Re: Re: My menu and numbers

[Guest guest]

At 08:45 AM 4/22/2005, you wrote:

>And congratulations on taking the bull by the horns, so to speak, Rick!

>Vicki

Thanks Vicki!

Oh and by the way - now I can 'see' the bull. I thought I needed a new

eyeglass prescription (the current one is over 3 years old). When I got my

number way down, my eyesight improved dramatically! Wasn't expecting that!

Rick

[Guest guest]

At 08:45 AM 4/22/2005, you wrote:

>And congratulations on taking the bull by the horns, so to speak, Rick!

>Vicki

Thanks Vicki!

Oh and by the way - now I can 'see' the bull. I thought I needed a new

eyeglass prescription (the current one is over 3 years old). When I got my

number way down, my eyesight improved dramatically! Wasn't expecting that!

Rick

[Guest guest]

At 11:13 AM 4/22/2005, you wrote:

>Rick, have you tried spliting the Lantus shot? In type IIs who take large

>doses of Lantus they have found that it doesn't last anywhere near 24

>hours. By splitting the dose it will last longer and might take care of

>the DP.

>

>

Hi ,

No I haven't tried that yet, but I've been considering it based upon what

you and others have been saying here.

I did try Helen's suggestion last night. My bedtime glucose was 109. I took

three units of Humalog and also bumped my Lantus up from 60 to 65 units.

This morning when I got up my bg was 110 - so at least it was 'flat' today

rather than a rise.

Rick

[Guest guest]

At 11:13 AM 4/22/2005, you wrote:

>Rick, have you tried spliting the Lantus shot? In type IIs who take large

>doses of Lantus they have found that it doesn't last anywhere near 24

>hours. By splitting the dose it will last longer and might take care of

>the DP.

>

>

Hi ,

No I haven't tried that yet, but I've been considering it based upon what

you and others have been saying here.

I did try Helen's suggestion last night. My bedtime glucose was 109. I took

three units of Humalog and also bumped my Lantus up from 60 to 65 units.

This morning when I got up my bg was 110 - so at least it was 'flat' today

rather than a rise.

Rick

[Guest guest]

On Fri, 22 Apr 2005 12:17:09 -0500 Rick

writes:

>

> At 11:13 AM 4/22/2005, you wrote:

>

> >Rick, have you tried spliting the Lantus shot? In type IIs who take

> >large doses of Lantus they have found that it doesn't last anywhere

near

> >24 hours. By splitting the dose it will last longer and might take

> care of the DP.

> >

> >

>

> Hi ,

>

> No I haven't tried that yet, but I've been considering it based upon

> what you and others have been saying here.

>

> I did try Helen's suggestion last night. My bedtime glucose was 109.

> I took three units of Humalog and also bumped my Lantus up from 60 to

65

> units.

It might be a good idea to only try one adjustment at a time. It makes it

easier to determine which tweek made the improvement.

Also, if you are going to use a short acting insulin at night to cover

your fbg you might consider using novolog instead of humalog because

novolog lasts, in most cases, for six hours while humalog lasts for only

4 hours. If taking the humalog at bedtime brought your fbg down, in

reality it was on the rise when you tested when you woke unless you are

like me and only sleep for 4 hours a night.

> This morning when I got up my bg was 110 - so at least it was 'flat'

> today rather than a rise.

>

This is good progress and you should feel good about it but the trick is

keeping the pattern in tact. As a type I I think it is easier to figure

out the pattern because food intake is not as much of a meany to fbg's.

Well pizza would disagree because with this type I I see the error of my

ways the following AM and not 2 or 3 hours PP. If you eat that baked

potato, as a type II it will come back to bite you with your fbg's.

Judging from the numbers you listed in a previous post your goal seems to

be under 100 as it should be when considering potential complications and

what would this list do without you?

I would suggest to repeat last night's routine for two or three nights

and see if you get the same results. Of course you would have to drive

past the Dairy Queen while you are testing the best routine for you. If

you basically get the same result as this morning then try splitting the

Lantus dose and try that for two or three days. If your fbgs are better

then you have a routine to work with. If they stay the same as this

morning try novolog and see if there is an improvement.

Once you find the formula that is working you can work on bringing down

the amount of Lantus you are taking. Unfortunately, using insulin is an

ever changing process. Just when you think you have it right a gremlin

gets in and messes something up.

>

[Guest guest]

On Fri, 22 Apr 2005 12:17:09 -0500 Rick

writes:

>

> At 11:13 AM 4/22/2005, you wrote:

>

> >Rick, have you tried spliting the Lantus shot? In type IIs who take

> >large doses of Lantus they have found that it doesn't last anywhere

near

> >24 hours. By splitting the dose it will last longer and might take

> care of the DP.

> >

> >

>

> Hi ,

>

> No I haven't tried that yet, but I've been considering it based upon

> what you and others have been saying here.

