Ask D"Mine: Back to Basics on Diabetes

http://type2diabetestreatment.net/diabetes-mellitus/ask-dmine-back-to-basics-on-diabetes/

Happy Saturday! Welcome to Ask D"Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois.

We’ve had some “back to basics” questions piling up at the bottom of the mailbag, and while some may seem simple to veterans, remember that before diagnosis none of us knew diddly-squat about diabetes. The only dumb question is the one that’s not asked!

Need help navigating life with diabetes yourself? Email us at AskDMine@diabetesmine.com

Oyinkan, type confused from Connecticut, writes: Please tell me the difference between type 1 and type 2 diabetes.

Wil@Ask D’Mine answers: Sure. Both types are, for all practical purposes, the same disease caused by different circumstances.

That statement is sure to generate a lot of hate mail, so let me elaborate.

Type 1 is an autoimmune disease. For reasons we don’t yet understand, in some people the immune system freaks out and kills the cells in the body that produce insulin. Bam! Instant diabetes. (Well, OK, it’s more like a six-week process, but it’s quick.)

Type 2 is a disease of insulin resistance. For reasons we don’t yet understand, in some people the body just doesn’t use insulin well and the body over-produces insulin until the cells in the body that produce insulin are worn out. Bam! Instant diabetes. (Well, OK, this process takes years and years and years.)

While the two types are medically different, in the trenches the only difference is that for quite a while type 2s still have some native insulin production and this allows for a wider range of treatment options, many of which are pills. Type 1s need external insulin to stay alive right out of the gate, but so too will most type 2s in the fullness of time.

The risks to the body from high blood sugar are the same for both types of diabetes.

As is the frustration of daily management.

Jackie, type 2 from Nevada, writes: I recently was diagnosed with type 2 diabetes. I need to know, if total carbs listed on the label is 8 grams, does that mean the whole package or per serving?

Wil@Ask D’Mine answers: All the information on the nutrition facts label is for a single serving, so the 8 grams on the label you are looking at is for just one serving. If you look up at the very top of the label it will tell you how large the serving is, and how many servings are in the package.

In some (rare) cases the entire package is actually a serving, but most packages of food contain more than a single serving beause the serving sizes on our labels don’t reflect real-world eating. Of course, depending on what the food is, you might eat the whole package, and if you do you’ll have to serve up some math with most of your meals! Just multiply the carbs by the number of servings.

It seems crazy at first, but the system isn’t really designed for people with diabetes. It’s designed to let consumers compare similar foods and make smart decisions about what they want to put into their bodies.

Tracy, type 2 from Texas, writes:I used to take 85 units of Lantus two times per day. How many units of Toujeo am I supposed to take and how many times a day?

Wil@Ask D’Mine answers: That’s actually not a simple question. The short answer is that you’d at least start with what you were taking before, because even though Toujeo is three times more concentrated than Lantus, the pen is designed so that it delivers one-third as much medicine at any given setting.

Yeah. It’s so simple none of us can get our heads around it.

I think that with all these new insulins in various strengths we need to free our minds of the idea of units of insulin (which was originally a volume-based metric) and instead begin to think about the numbers on the base of the pens as universal dosing values. The number you dial the pen to really has no relationship to volume anymore. Instead, it reflects an equal therapeutic punch and it might be a little bit for fluid or a lot.

At least with the playing field truly leveled with these new insulin pens, you don’t have to fret when your doc (or your insurance company) changes you from one insulin to another. If you take 65 units of Lantus, you’d also take 65 units of Levemir, or Toujeo, or Tresiba, or Humulin R U-500 KwikPen, or whatever new insulin we’ll have tomorrow.

But like I said, it’s really not that simple. Because in the trenches, these are not one-size-fits-all medications. The fact is that each of them will work a little differently in every individual person, and it’s highly unlikely that the dose of one that worked perfectly will work perfectly with another. You’ll have to use trial, and—unfortunately—error, to work out your new optimum dose.

Making things a bit more complicated for you is the fact that you’re taking two doses a day. Many of the newer insulins have action profiles that are different from what we are used to, and that makes the effects of multiple doses harder to predict.

In your case, I’m going to pass the buck back to your doctor.

Michelle, type 2 from Michigan, writes: I take 65 units of Toujeo a day. How many doses will I get out of the 450 units/1.5ml pre-filled pen?

Wil@Ask D’Mine answers: The Toujeo pen holds 450 “units.” So 450 ÷ 65 = 6.9230769

Well, crap. That realistically means you’ll get six days out of a pen, with 60 units left over, which is too much to just throw away. Looks like about once a week you’ll have to take two shots, one to use up the pen and one to get you up to your proper dose.

Michael, type 2 from Florida, writes: I’m in London on holiday andI missed my basal injection the last two nights. I take 32 units at night only, and take metformin and glipizide during the day. What should I do?

Wil@Ask D’Mine answers: You must be having a very good time. Funny. I never thought of London as being that big a party town. Anyway, needless to say, once you’ve missed two days of shots, there’s no making them up without overdosing, and it’s your pills that kept you out of total trouble. At least you had some medication to fight blood sugar during the day.

When it comes to basal insulin, there’s no hard-and-fast rule on make-up shots, but the next morning is absolutely too late! Much less two mornings later.

Like all insulins, even the slow ones can “stack,” so if you take a shot waaaaaaay out of the normal time sequence, it has the effect of doubling the amount of insulin in your system when you take your next shot; so if you’ve missed it by more than a few hours, just skipping it and waiting for the next dose is the safest bet. An alternative is to take half your normal dose when you remember it, then take two-thirds of your normal dose the next time to try to reset your system.

I’d recommend this more complicated approach for type 1s and the “just take your next damn dose” on time approach to type 2s.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn"t adhere to Healthline"s editorial guidelines. For more information about Healthline"s partnership with Diabetes Mine, please click here.

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