofi’ll just point a blaming finger at Owen Mumford, inventors of both the Mumbo Jumbo (2U) and the Mumbo Mini (1U). To me, they have the appearance of cattle prods designed by Fisher Price…and you can’t back-dial a dose…and you can keep on dialling even if the insulin is finished. A mooing boo to the the experimental cattle who approved of it.

  • #10248

    Tim
    Keymaster

    I once wrote an article about why pens were so ugly:

    http://www.shootuporputup.co.uk/2010/01/why-are-insulin-pens-so-ugly/

    And they are – I hate all of them. Given that you use them every day it’s not much to ask for a decent, heavyweight pen that works. I would happily buy one rather than burden the NHS with such luxury

  • #10254

    Anonymous

    Still got a soft spot for NovoPens. Recently changed to the ‘portly executive board member’ styled Memoir purely for the dose/time memory function. The NovoPen Echo would have afforded this without the need to change insulins, but NovoNordisk, in their wisdom, have decided we are not worthy of their new toy in the UK – well not yet anyway.

  • #10301

    Anonymous

    Sorry tim but mdi for me was nothing but hassle ! If anyone can manage to keep a tight control on 4 jabs a day well done :) but insulin on tap night and day is superb , every one should be given the chance to try one and see the difference .

  • #10306

    Anonymous

    I’m starting to feel left out cos I’m on the MDI rigmarole. Apparently though as long as I take my Lantus at the same time everyday and I count my carbs then I’ll be able to work out how much Humalog to take. Therefore, in my massive bag I also carry a calculator to work out the carb content of foods. It’s a pain having to weigh food before I can get stuck in about it so I can work out the carb content. I’m sure the Humapen Luxura comes in half unit increments – but only if you beg on your hands and knees to any diabetic doctor/nurse who will listen. They want the HbA1c below 10 but won’t give us the equipment to tighten our control? Haha leave it up to ‘betic folk to crack the jokes!

  • #10308

    Tim
    Keymaster

    @simon1972 – MDI is a pain in butt (well, stomach and legs) but it is possible to get by on it. I recently read Pumping Insulin on @alison‘s suggestion and have adapted some of the fancy things, like square waves, for MDI. Anyway, A1C has been under 6.5% for a while but that said, that good result disguises a lot of swings – especially to the low.

    I just think pumps are a better tool for doing what we’re trying to do – simulate what the pancreas does by itself.

  • #10309

    Tim
    Keymaster

    @gillian – I too carried a calculator around when I was first diagnosed – I just can’t do sums! (My A levels were in English Lit, Geography and History and my degree is law – I do writing, not maths!) I now use my mobile for calculations.

    When I started carb counting I carried around a little notepad and every time I had a meal I wrote it down and the amount I injected for it. So, for example, “Spaghetti bolognese = 9 units”. Next time I had spag.bol I would just look it up in my notebook and inject accordingly (obviously allowing a bit either way if BG was high or low; or adding / subtracting if portions were abnormally large or small). Before long I had a useful cheat-sheet of meals and the amounts I needed to stick in.

  • #10310

    Annette A
    Participant

    @tim – totally agree. MDI and carb counting gave me an A1C of 7.2 for the first time in years, but couldnt help with the underlying swings that the long term (Lantus) insulin just exacerbated. 1.5 weeks into having a pump, and it appears it’s removing/dealing with my 3am dip which I’ve had all my life and my dawn phenomenon, and does appear to be making it easier to deal with the hormone-induced swings as well.
    MDI was a large step forward. Pumps are a jump further.

  • #10311

    Alison
    Keymaster

    I think carb counting is the key to everything – it’s the only way you can accurately adjust insulin, whether you’re on MDI or pump. The pump is a good tool for the job, but you still need to get the carb counting right otherwise it’s just a fancy way of delivering the wrong amount of insulin.

  • #10312

    Tim
    Keymaster

    I suppose being relatively recently diagnosed, I’ve know nothing but carb counting as that was what I was trained on during my first few days as a diabetic. So it’s just second-nature to me now I guess.

  • #10313

    Anonymous

    @tim + @alison

    How did you guys start carb counting? Docs, Books, other people who carb count? Think it might be a god idea for me to give it a try or at least try and grasp the basics.