>

> I did try Helen's suggestion last night. My bedtime glucose was 109.

> I took three units of Humalog and also bumped my Lantus up from 60 to

65

> units.

It might be a good idea to only try one adjustment at a time. It makes it

easier to determine which tweek made the improvement.

Also, if you are going to use a short acting insulin at night to cover

your fbg you might consider using novolog instead of humalog because

novolog lasts, in most cases, for six hours while humalog lasts for only

4 hours. If taking the humalog at bedtime brought your fbg down, in

reality it was on the rise when you tested when you woke unless you are

like me and only sleep for 4 hours a night.

> This morning when I got up my bg was 110 - so at least it was 'flat'

> today rather than a rise.

>

This is good progress and you should feel good about it but the trick is

keeping the pattern in tact. As a type I I think it is easier to figure

out the pattern because food intake is not as much of a meany to fbg's.

Well pizza would disagree because with this type I I see the error of my

ways the following AM and not 2 or 3 hours PP. If you eat that baked

potato, as a type II it will come back to bite you with your fbg's.

Judging from the numbers you listed in a previous post your goal seems to

be under 100 as it should be when considering potential complications and

what would this list do without you?

I would suggest to repeat last night's routine for two or three nights

and see if you get the same results. Of course you would have to drive

past the Dairy Queen while you are testing the best routine for you. If

you basically get the same result as this morning then try splitting the

Lantus dose and try that for two or three days. If your fbgs are better

then you have a routine to work with. If they stay the same as this

morning try novolog and see if there is an improvement.

Once you find the formula that is working you can work on bringing down

the amount of Lantus you are taking. Unfortunately, using insulin is an

ever changing process. Just when you think you have it right a gremlin

gets in and messes something up.

>

[Guest guest]

On Fri, 22 Apr 2005 12:17:09 -0500 Rick

writes:

>

> At 11:13 AM 4/22/2005, you wrote:

>

> >Rick, have you tried spliting the Lantus shot? In type IIs who take

> >large doses of Lantus they have found that it doesn't last anywhere

near

> >24 hours. By splitting the dose it will last longer and might take

> care of the DP.

> >

> >

>

> Hi ,

>

> No I haven't tried that yet, but I've been considering it based upon

> what you and others have been saying here.

>

> I did try Helen's suggestion last night. My bedtime glucose was 109.

> I took three units of Humalog and also bumped my Lantus up from 60 to

65

> units.

It might be a good idea to only try one adjustment at a time. It makes it

easier to determine which tweek made the improvement.

Also, if you are going to use a short acting insulin at night to cover

your fbg you might consider using novolog instead of humalog because

novolog lasts, in most cases, for six hours while humalog lasts for only

4 hours. If taking the humalog at bedtime brought your fbg down, in

reality it was on the rise when you tested when you woke unless you are

like me and only sleep for 4 hours a night.

> This morning when I got up my bg was 110 - so at least it was 'flat'

> today rather than a rise.

>

This is good progress and you should feel good about it but the trick is

keeping the pattern in tact. As a type I I think it is easier to figure

out the pattern because food intake is not as much of a meany to fbg's.

Well pizza would disagree because with this type I I see the error of my

ways the following AM and not 2 or 3 hours PP. If you eat that baked

potato, as a type II it will come back to bite you with your fbg's.

Judging from the numbers you listed in a previous post your goal seems to

be under 100 as it should be when considering potential complications and

what would this list do without you?

I would suggest to repeat last night's routine for two or three nights

and see if you get the same results. Of course you would have to drive

past the Dairy Queen while you are testing the best routine for you. If

you basically get the same result as this morning then try splitting the

Lantus dose and try that for two or three days. If your fbgs are better

then you have a routine to work with. If they stay the same as this

morning try novolog and see if there is an improvement.

Once you find the formula that is working you can work on bringing down

the amount of Lantus you are taking. Unfortunately, using insulin is an

ever changing process. Just when you think you have it right a gremlin

gets in and messes something up.

>

[Guest guest]

I wasn't referring to overlapping doses of Lantus; I was referring to

overlapping doses of UL, which is the way I take it, for excellent

coverage with no peak. But my doses are not equal, as I mentioned

before. This allows for the fact that my basal insulin requirements

aren't the same in the a.m. as in the p.m.

Vicki

Re: Re: My menu and numbers

>>

>>

>> >

>> >

>> >

>> >

>> > >If you give the Lantus a fair try and it still seems to be

>> keeping

>> > you

>> > awake, you might consider trying Ultralente as your basal. Very

>> few

>> > doctors ever prescribe this -- it actually doesn't even need a

>> > prescription since it's an old insulin, and it's a lot cheaper

>> than

>> > Lantus. It has a reputation as being unpredictable but IMHO, this

>> is

>> > because most doctors don't understand how to use it to best

>> > advantage,

>> > i.e. twice a day, 12 hours apart. Also, it takes some

>> experimentation

>> > to

>> > get the dosing correct. Very often the a.m. dose is half the p.m.

