FINALLY on bolus and basal insulin!

Good morning followers! I hope you’ve had fantastic holidays. 🙂 My life’s been super hectic, but in a really good way. My last post was in September, not because I didn’t want to blog anymore, but because all my energy went into my mental health and life circumstances. Now things seem to smoothing out a bit and my desire to write is kicking back in, woop!

Last Monday, I went back to my specialist. I’ve talked before about going off the oral medication (gliclazide) and starting an insulin bolus regime instead, but was met with quite some resistance when I finally reached out back in October.

At that time, the specialist (who happened to be an intern) was very focused on prescribing me Victoza, a medication used primarily for type 2 diabetics. Now while it sounded like a great medication, I had one problem with it; I’m a type 1 diabetic, not type 2, and my pancreas is already struggling like hell to give me enough insulin while LADA takes its course. Victoza is designed to trigger insulin release from the beta-cells when your food reaches a certain point in the digestive tract, which helps to even out your levels and leads to weight loss in most people who use it. Great! But only if your body can actually produce enough insulin of its own.

The running theme I got was “you’ll lose weight on this medication, but you’ll probably gain with insulin”. So I asked, why do people gain weight with insulin? Is it because they inject too much and need to eat to cover their insulin? Is it because they just don’t bother adapting their diet so they consume more calories than they use? Is it because they were eating everything and losing weight due to a lack of insulin production, and then on insulin their bodies can finally use all the fuel they’re putting into their mouths leading to weight gain? Is it because they don’t exercise much or at all while eating generously?

He said all of these are possible, and when I expressed interest in switching to insulin instead because I’m confident in my ability to control these factors, he backpedaled and wanted me to consider Victoza anyway. It just so happened that because I was already on basal insulin, insurance nationwide wouldn’t cover it. There are strict regulations and requirements a patient has to meet before they’re put on that med, and basal insulin use disqualified me. Initially he suggested I go off the basal and just take the other med instead, but I absolutely refused because my gut instinct told me that was a terrible idea. Then he informed me that regulations were about to change in the new year for this and suggested that we meet again in January to see what the situation was and take it from there.

I felt frustrated but relented. I didn’t have a lot of info on Victoza at the time, so I couldn’t really formulate whether or not I wanted it. After some research I was 100% confident it was not for me, and went to my appointment last Monday with that in mind.

He started the appointment with an explanation on the state of regulations; the change was approved, but not yet implemented, and he didn’t know when they would so I’d have to wait. Although I went in with “I don’t want Victoza” at the front of my mind, I hooked in on that and said I was absolutely not willing to wait any longer. I’ve been dealing with very hard to control values for almost half a year and I can’t afford to waste more time waiting for regulations to go through. He said that he could put me on Novorapid, but that it closed the chapter on Victoza.

Fine by me! I agreed immediately, and he prescribed the insulin to me and took me off the gliclazide. I walked out of that appointment feeling a lot of things. I texted my best friend immediately that I finally got the insulin because I was excited and happy, but I also felt bad for people who get thrown into situations like that and don’t have the ability to stand up for themselves or do the research I did. I’m not sure where my treatment would be at right now if I’d just gone along with this. I feel it would have been horrible for me, and I can only imagine that there are people out there suffering from bad decisions made by doctors who don’t listen to their patients in similar situations.

Either way, I picked up my insulin the same day and got started immediately. The specialist told me to take 4 units for every meal, but I find that I am very sensitive to insulin so 2 units is enough for most smaller meals. 4 works best for dinner. As my meals typically don’t exceed 40gr carbs that is actually plenty. I’m still trying to find my actual insulin:carbs ratio so I’ve been testing and experimenting vigorously to see what my body does with carbs so I’m still spiking after meals, but I’m getting the hang of correction dosages pretty well. It took me a day to wrap my head around “insulin doesn’t stack if you take what you need to cover the carbs you eat, even if you eat twice in 2 hours – total insulin for total carbs is what matters here”. I did learn very fast that you don’t correct shortly after eating when you injected enough insulin for the carbs even if you’re spiking at 13. My problem was the timing of the insulin, not so much the amount, so when I biked home I crashed from 13 to 4, nearly into a hypo.

insulin

This is why I love experimenting and pushing boundaries though; nothing makes me learn things quicker than to just go ‘let’s see what this does’. (I’m playing it safe, don’t worry. I always have glucose on hand for crashes and am very aware of what I’m doing and need to look out for.) It’s still too early for me to go low carb as I still need to get this figured out, but hopefully I can progress to 3 out of 7 days in the week of low carbing to get started.

I seem to roll around between 1:15 – 1:30 for my ratio, which is not uncommon for LADA diabetics I’ve heard. But my average values tend to be pretty alright so far, and I’m looking forward to getting this harness on my diabetes and making sure it behaves while I work on my health!

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4 thoughts on “FINALLY on bolus and basal insulin!

  1. Hi stranger

    How weird, I just logged onto my blog for the first time in months as well…I was actually thinking of deleting it and starting a new one not under my name (never was happy with that) but not sure what I’d call it. Still deciding.

    Happy New Year to you

    My mum is on insulin and the amount of weight she has gained is quite worrying. Apparently some of it isn’t getting through so it’s being stored and is somehow turning into fat (I’m not too sure on the science behind it all) but hopeful they can find a way to sort it out and get her weight down.

    Good luck with it and good to see you back (although I may vanish haha)

    • Happy new year!! I hope you stick around, you can always change your settings and remove your name without starting over. 🙂

      I don’t know the details on your mom’s situation, but all I know is that you need to inject insulin based on the amount of carbs you’re taking, not the other way around. AKA my ratio seems to be at 1:15 today (1 unit insulin per 15 grams of carbs). If I eat 60 grams of carbs I need to take 4 units of insulin. If I don’t burn off those carbs with exercise in the next 3-5 hours while the insulin works, the excess gets turned into fat. That’s what insulin does in all of us, even nondiabetics. Glucose is a fuel, if it’s not used when your body releases the insulin or you inject it, it gets stored.

      This is something they generally DON’T teach to diabetics, unfortunately. I’ve heard from a lot of folks in the UK that the NHS is very negligent in this area and just prescribes x amount of insulin and you have to eat for that amount so your sugars stay okay. (The specialist kind of did the same thing with me here.) This is really bad and leads to weight gain in almost everyone. It’s probably THE main reason people gain weight on insulin.

      If your mom doesn’t have any other special circumstances to take into account, maybe she can keep a proper track of her carb intake and see how much insulin she needs for those carbs, if she’s not already doing this. Lowering both insulin and carb intake is the key to weight loss for diabetics who are insulin dependent, so I highly recommend that. Once I’ve settled down into a proper routine for my insulin regime, I’m looking into low carbing myself for this reason.

  2. Insulin is a fat storing hormone. This is why people tend to gain weight on it. However, leading a normal lifestyle can help prevent this. I was diagnosed at age 14 and have only fluctuated 10lbs my whole life, I’m 25 now. So yes insulin is a fat storage hormone, but does not explicitly make you fat.

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