  • #10314

    Annette A
    Participant

    Interestingly, when I was first diagnosed in 1977, I (or rather, my mother) had to carb count in a way. Back then,it was X insulin = Y carbs per meal (so the insulin lead the carbs, rather than the other way round as it is now). And I just kept on doing that, through the changes in advice (you can eat normally, just sensibly/dont eat too many carbs, but dont mind what/and back round to carb counting). So when carb counting as we know it came into trend, I was one step ahead of the game (already knowing how much things counted/how to interpret idiot labelling).
    @mike – I started how I’m doing it now through a course run by my diabetic clinic (which I only did because it was a prerequisite to being considered for a pump, but am really glad I did it now!)

  • #10315

    Tim
    Keymaster

    @mikeinspain – very much worth doing. I was only diagnosed five years ago, so I’ve done nothing but carb count since diagnosis; so I got all my training alongside my initial “here’s how to inject”, etc., stuff.

    There’s an online course about carb counting (and other stuff) here http://dafneonline.co.uk/ which might of use.

  • #10316

    Anonymous

    Cool, will check it out.. Thanks

  • #10317

    Alison
    Keymaster

    @mikeinspain I was diagnosed aged 4 so my parents learnt to carb count and I’ve never really known any different, it’s just second nature to me now.

    There’s also some good online carb training at http://www.bdec-e-learning.com

  • #10318

    Anonymous

    Thanks Alison

    I did register on the site you mentioned above, however naughtily I have done nothing else since! “hand slapped”
    :-)

  • #10319

    Anonymous

    @annette Anderson – bit late for you pumpers, but anyone else who suffers an overnight Lantus dip could try shifting the injection to breakfast time. I’ve recently solved a years-of-waking-up-low problem by doing just that: http://www.everydayupsanddowns.co.uk/2010/05/morning-person.html

  • #10320

    Tim
    Keymaster

    @mike – I didn’t know you had a blog! I’ve duly added it to our (well hidden and underused) links page!

  • #10325

    Anonymous

    Added you to ours a few weeks back daaaahlig… Mwah! Mwaaaaaaah!

  • #10326

    Annette A
    Participant

    @mike – yes, I did this myself a few years ago (on advice from the DSN) and it certainly helped – reduced night time hypos to a couple of times a month and not too serious. So worth a try for anyone going hypo overnight.

  • #10330

    Tim
    Keymaster

    @mike – I think that’s the first time I’ve been air-kissed on the blog! A day to put on the calendar!

  • #10332

    Anonymous

    Who’d have thought ‘air kiss on blog’ would have beaten ‘being sick on a doctor’ to your long list of lifetime achievements.

  • #10333

    Cecile
    Participant

    @mike: According to my interpretation of Lantus’s action profile, the best time to inject would be at 2AM – which I’ve tried a few times, but I’m not very responsive to importune alarm clocks, so I’m back to 22:00…and waking up with a BG of 2. Which I can live with (Lantus not as efficient an emetic as Protaphane)

    @tim: Take an overnight shot of Protaphane and start stalking Dr. Oz in the morning…2 flies with 1 swat.

  • #10334

    Anonymous

    @Cecile (@ckoei?) ah now don’t forget Lantus’s marvellous 3-day lag before settling down. At one stage I tried altering my basal based on my 10pm bg reading. Complete chaos. Afterwards I read that L is well known for taking a few days before grumpily settling in to any new system. Levemir is far more flexible apparently, and since it often exhibits a shorter (16-18h) activity period is often split into two doses for variable night time/day time basal requirements.

    I’d forgotten Protaphane. Golly, that was a long time ago!

  • #10340

    Alison
    Keymaster

    Ah, good old Lantus, those were the days. I had real issues with morning hypos on Lantus and found that splitting the dose and taking half in the morning and half in the evening helped a lot. It still wasn’t perfect, but it was nowhere near as bad as taking it all in one go.

  • #10344

    Tim
    Keymaster

    I used to split my lantus dose and no don’t bother, it didn’t seem to make much of a difference for me.

    Despite claims by the manufacturers, you’ll have all noticed it peaks after about 4 hours and then lasts about 20 hours or so. D’oh!

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