>>

>> > dose.

>> > I get excellent basal control with it, as do quite a few others

>> here.

>> > Vicki

>> > I'm not familiar with Ultralente. Is that like Humulin N?

>> >

>> > Kat

[Guest guest]

I wasn't referring to overlapping doses of Lantus; I was referring to

overlapping doses of UL, which is the way I take it, for excellent

coverage with no peak. But my doses are not equal, as I mentioned

before. This allows for the fact that my basal insulin requirements

aren't the same in the a.m. as in the p.m.

Vicki

Re: Re: My menu and numbers

>>

>>

>> >

>> >

>> >

>> >

>> > >If you give the Lantus a fair try and it still seems to be

>> keeping

>> > you

>> > awake, you might consider trying Ultralente as your basal. Very

>> few

>> > doctors ever prescribe this -- it actually doesn't even need a

>> > prescription since it's an old insulin, and it's a lot cheaper

>> than

>> > Lantus. It has a reputation as being unpredictable but IMHO, this

>> is

>> > because most doctors don't understand how to use it to best

>> > advantage,

>> > i.e. twice a day, 12 hours apart. Also, it takes some

>> experimentation

>> > to

>> > get the dosing correct. Very often the a.m. dose is half the p.m.

>>

>> > dose.

>> > I get excellent basal control with it, as do quite a few others

>> here.

>> > Vicki

>> > I'm not familiar with Ultralente. Is that like Humulin N?

>> >

>> > Kat

[Guest guest]

I wasn't referring to overlapping doses of Lantus; I was referring to

overlapping doses of UL, which is the way I take it, for excellent

coverage with no peak. But my doses are not equal, as I mentioned

before. This allows for the fact that my basal insulin requirements

aren't the same in the a.m. as in the p.m.

Vicki

Re: Re: My menu and numbers

>>

>>

>> >

>> >

>> >

>> >

>> > >If you give the Lantus a fair try and it still seems to be

>> keeping

>> > you

>> > awake, you might consider trying Ultralente as your basal. Very

>> few

>> > doctors ever prescribe this -- it actually doesn't even need a

>> > prescription since it's an old insulin, and it's a lot cheaper

>> than

>> > Lantus. It has a reputation as being unpredictable but IMHO, this

>> is

>> > because most doctors don't understand how to use it to best

>> > advantage,

>> > i.e. twice a day, 12 hours apart. Also, it takes some

>> experimentation

>> > to

>> > get the dosing correct. Very often the a.m. dose is half the p.m.

>>

>> > dose.

>> > I get excellent basal control with it, as do quite a few others

>> here.

>> > Vicki

>> > I'm not familiar with Ultralente. Is that like Humulin N?

>> >

>> > Kat

[Guest guest]

I was referring to UL's unpredictable reputation, not Lantus'.

Vicki

Re: Re: My menu and numbers

>>

>>

>> >

>> >

>> >

>> >

>> > >You know, Kat, what's really important is to take however much

>> > insulin

>> > you need to get your numbers lower -- whatever that is. You may

>> have

>> > high insulin resistance like Stacey so you simply need more

>> exogenous

>> > insulin than other diabetics. It certainly doesn't mean you've

>> failed

>> > or

>> > anything like that.

>> >

>> > >It sounds like you might need a little attitude adjustment,

>> then

>> > hopefully everything else will fall into place.

>> > Vicki

>> > Yes, I am giving the Lantus another try. I have to increase it

>> very

>> > slowly and dread doing so because it keeps me awake most of the

>> night

>> > whenever I start it or increase it. I don't recall ever reading

>> > anyone having this effect from insulin. After 2-3 nights of

>> > sleeplessness, I adjust, and then am okay again. Then it's time

>> to

>> > increase it again. ugh

>> >

>> > Kat

>

[Guest guest]

I was referring to UL's unpredictable reputation, not Lantus'.

Vicki

Re: Re: My menu and numbers

>>

>>

>> >

>> >

>> >

>> >

>> > >You know, Kat, what's really important is to take however much

>> > insulin

>> > you need to get your numbers lower -- whatever that is. You may

>> have

>> > high insulin resistance like Stacey so you simply need more

>> exogenous

>> > insulin than other diabetics. It certainly doesn't mean you've

>> failed

>> > or

>> > anything like that.

>> >

>> > >It sounds like you might need a little attitude adjustment,

>> then

>> > hopefully everything else will fall into place.

