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multiple daily injections ??

Discussion in 'General Discussion' started by Artgirl, Dec 13, 2015.

  1. Artgirl

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    My daughter was eventually planning to go to multiple daily injections....my question is if she uses pens will she need to inject 2 insulins or 1 insulin when she eats and one base one in the morning only? Whoever uses this method...is it really more flexible when you are injecting so often?
     
  2. sszyszkiewicz

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    For my son it was an injection to cover each meal/significant covered snack with a "fast" acting insulin like humalog/novolog/apidra and a once daily injection of Lantus.
     
  3. rgcainmd

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    If you are not using a pump and your daughter is injecting more than once daily, you are already using multiple daily injections. If you chose not to use a pump, you will need two insulins: a long-acting (like Lantus or Levemir) and a short-acting (like Humalog, Novolog, or Apidra.) With a pump, you use only short-acting insulin. IMO (and in the opinions of many, if not most, of the parents on this Forum) pumping gives you the most flexibility.

    Based on the types of questions you have been asking, I can't help but wonder whether you've read any of the diabetes books parents on this Forum have recommended?
     
  4. StacyMM

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    Just one insulin when she eats. The other insulin gets taken once (most people do one basal shot a day, I think, but there are people that split it in two) a day. This is your basal insulin and it's what your body uses to cover basic needs. Not sure where you are, but in the US, the most commonly used basal insulins are Lantus and Levemir. The insulin you use for food and corrections is a rapid-acting insulin and it's given to break down the food and bring down highs. In the US, the two most common are Novolog and Humalog, although Apidra is getting more popular, it seems.

    I really like the flexibility of MDI over a regimen of NPH or other intermediate-acting insulins. You can cover food as you eat, see results more quickly as it peaks sooner, and have less of an eating schedulele. Just my opinion, though - there are people that rock NPH regimens. I've never done it so I can't say anything that's based on experience - our hospital starts kids on MDI with slow and rapid insulins so that's what we know.

    On MDI, my daughter takes 2 basal injections a day and then has 4-5 bolus injections for meals/snacks. She may have corrections, too, although she is much less likely to get highs on MDI than she was on a pump so corrections aren't that common and probably average less than one a day. Bare minimum for most MDI'ers is probably 4 - 1 basal and 3 meal boluses.
     
  5. MomofSweetOne

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    Please don't be afraid to ask questions. That's what most of us are here for, as well as the support we gain from each other.

    MDI is when the PWD doses insulin each time they eat. In the past, the standard was twice a day shots with the lunch being covered by an insulin that peaked at lunchtime. MDI switched that to three times a day (or more, depending on the eating habits) plus corrections at bedtime, etc. MDI is much easier to live with than the other. Life isn't ruled by diabetes timing. The peaks are more predictable. There's no comparison.

    In the past it was considered unreasonable to test even three times per day. Now that is considered sub-standard care. Even four times per day puts the person at much higher risk of complications. There's a graph correlating # of tests with A1C and another with A1C with complications.

    Diabetes management continues to change. The best thing to do is to read, ask questions, and not get stuck in a rut of what's comfortable. Learning something new can increase quality of life tremendously.
     
  6. funnygrl

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    That's not really true in a diabetes context. If someone is doing two shots of NPH and R or rapid a day they are not usually considered to be on MDI, they're considered to be on "convential insulin therapy" versus "intensive insulin therapy." The term MDI is usually reserved for a basal/bolus regimen context. I think it's pretty rare for any type 1 to start on NPH any more.
     
  7. Artgirl

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    Thank you, there's some great info here. We were started on fast acting and long acting insulin. ...humolog and humilin n..but it offers very little flexibility. I think MDI will be perfect as she wants to head to university in 2 years. I am reading about diabetes, i just read the book When a child has diabetes. One day ,one book at a time.
     
  8. rgcainmd

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    Thank you for the clarification! I stand corrected.
     
  9. Sprocket

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    My daughter is on MDI with levemir and rapid insulin. She's 14 and will be off to university in 3 years. We are using these next few years to learn and manage as best we can before she is on her own.
    She loves mdi and we have recently bought a Dexcom, which gives us a whole part of the picture we've been missing. In our opinion, MDI has more freedom and flexibility than pumping. She has no intention of being tethered to something, and she injects and off she goes. She eats when and what she wants and we have an understanding of insulin on board and insulin durations and peaks, so we don't feel a pump would offer anything better than what we're doing. We have learned a lot - from these threads and also from resource books and when you have a full understanding of insulins and how they're affected by so many factors like activity, hormones, different types of carbs etc, you are well on your way to excellent management on MDI. You are doing the right thing. It takes time to understand and learn everything you need to know and there's always something new that throws you for a loop.
     
  10. rgcainmd

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    MDI does not give you the flexibility of having variable basal rates throughout the day and night, and the ability to set temporary basal rates for short or long periods of time whenever you want. Pumping allows me to fine-tune in a way that is simply not possible with MDI.
     
  11. Michelle'sMom

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    I applaud your support of your daughter's choice. I know several young adults who do very well on MDI. I read
    A post from a ped endo recently that emphasizes your point. It's not about the latest & greatest gadget. It's about learning to use your choice of tools to the best of your ability.
     
  12. Michelle'sMom

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    There is definitely more flexibility with Lantus/Levemir than NPH (Humulin N). As I'm sure you've seen, NPH requires eating on a schedule to avoid lows. Since teens are notorious for not following any schedule, it can make things much harder.

    All of the books recommended by others are excellent. One book at a time, one day at a time is right. Take things at your own pace & you'll be less likely to be overwhelmed by all the information.
     
  13. StacyMM

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    The freedom is pretty awesome. So much less to carry and so, so much less time needed to get good numbers. I always forget how carefree MDI is when the kids are pumping...and then DD goes back to MDI and I remember. For uploading Dex multiple times a week and tweaking things regularly to going three weeks without a single change in calculations is amazing. And the stability of a long-acting insulin is great - I think that if DD decides to pump again, I'll push a more untethered approach and still cover most of the basal with a long-acting. For her, MDI is a good choice - she loves it and spends less time thinking about diabetes, less time reacting to highs and lows, and less time dealing with supplies. And having the chance to heal up her stomach makes me feel better. She can calculate and inject and be on her way in a minute, back to fun.
     
  14. Sprocket

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    It's true about the long acting insulin. I have to say I feel much better that we have that working in the background as opposed to rapid only by pump. When basals and ratios are correct, she can eat a lot or nothing - whatever she wants.
    In the future, if she decides to pump, I feel good that my daughter will know how to perfectly manage her diabetes on MDI. I think a lot of endos (and parents for that matter) are eager to get kids on a pump early on without understanding or seeing the merits of MDI.
    It's also true that pump does not not equal better management - it's just a different way to go about it.
     
  15. Artgirl

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    I think this is what we are going to do sooner than later...having to wake a teen up on the weekend is becoming more difficult. I will have to learn more about it.
     

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