© Coos Visser, Leeuwarden, Holland
It was hard to stop writing this logbook, but there will be no additional information of great value when I go on this way. That's why I decided to make some conclusions.
| General findings |
Conclusions written down below are made related to the following findings:
1. Demands made to me (as person suffering diabetes).
The following questions have to be answered positive, when you want to switch over to Humalog insulin:
1. Am I self-regulating my diabetes?
This means. Do I want to measure my BG's very often at regular times. In Dutch there is the following expression: "Meten is weten", which means in this context: BG control is knowledge. When switching to Humalog this is very important!
2. Is there enough knowledge concerning diabetes?
Of course it's very important to know what diabetes is and which control mechanisms are involved. This makes it much more comfortable to communicate with your Doc and/or diabetic nurse.
3. Is there a goal what has to be reached with this switch?
In my opinion this is one of the most important questions. When I didn't have a goal to go for, I possibly would have stopped this whole switch. When having those high BG's, this also has emotional effects and without having this goal I could have resigned!
4. Is there enough enthusiasm for starting a dialogue?
This means besides listening to your Doc, also being active to
reach a good BG control without changing your normal way of life.
1. It's very easy and fast to correct high BG's.
2. Social life becomes better because I can eat a normal breakfast right after injecting!
I'm not able to mention real disadvantages. Nevertheless I want to mention some findings which are of interest:
1. Diabetes regulation is quite different compared to the old insulin regimen. This takes time and lots of energy!
2. I've to inject more often. Maybe this will not be the case in your situation, but I think it will make clear to ask this question before the switch: Do I want to inject more often per day? In this case it must be clear there are some things to keep in mind:
The topics stated under 2. were send to me by Holly Brown who works as a Diabetes Educator at the Orillia Soldiers Memorial Hospital, Diabetes Education Centre in Orillia, Ontario.
| Final conclusions |
1. Humalog has a positive impact concerning my BG control.
2. Although there are more variation possibilities, you have to keep in mind what has to be done in other situations.
It must be clear I've different life styles and lots of
activities, as
most people have. When activities take place at a regular base,
it is possible to create different insulin schemes.
3. Humalog gives a better opportunity to plan short term activities.
For happenings not taking place at regular base, it's possible to inject less Humalog before and when needed there can be injected additional Humalog 3 hours later.
4. In normal life diabetes plays a more pronounced mental role.
Because the variation possibilities, I've to think about what will happening different circumstances with my BG's. When using Actrapid I knew exactly what would happen within the next six to eight hours. I had to think about my BG control only when injecting insulin. Using Humalog means thinking about the BG's about 3 hours after the last injection.
5. It is possible to manage my diabetes in such a way to feel (more) comfortable with it.
The goal I've setup when starting is reached.
There is one question asked to me via E-mail I have to answer here: Are you going to stay using Humalog? YES!
Friday November 29, I've visited my Doc again to discuss the switch. The last weeks I measure my BG's before breakfast and before sleeping on a regular base. When seeing the BG's in the morning, they are most of the time low (below 4 mmol/l), so I decided to inject 4I (instead of 6I) before sleeping. I also had some problems to awake, caused by the low BG.After this change, BG's in the morning are between 5 and 8 mmol/l and there are no problems anymore.
This is my insulin scheme:
Before breakfast: 7H
Before lunch: 6H + 4I
Before dinner: 8H
Before sleeping: 4I
Also the HbA1c result was reported: 5.8. I was surprised by this
result, because I'd measured very high BG's in the last 6 weeks.
There have been a lot of low BG's as well. I hope this logbook
makes clear how I felt about this. My Doc already predicted it
would below 7, so he was right about this!
Because after suffering diabetes for more than 10 years, my doc is surprised about the small amount of insulin I use (about 30 units / 24 hours). Because of this he wants to measure the C-peptide, to see if my body still has some insulin production. We both don't think this will be the fact, but in this way we will be sure about it.
A small explanation about C-peptide:
In the normal body (non-diabetic) insulin is released as pre-insulin. This pre-insulin has another protein (C-peptide) connected which will be split of in the bloodstream. It is possible to analyse the C-peptide. When being diabetic there is no insulin released from the isles of Langerhans (which don't exist anymore) and the insulin injected doesn't contain this C-peptide. When there is C-peptide detectable in the bloodstream, it will be clear the body is still able to produce (some) insulin, which means there are (some) isles of Langerhans left.
When visiting my Doc in January, he told me no C-peptide was detected in my blood sample, which means I'm a true DM type 1.
In my opinion this logbook is finished now. When you think subjects are unclear or additional things have to be mentioned, please let me know. When retrieving messages about this, I will make a final update.
When writing this logbook, I only used a simple ASCII-editor to create this document. At the end of February 1997, I started using Frontpage editor, which has lots of things I've used to rebuild this document (lots of tables are implemented). Please inform me if you've problems reading this document!
Of course there will be situations in the future in which I have to anticipate with the new experiences I have now. Seeing the conclusions I don't think there will be big problems to solve.
Please leave a
note if you have additional info!