>> > Vicki

>> > Yes, I am giving the Lantus another try. I have to increase it

>> very

>> > slowly and dread doing so because it keeps me awake most of the

>> night

>> > whenever I start it or increase it. I don't recall ever reading

>> > anyone having this effect from insulin. After 2-3 nights of

>> > sleeplessness, I adjust, and then am okay again. Then it's time

>> to

>> > increase it again. ugh

>> >

>> > Kat

>

[Guest guest]

I was referring to UL's unpredictable reputation, not Lantus'.

Vicki

Re: Re: My menu and numbers

>>

>>

>> >

>> >

>> >

>> >

>> > >You know, Kat, what's really important is to take however much

>> > insulin

>> > you need to get your numbers lower -- whatever that is. You may

>> have

>> > high insulin resistance like Stacey so you simply need more

>> exogenous

>> > insulin than other diabetics. It certainly doesn't mean you've

>> failed

>> > or

>> > anything like that.

>> >

>> > >It sounds like you might need a little attitude adjustment,

>> then

>> > hopefully everything else will fall into place.

>> > Vicki

>> > Yes, I am giving the Lantus another try. I have to increase it

>> very

>> > slowly and dread doing so because it keeps me awake most of the

>> night

>> > whenever I start it or increase it. I don't recall ever reading

>> > anyone having this effect from insulin. After 2-3 nights of

>> > sleeplessness, I adjust, and then am okay again. Then it's time

>> to

>> > increase it again. ugh

>> >

>> > Kat

>

[Guest guest]

I guess you haven't been reading all the posts that pass through heren

over the years...(and I can't say I blame you, with all your other

commitments)...the fact that eyesight improves when BGs come down has

been mentioned now and then. Well, maybe even more than now and then

,smile.

Vicki

Re: Re: My menu and numbers

>

> At 08:45 AM 4/22/2005, you wrote:

>

>

>>And congratulations on taking the bull by the horns, so to speak,

>>Rick!

>>Vicki

>

>

> Thanks Vicki!

>

> Oh and by the way - now I can 'see' the bull. I thought I needed a new

> eyeglass prescription (the current one is over 3 years old). When I

> got my

> number way down, my eyesight improved dramatically! Wasn't expecting

> that!

>

> Rick

>

[Guest guest]

Well, yes, of course. Doctors are used to seeing all diabetics with poor

control. I just said it that way because the larger percentage of

diabetics are type 2...out in the real world and here on this list too.

Vicki

Re: Re: My menu and numbers

>

> In a message dated 4/22/05 9:21:07 AM Eastern Daylight Time,

> whimsy2@...

> writes:

>

>>And

>>most doctors are used to seeing type 2s with out-of-control numbers.

>>>>>>>>

>

> And type 1s with out of control numbers as well.

>

> The DCCT trials stated with type 1s, not type 2s, and, like type 2s,

> the

> average type 1 doesn't have an a1c of 6.5 or below.

>

> Stacey

>

[Guest guest]

Well, yes, of course. Doctors are used to seeing all diabetics with poor

control. I just said it that way because the larger percentage of

diabetics are type 2...out in the real world and here on this list too.

Vicki

Re: Re: My menu and numbers

>

> In a message dated 4/22/05 9:21:07 AM Eastern Daylight Time,

> whimsy2@...

> writes:

>

>>And

>>most doctors are used to seeing type 2s with out-of-control numbers.

>>>>>>>>

>

> And type 1s with out of control numbers as well.

>

> The DCCT trials stated with type 1s, not type 2s, and, like type 2s,

> the

> average type 1 doesn't have an a1c of 6.5 or below.

>

> Stacey

>

[Guest guest]

Well, yes, of course. Doctors are used to seeing all diabetics with poor

control. I just said it that way because the larger percentage of

diabetics are type 2...out in the real world and here on this list too.

Vicki

Re: Re: My menu and numbers

>

> In a message dated 4/22/05 9:21:07 AM Eastern Daylight Time,

> whimsy2@...

> writes:

>

>>And

>>most doctors are used to seeing type 2s with out-of-control numbers.

>>>>>>>>

>

> And type 1s with out of control numbers as well.

>

> The DCCT trials stated with type 1s, not type 2s, and, like type 2s,

> the

> average type 1 doesn't have an a1c of 6.5 or below.

>

> Stacey

>

[Guest guest]

On 22 Apr 2005 17:05:13 -0000 diabetes_int writes:

>

>

> On Thu, 21 Apr 2005 20:19:37 -0700 " whimsy2 "

> writes:

> >

> > If you give the Lantus a fair try and it still seems to be keeping

> > you awake, you might consider trying Ultralente as your basal.

I tried UL, twice. I have no idea why I was a gluton for punishment Twice

but the rerun was worse than the first time and the first time was pretty

bad.

Over the years I have tried just about every insulin ever made and if

they were betting on one insulin to drop like a hot potato, I would have

voted for UL. The decision makers dropped Lente instead, so I would have

lost that bet. And the hypos with UL were killers and I mean that

literally.

