How I Use MDI

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A lot of people have asked me questions about how I manage my type 1 diabetes via multiple daily injections so that’s what this post is about.

Firstly, I want to say that this is what I do and what works for me and before you try to change anything to your diabetes management, you want to talk to your doctor.  Insulin dosages vary person to person depending on their weight, activity level, stress level, diet, insulin resistance, medications, etc.

I use Lantus insulin as my long acting “basal” insulin and Humalog insulin as my fast acting “bolus” insulin.

My Lantus routine

Every night around 10pm I give an injection of Lantus.  Based on my weight which hovers between 130-140 pounds, I am to give about 20 units per day.  This does work for me.  However, I try to exercise each day and eat a diet that is void of processed foods and low in glycemic load.  These two factors cause my insulin needs to decrease.  If I’m exercising and eating the way I try to, I use about 12 units of Lantus.  If I don’t do one of these, I will need about 15-16 units of Lantus.

I just want to note that when I removed wheat out of my diet, I lowered my Lantus by about 5 units, daily.  Kind of amazing.

Anyway, Lantus is advertised as a 24 hour insulin you take once a day.  If you open up the folded pamphlet that comes with Lantus and read it, you’ll discover Lantus lasts closer to around 20-21 hours.  So being aware of this, each day around dinner time, I give a extra unit or two of insulin in order to combat the dying out of Lantus in my system.  Or I do a really short workout and that takes care of things, too.

How do I deal with dawn phenomenon?

Well, I had a hard time with it when I gave my Lantus in the mornings because it would run out just before I woke up and cause me to wake up pretty high unless I slept around 75-80 (in that case dawn phenomenon didn’t do anything to me).  So that’s why I give Lantus at night.  Each morning, I notice that if I wake up at 7:30am or before 7:30am, I don’t deal with the dawn phenomenon.  If I sleep past that time, I will start to go up pretty quickly.  I don’t know why my dawn phenomenon seems to kick in so late, but it does.  By experimenting with testing at different times in the morning before you give insulin or eat, you can pinpoint the general time your body starts pushing your blood sugars up each morning.  I do find that if I sleep under 100, dawn phenomenon doesn’t do anything.  But sometimes I don’t feel safe sleeping at that blood sugar level, because perhaps I did more exercise than usual or something and in those cases I’ll try to sleep between 110-140.  Being in that range in the early morning typically causes a dawn phenomenon spike for me so I try to get up at the same time each day and give insulin and eat first thing.

My Humalog routine

I use Humalog as needed and before meals.  I just count carbs and take note of my insulin/carb ratio which is about 1:15.  Most of my meals let me give below 2-3 units of insulin so I don’t usually have to worry about really high or low post meal blood sugar swings.  I do notice that sometimes I’m really stressed and sometimes forget to drink water.  As a result my blood sugar climbs considerably.  I give an extra amount of insulin with meals to combat this.  If the stress is a bit chronic (long term) I’ll up my Lantus instead of my Humalog-which I reserve for very temporary situations.

About injecting

I inject in public as needed.  I inject in my abdomen, hips, arms, and above my breasts (click here for a video of that).  I reserve my hips and arms for times my blood sugar is kind of low (around 75) and my abdomen and the fatty tissue above my breasts for the times I’m ready to eat or over 120 because those areas tend to yield faster results with the insulin.  I rotate a lot more than I used to because it helps avoid the buildup of scar tissue-which absolutely affects insulin absorption and makes it more random.  After giving an insulin shot, I put my fingers over the area and press gently for a few seconds.  This is supposed to help the insulin get absorbed.  I don’t use insulin pens because sometimes I am not sure how much insulin I got or sometimes insulin leaks from the site.  I like the small child-sized syringes by BD that hold up to 30 units of insulin and have a very short and fine needle.  If you are not thin or average weight, you’ll want a longer needle in order to ensure the insulin gets properly absorbed.

Carrying and caring for insulin

I carry a case with my meter and Humalog insulin at all times.  I keep Lantus in the fridge in the butter compartment.  I don’t keep Humalog anywhere near my Lantus because I don’t want to risk giving a huge amount Humalog when I intended to give Lantus.  I’ve done that twice and it resulted in me seeing the paramedics on both occasions.  After 30 days I dispose of Lantus and Humalog (even though I have plenty left).  I never refrigerate my Humalog because it lasts 30 days without refrigeration and it is supposed to be disposed of after 30 days anyway.

Does it work for me?

So that’s how I do it.  I have managed to use the method described above for 5 years now and keep my A1c below 6% the entire time.  Shots work if you understand some insider info and consider appropriate timing and carb counting.  I had to learn a lot of this the hard way or through my doctors.  If any of this info is news to you, talk to your doctor about it.  Make sure you understand the ins and outs of the insulin you use.  It totally affects diabetes management.

Please read this part again:

Please remember that changes to your diabetes management should be done carefully and *technically* with the approval and guidance of a physician.  Don’t get hurt and then blame me Winking smile

XOXO

4 Comments

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Do you think your insulin needs decreased when you removed wheat because you were eating less carbs by default or do you think it was simply related to the wheat itself? I have noticed a difference too when I took out gluten, but I have also been eating less carbs of those types of carbs because of it. Not to mention taking out the gluten prevented me from getting sick, so I am sure that had something to do with it too. Just curious!

Ooh! Great thing to point out Melissa! I think it gluten was making me sick. And it caused stomach issues and raised my need for insulin. So I think it was both fewer carbs and that as well, resulting in my sharp decrease for insulin. I think it’s interesting that you found the same thing happened to you!

We also prefer mdi. We are not on a low carb diet because my son is 14, skinny and growing fast. I have a couple questions. At what bg do you correct at night? We were told not to correct below 200 when first dx, and only use a a half correction. Now I correct a 180 or above but use a half correction. I am thinking perhaps that is not sufficient. Also we switched lantus to morning because of way too many night time fluctuations and night time lows. Lantus in AM has been such a God send for us (I know it does not work for most people) His night number as almost flat now, except for when he gets dp. I assume his body is dumping growth hormones because as I said he is growing FAST!! I am checking at about 1-3 am for his usual night time check but now also checking at 6ish for dawn phenomenon, which is occurring about half the time so I can correct that. His night numbers have not been great – about 170-120. But they have been much more predictable and flat since switching to AM lantus (again, not recommending it to anyone else- just sharing our experience). His correction factor is spot on so I think I may start to correct if 170 or over, again with just the half correction for a 170.

Hi Donna! At night, I usually correct if I’m over 140. But, I’m not a growing child and I keep my daily activities more or less scheduled versus a child who has more random activity. At his age, I too was eating more and growing fast. At that time the fastest insulin peaked in two hours. We corrected my blood sugar when it was over 160, but the insulin wouldn’t bring that down for quite a while so we had more time to get a resulting drop in blood sugar. With today’s faster insulin, I’d suggest talking with your son’s doctor about wanting to change the correction threshold because in growing children, things are more unpredictable and it’s always a good idea to have a little more cushion. 120-170 at night is so much better than I had at that age :) There are other factors which make me not correct insulin at 140 or 150. Sometimes if my stomach is empty (from a BM or the occasional loose BM) my sugars will drop over night and giving even a tiny bit of insulin will give me a huge drop. This is one reason why tighter control is so much easier in adults- children aren’t necessarily communicating to their parents their current digestion status, their stress levels, their extra spurts of exercise throughout the day-and it all affects blood sugars. You sound like you are both doing an awesome job. :)

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