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Huminsulin 30/70 Dosage
Hi,
I am a person with diabetis for nearly 10 years. For nealry 9 years I am oral medication Amaryl 1mg and then 2mg, and then 2mg+Metformin. However, in the recent year I switched over to Huminsulin 30/70 with inititial dosage of 16 IU morning + 500 mg metformin + 8 IU evening. Then there is an episode of Hypoglycemia, with a seizure. Then I have come down to 12 IU before breakfast + 500 mg Metformin + 6 IU Before dinner and then 12 IU before breakfast with 500 mg metformin after lunch and Amaryl2mg+metformin 500 before dinner. However, there is another hypoglycemic episode in which I was fainted admitted in hospital and after glucose IV I was normal. But I remember that I have dialed 13-14 IU on the pen instead of 12 IU. Then I assumed that the hypoglycemic episode is due to 2 extra units. Then I changed to 8-10 IU before lunch based on glucose levels (As I am afraid of another hypoglycemic incident), and Amaryl 2mg+500 mg metformin before breakfast and before dinner. However, there is another hypoglycemic episode. This time I remember that I had 10 IU on the previous day before lunch. Next day morning I did a 2km walk, little exercise and then I had cornflakes with milk and then I played shuttle badminton for 1/2 hr, which I am not doing daily. I was in shopping mall felt the symptoms of hypoglycemia and I had an coke and orange juice. Still I was fainted and admitted in hospital and become normal after three to four hours.
Now I have stopped insulin and was on Amaryl 2 mg + 500 mg metformin before breakfast and 500 mg metformin after lunch and Amaryl 2 mg + 500 mg metformin before dinner. But my blood sugar levels are (average for two months) ~ 150 FBS and 250-300 PPBS and 200-250 after lunch.
My weight is 56-58 Kg with 5ft 5inch height and I am Indian.
My doubts are,
1) What is the maximum dosage / day of Amaryl
2) What is the maximum dosage / day of Metformin
3) What is the maximum dosage /day of combination of Amaryl and Metformin
4) What is the minimum dosage/day and minimum single dosage of Huminsulin 30/70 per day
5) How can I Optimize the oral medication only.
6) How can I Optimize the insulin + oral medication
7) Can I alternate between Insulin and Oral medications like one month on Insulin and One month on Oral medication OR any specific period for switching over.
8) Any dosage charts / nomographs based on weight and blood glucose levels.
9) Any web resources on diabetic medications dosage

Advance thanks to one and all

Krishna
 

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Hi Krishna,

I'm not an insulin user and therefore my comments may be subject to correction by other more experienced users on the forum. In India doctors still go with the 70/30 mix. Insulin use, however is a very vast & complex subject and the doctors here lack adequate knowledge on the subject. Most insulin users here, will tell you that they use different insulins for their basal & bolus needs. Then again the titration (calibration) for each person's needs has to be carefully evaluated and dosage set according to that.

If you will study the diet & nutrition pages here, you will find that most of us depend on a severe restriction of our carbohydrate intake to control our sugars. As a T2, I think that would be the right approach for you in the long term and you can be freed of the hypo events.

Do hang around, ask a lot of questions, read a lot and you should be on your way to better health. As a first measure please read Blood Sugar 101 & update your knowledge. Good Luck.
 

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Sorry your having so much trouble.

exercise can cause lows
without testing (BG numbers) before you eat, 2 hours after you eat, fasting, there is no way to help you. and what you eat.

Except I will say it is VERY difficult to get consistent numbers with mix insulins (30/70)
they are a mix of fast and slow insulin.

the other have of the equation is food. since carbs raise BG your carbs need to be balanced by insulin.

most people go off Amaryl when they go on insulin. (amaryl forces the pancreas to make insulin) if your pancreas is wearing out it may be working in spits and spats resulting in inconstant BG.

you need to test and keep a chart of medication, food (grams of carbohydrate) exercise.
 

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Normal bgs for diabetic are around 100 or less for fasting and 120-140 after meals. Those bgs you quoted seem very high, not normal. I only take metformin and I take the maximum dose of 2550 mg. I don't know what the max dose oa amyrl is. Many docs in the US are weaning their patients off of it because it tends to cause severe hypos. As said above the mixed insulins have lost favor here because they are difficult to control. Most here will use 2 separate insulins. A long acting like Lantus or Levemir once or twice per day and then a fast acting insulin at each meal. That way they can dose it specifically to the carbs they are eating.

Has anyone ever mentioned anything to you about eliminating carbs in your diet? When you are diabetic eating too many carbs will raise bgs.
 

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Krishna

You have to understand a few things

Unless you have the same amount of food every day for lunch only then the same insulin dose everyday will work. If you take 12 units for lunch every day but have different number of rotis, or different amount/type of dal and different veggetables your blood sugar will never be consistent. Never

The post meal sugar depends on three things -> pre meal blood sugar, amount of carbohydrates (not just sugar), and amount of dose.

If you take a fixed dose then you have to eat the same meal (quantity of nutrients proteins, carbs, fats) every time.

The other option is to adjust your dose based on the above three parameters

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The most important aspect of your diabetes management will be diet. If you want to optimize and control with oral medicines only then do the following

1. Be ready to use a lot of strips
2. Check before meals and then after every meals.

Soon you will realise the foods that make your sugars go up. Eliminate them. You will soon realize the culprits will be rotis, rice, bread, cornflakes, oats etc. Veggies, non veg foods and paneer will be nicer to your BGs

Always keep your BG meter with you. The minute you start feeling odd test your blood sugar. Keep glucose powder (not sugar, glucon D) also with you. If your sugar is low eat some glucose and check again in 15 minutes. If number is still falling eat some more glucose and check again in 15 minutes.

If you find your insulin is still giving numbers of under 100 (post meal) then reduce the dose

Please use a lot of strips. In due course your requirement of strips will fall. But better be safe (and dead with a hypo) than spend a few extra bucks on strips. (Go to ebay and healthkart and buy strips from there, you will find cheap strips for Accu chek active there)
 
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And please give up the 70/30 insulin. Ask your doctor for separate long acting and short acting insulin.

I would never choose convenience of one unreliable injection over two accurate injections...

Please talk to your doctor !
 
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