> Very few

>

> >

> Or taking the Lantus earlier might help but IMHO UL is not the

> alternative.

>

I hear scads of people take Lantus in the AM. I do not take it at bedtime

but a couple of hours earlier, which fixed the problem I initially had

with Lantus. Maybe type IIs have a different absorbtion rate than type

Is, which helps with an AM dosing.

> I sound like a broken record but Lantus was put out as the

> alternative to NPH, not UL.

Very true and you aren't a broken record, you are using the repeat

button. I guess from time to time it has to be said, Lantus was ok'd by

the FDA as a substitute to NPH, not UL. When someone is on NPH for a long

time they learn how to work around it's peaks and except for the peaks

NPH has fewer problems than UL IMHO.

>

> > doctors ever prescribe this -- it actually doesn't even need a

> > prescription since it's an old insulin, and it's a lot cheaper

> > than Lantus.

>

> Effectiveness should be th number 1 concern, not whether a

> prescription is needed or the cost. If cost is a major factor then NPH

doesn't

> require a script and cost is the same as UL. BUT, Lantus has great

> advantages and regardless of the manufacturer's admonitions to not

alter bedtime

> dosing or amount of shots,

>[snip]

Cost unfortunately has to be a consideration for some people when they

are on a fixed income or don't have prescription coverage from insurance

but there are ways to get the meds one needs regardless of ability to

pay. If the only option is to use an old insulin then I too would go with

NPH. If cost is not an issue I would rather go through an extended

tweaking process with Lantus than go with UL.

> > It has a reputation as being unpredictable but IMHO, this is

> >

> And IMO, that is a valid reputation. And it is, for many, more than

> just unpredictable.

I'll drink to that. For the few who successfully use UL, this is a good

example of YMMV. This repeated sales pitch for UL that you don't need a

prescription and it costs less makes me feel like someone is trying to

sell me a Yugo. Remember them? They were cars made in I think Yugoslavia

(probably why they had the name Yugo). They were so cheap many people

didn't need to take out a loan to buy one but they were terrible cars

that cost a bundle to make usable. While cost and a need for a

prescription might be a consideration for some in deciding what insulin

they should use, UL is not the only consideration for these two factors

and the bottom line should be what works best for the user.

[more snipping]

> Try spliting the dose or taking it in the morning or checking to see

> if it works the whole 24 hours and with time and a little patience you

> might overcome some if not all of the problems you are now having. No

two

> DMers are the same and you have to figure out what is best for you,

> regardless of what the doctor, or the Lantus says.

>

I might add making changes slowly and giving several days with each

change to see if the changes work.

> > because most doctors don't understand how to use it to best

> > advantage, i.e. twice a day, 12 hours apart.

> This is what works for you Vicki and that is great that you found a

> way to use UL but the problems, generally with UL is not that the

> doctors don't understand it.

Maybe most doctors DO understand how to use UL and that is why they don't

prescribe it.

> With time and Novo bringing out detemir and

> then Eli Lilly bringing out their version you will probably find that

UL will

> be discontinued like Lente was discontinued and the animal insulins.

> When that happens you will find a way to work with Lantus or Detemir or

> whatever they name Lilly's alternative.

>

We have entered a new era in DM control and UL is not in the insulin

companies plans for the future and with time it will not be in the DMers

plans for the future either. When human insulin was introduced some

people claimed that we shouldn't use the new fangled insulin because it

made DMers hypo unaware. Their cry was " use what you know " . Their

campaign didn't work and both novo and eli lily dropped animal insulins.

A small company in the UK bought the rights to produce animal insulin but

I think they quietly went out of business. For all the yelling and cries

of doom and gloom, there just wasn't enough call for the old insulins.

>

> >Also, it takes some

> > experimentation to get the dosing correct.

>

> No matter what insulin you choose, it takes some experimentation to

> get the dosing correct. It's the side effects that become the problem.

> I get excellent basal control with it, as do quite a few others

> here.

>

I know of two other people who use UL and are on this list. I would be

interested in knowing just how many list members do use UL..

> >

> I know of two other people who use UL and are on this list. I would

> be interested in knowing just how many list members do use UL.

>

I sure would like the UL users on this list to raise their hand. I would

be surprised if there were large number.

[Guest guest]

On 22 Apr 2005 17:05:13 -0000 diabetes_int writes:

>

>

> On Thu, 21 Apr 2005 20:19:37 -0700 " whimsy2 "

> writes:

> >

> > If you give the Lantus a fair try and it still seems to be keeping

> > you awake, you might consider trying Ultralente as your basal.

I tried UL, twice. I have no idea why I was a gluton for punishment Twice

but the rerun was worse than the first time and the first time was pretty

bad.

Over the years I have tried just about every insulin ever made and if

they were betting on one insulin to drop like a hot potato, I would have

voted for UL. The decision makers dropped Lente instead, so I would have

lost that bet. And the hypos with UL were killers and I mean that

literally.

> Very few

>

> >

> Or taking the Lantus earlier might help but IMHO UL is not the

> alternative.

>

I hear scads of people take Lantus in the AM. I do not take it at bedtime

but a couple of hours earlier, which fixed the problem I initially had

with Lantus. Maybe type IIs have a different absorbtion rate than type

Is, which helps with an AM dosing.

> I sound like a broken record but Lantus was put out as the

> alternative to NPH, not UL.

Very true and you aren't a broken record, you are using the repeat

button. I guess from time to time it has to be said, Lantus was ok'd by

the FDA as a substitute to NPH, not UL. When someone is on NPH for a long

time they learn how to work around it's peaks and except for the peaks

NPH has fewer problems than UL IMHO.

>

> > doctors ever prescribe this -- it actually doesn't even need a

> > prescription since it's an old insulin, and it's a lot cheaper

> > than Lantus.

>

> Effectiveness should be th number 1 concern, not whether a

> prescription is needed or the cost. If cost is a major factor then NPH

doesn't

> require a script and cost is the same as UL. BUT, Lantus has great

> advantages and regardless of the manufacturer's admonitions to not

alter bedtime

> dosing or amount of shots,

>[snip]

Cost unfortunately has to be a consideration for some people when they

are on a fixed income or don't have prescription coverage from insurance

but there are ways to get the meds one needs regardless of ability to

pay. If the only option is to use an old insulin then I too would go with

NPH. If cost is not an issue I would rather go through an extended

tweaking process with Lantus than go with UL.

> > It has a reputation as being unpredictable but IMHO, this is

> >

> And IMO, that is a valid reputation. And it is, for many, more than

> just unpredictable.

I'll drink to that. For the few who successfully use UL, this is a good

example of YMMV. This repeated sales pitch for UL that you don't need a

prescription and it costs less makes me feel like someone is trying to

sell me a Yugo. Remember them? They were cars made in I think Yugoslavia

(probably why they had the name Yugo). They were so cheap many people

didn't need to take out a loan to buy one but they were terrible cars

that cost a bundle to make usable. While cost and a need for a

prescription might be a consideration for some in deciding what insulin

they should use, UL is not the only consideration for these two factors

and the bottom line should be what works best for the user.

[more snipping]

> Try spliting the dose or taking it in the morning or checking to see

> if it works the whole 24 hours and with time and a little patience you

> might overcome some if not all of the problems you are now having. No

two

> DMers are the same and you have to figure out what is best for you,

> regardless of what the doctor, or the Lantus says.

>

I might add making changes slowly and giving several days with each

change to see if the changes work.

> > because most doctors don't understand how to use it to best

> > advantage, i.e. twice a day, 12 hours apart.

> This is what works for you Vicki and that is great that you found a

> way to use UL but the problems, generally with UL is not that the

> doctors don't understand it.

Maybe most doctors DO understand how to use UL and that is why they don't

prescribe it.

> With time and Novo bringing out detemir and

> then Eli Lilly bringing out their version you will probably find that

UL will

> be discontinued like Lente was discontinued and the animal insulins.

> When that happens you will find a way to work with Lantus or Detemir or

> whatever they name Lilly's alternative.

>

We have entered a new era in DM control and UL is not in the insulin

companies plans for the future and with time it will not be in the DMers

plans for the future either. When human insulin was introduced some

people claimed that we shouldn't use the new fangled insulin because it

made DMers hypo unaware. Their cry was " use what you know " . Their

campaign didn't work and both novo and eli lily dropped animal insulins.

A small company in the UK bought the rights to produce animal insulin but

I think they quietly went out of business. For all the yelling and cries

of doom and gloom, there just wasn't enough call for the old insulins.

>

> >Also, it takes some

> > experimentation to get the dosing correct.

>

> No matter what insulin you choose, it takes some experimentation to

> get the dosing correct. It's the side effects that become the problem.

> I get excellent basal control with it, as do quite a few others

> here.

>

I know of two other people who use UL and are on this list. I would be

interested in knowing just how many list members do use UL..

> >

> I know of two other people who use UL and are on this list. I would

> be interested in knowing just how many list members do use UL.

>

I sure would like the UL users on this list to raise their hand. I would

be surprised if there were large number.

[Guest guest]

On 22 Apr 2005 17:05:13 -0000 diabetes_int writes:

>

>

> On Thu, 21 Apr 2005 20:19:37 -0700 " whimsy2 "

> writes:

> >

> > If you give the Lantus a fair try and it still seems to be keeping

> > you awake, you might consider trying Ultralente as your basal.

I tried UL, twice. I have no idea why I was a gluton for punishment Twice

but the rerun was worse than the first time and the first time was pretty

bad.

Over the years I have tried just about every insulin ever made and if

they were betting on one insulin to drop like a hot potato, I would have

voted for UL. The decision makers dropped Lente instead, so I would have

lost that bet. And the hypos with UL were killers and I mean that

literally.

> Very few

>

> >

> Or taking the Lantus earlier might help but IMHO UL is not the

> alternative.

>

I hear scads of people take Lantus in the AM. I do not take it at bedtime

but a couple of hours earlier, which fixed the problem I initially had

with Lantus. Maybe type IIs have a different absorbtion rate than type

Is, which helps with an AM dosing.

> I sound like a broken record but Lantus was put out as the

> alternative to NPH, not UL.

Very true and you aren't a broken record, you are using the repeat

button. I guess from time to time it has to be said, Lantus was ok'd by

the FDA as a substitute to NPH, not UL. When someone is on NPH for a long

time they learn how to work around it's peaks and except for the peaks

NPH has fewer problems than UL IMHO.

>

> > doctors ever prescribe this -- it actually doesn't even need a

> > prescription since it's an old insulin, and it's a lot cheaper

> > than Lantus.

>

> Effectiveness should be th number 1 concern, not whether a

> prescription is needed or the cost. If cost is a major factor then NPH

doesn't

> require a script and cost is the same as UL. BUT, Lantus has great

> advantages and regardless of the manufacturer's admonitions to not

alter bedtime

> dosing or amount of shots,

>[snip]

Cost unfortunately has to be a consideration for some people when they

are on a fixed income or don't have prescription coverage from insurance

but there are ways to get the meds one needs regardless of ability to

pay. If the only option is to use an old insulin then I too would go with

NPH. If cost is not an issue I would rather go through an extended

tweaking process with Lantus than go with UL.

> > It has a reputation as being unpredictable but IMHO, this is

> >

> And IMO, that is a valid reputation. And it is, for many, more than

> just unpredictable.

I'll drink to that. For the few who successfully use UL, this is a good

example of YMMV. This repeated sales pitch for UL that you don't need a

prescription and it costs less makes me feel like someone is trying to

sell me a Yugo. Remember them? They were cars made in I think Yugoslavia

(probably why they had the name Yugo). They were so cheap many people

didn't need to take out a loan to buy one but they were terrible cars

that cost a bundle to make usable. While cost and a need for a

prescription might be a consideration for some in deciding what insulin

they should use, UL is not the only consideration for these two factors

and the bottom line should be what works best for the user.

[more snipping]

> Try spliting the dose or taking it in the morning or checking to see

> if it works the whole 24 hours and with time and a little patience you

> might overcome some if not all of the problems you are now having. No

two

> DMers are the same and you have to figure out what is best for you,

> regardless of what the doctor, or the Lantus says.

>

I might add making changes slowly and giving several days with each

change to see if the changes work.

> > because most doctors don't understand how to use it to best

> > advantage, i.e. twice a day, 12 hours apart.

> This is what works for you Vicki and that is great that you found a

> way to use UL but the problems, generally with UL is not that the

> doctors don't understand it.

Maybe most doctors DO understand how to use UL and that is why they don't

prescribe it.

> With time and Novo bringing out detemir and

> then Eli Lilly bringing out their version you will probably find that

UL will

> be discontinued like Lente was discontinued and the animal insulins.

> When that happens you will find a way to work with Lantus or Detemir or

> whatever they name Lilly's alternative.

>

We have entered a new era in DM control and UL is not in the insulin

companies plans for the future and with time it will not be in the DMers

plans for the future either. When human insulin was introduced some

people claimed that we shouldn't use the new fangled insulin because it

made DMers hypo unaware. Their cry was " use what you know " . Their

campaign didn't work and both novo and eli lily dropped animal insulins.

A small company in the UK bought the rights to produce animal insulin but

I think they quietly went out of business. For all the yelling and cries

of doom and gloom, there just wasn't enough call for the old insulins.

>

> >Also, it takes some

> > experimentation to get the dosing correct.

>

> No matter what insulin you choose, it takes some experimentation to

> get the dosing correct. It's the side effects that become the problem.

> I get excellent basal control with it, as do quite a few others

> here.

>

I know of two other people who use UL and are on this list. I would be

interested in knowing just how many list members do use UL..

> >

> I know of two other people who use UL and are on this list. I would

> be interested in knowing just how many list members do use UL.

>

I sure would like the UL users on this list to raise their hand. I would

be surprised if there were large number.

[Guest guest]

I think if doctors encouraged more frequent testing for diabetics, their

fears of hypos might be assuaged. Of course just testing doesn't

accomplish anything; you need to act on that too.

If I'm at 85 two hours after a meal, I'm pretty sure I'll go low in the

next hour -- and I know this because I test a lot and I know how my body

acts - so I have a small carby snack. Or glucose tabs, thereby heading

off the hypo.

Vicki

Re: Re: My menu and numbers

>

> In a message dated 4/22/05 9:21:07 AM Eastern Daylight Time,

> whimsy2@...

> writes:

>

>>I think a lot of doctors are unreasonably afraid of hypos, even mild

>>hypos, and feel more comfortable advising their diabetic patients to

> .keep well away from those numbers, even though there's really nothing

>>terribly dangerous about a number of 60 or so. As someone who tries

>>for

>>tight control, I'm there fairly frequently - and sometimes even

>>lower -

>>with no ill effects whatsoever.

>>>>>>>>.

>

> I agree that doctors are sometimes unreasonably afraid of hypos, but

> also

> remember that they fear this with good reason. One of the problems

> with

> exogenous insulin is that it isn't like that produced by the pancreas.

> Once you've

> injected, there's nothing you can do about it but test and eat glucose

> tabs. If

> you end up hating your meal and eat only a few bites, you might get

> into

> trouble, if the walk you go on turns into something much longer, you

> might go low,

> etc.

>

> Hypos apparently damage the brain, and severe hypos are just downright

> dangerous.

>

> It's my understanding that we don't actually know the full extent of

> what

> damage might occur at BG of under 70. IT's probably a slow

> accumulation, just as

> it is with high BG.

>

> My non-diabetic colleauge, who has a type 1 brother, says he's never

> found

> his BG out of the 90s. It's usually in the 70s -80s, but he's never

> seen it

> below 70. That tells me that 70 is the bottom of where I want to be.

> In a dream

> world, I'd like to stay below 100, but that hasn't been possible so

> far.

>

> Stacey

>

[Guest guest]

What's the advantage of taking less insulin if your body needs it?

Economic?

The only reason I could think of for a type 2 to take another med

besides insulin -- and that would only apply to metformin - is to reduce

insulin resistance.

Vicki

Re: Re: My menu and numbers

>

> At 08:30 AM 4/22/2005, you wrote:

>>Rick, are you taking any other diabetes meds? Some have had success

>>with

>>taking the metformin and/or actos/avandia at night rather than in the

>>morning or

>>with dinner.

>>

>>I split my metformin into two doses of 1000 mg each, morning and

>>bedtime. I

>>can't say I've noticed any effect whatsover with changing timing, but

>>YMMV.

>>

>>Stacey

>

> Hi Stacey,

>

> Just insulin at this point. Before I went on insulin the 1st time,

> several

> years ago, my doc tried Metformin and both Avandia and actos. I maxed

> out

> on Metformin and it did not make any apparent difference. Actos at

> 1st,

> then Avandia later made small changes, very small changes. At that

> point,

> my doc suggested insulin. Having heard the good testimony here, I said

> yes

> immediately. He put me on Lantus and Humalog. At that time, he kept me

> on

> Avandia also. Later I read that taking Avandia while using insulin

> often

> causes edema in people. I have always had some since before diagnosis,

> but

> it did get a lot worse using Avandia and insulin at the same time.

>

> This time around, I am using insulin alone. My doc suggested Metformin

> the

> other day, as a way to be able to reduce the amount of insulin I take.

> Having had the results I did before, I declined. I really don't mind

> taking

> more units since it is making a huge difference. If I decide to try

> something additional later, I may go ahead and try Avandia or Actos

> again.

> If I do, I'll have to decide if the reduction in insulin is worth the

> additional edema. (

>

> Rick

[Guest guest]

On Fri, 22 Apr 2005 12:39:05 -0700 " whimsy2 " writes:

>

> I was referring to UL's unpredictable reputation, not Lantus'.

I know, see below. You said UL has a reputation for being unpredictable

and I said IMO it is a valid reputation

> >> It has a reputation as being unpredictable but IMHO, this is

> >>

> > And IMO, that is a valid reputation. And it is, for many, more

> than just unpredictable

[Guest guest]

On Fri, 22 Apr 2005 12:39:05 -0700 " whimsy2 " writes:

>

> I was referring to UL's unpredictable reputation, not Lantus'.

I know, see below. You said UL has a reputation for being unpredictable

and I said IMO it is a valid reputation

> >> It has a reputation as being unpredictable but IMHO, this is

> >>

> > And IMO, that is a valid reputation. And it is, for many, more

> than just unpredictable

[Guest guest]

On Fri, 22 Apr 2005 12:39:05 -0700 " whimsy2 " writes:

>

> I was referring to UL's unpredictable reputation, not Lantus'.

I know, see below. You said UL has a reputation for being unpredictable

and I said IMO it is a valid reputation

> >> It has a reputation as being unpredictable but IMHO, this is

> >>

> > And IMO, that is a valid reputation. And it is, for many, more

> than just unpredictable