Howdy,

Just wanted to poke in here with a question. I can't remember if this is my first post here but I just wanted to ask a general question that has come up with a relative now having to take insulin shots for diabetes. Is it true there is some kind of patch pin type alternative that people can now carry around and use instead, or maybe in place of one of the three shots a day? From the description it reminded me of those nicotine patches people use to break smoking, but I have no idea if it is some bogus thing.

I will be doing my own research of course, but what I am looking for is the jargon, what the name of it is called, if it exists, so can look it up efficiently. Do any of you know or recognize something like that?

Thanks in advance

It sounds like you're talking about the OmniPod insulin pump.

I'm type 1 for 35 years, I've been on a pump for 16 and it's the best thing I've ever done. (I have used Medtronic pumps, not OmniPod).

EMY92 said:

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It sounds like you're talking about the OmniPod insulin pump.

I'm type 1 for 35 years, I've been on a pump for 16 and it's the best thing I've ever done. (I have used Medtronic pumps, not OmniPod).

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Emy92,

Thanks. That gives a start, just what I was looking for. Some terms and brand names to investigate.

Already `pump' sounds like something more portable, something where you have more travel and setting flexibility to apply it?

Edit: Damn, meant to put a thumbs up. ;-)

Is this a type 1 or 2?

Closer to Type 1. It was diagnosed more Type 2 at first, but it doesn't seem correct now since having to do insulin injections three times a day.

That makes it more challenging. If they are still producing insulin, just not enough, then they are still type 2. An insulin pump will not be prescribed for that. I have a friend in that situation.

The insulin pens are the easiest, most portable solution in this case.

EMY92 said:

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That makes it more challenging. If they are still producing insulin, just not enough, then they are still type 2. An insulin pump will not be prescribed for that. I have a friend in that situation.

The insulin pens are the easiest, most portable solution in this case.

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Oh, so is Type 1 the complete inability to produce insulin? I thought a three-shot regimen each day set to the results of a blood sample device (actually four because there is one has to take without blood sample test first) meant it had gotten worse and changed.

titan said:

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EMY92 said:

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That makes it more challenging. If they are still producing insulin, just not enough, then they are still type 2. An insulin pump will not be prescribed for that. I have a friend in that situation.

The insulin pens are the easiest, most portable solution in this case.

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Oh, so is Type 1 the complete inability to produce insulin? I thought a three-shot regimen each day set to the results of a blood sample device (actually four because there is one has to take without blood sample test first) meant it had gotten worse and changed.

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It could be several things. Sounds like he has type 2 and it got much worse. Having three shots a day and long acting shot also has me thinking not type 1.

I mean type 1 more or less have to be ready to treat at any time.

As someone else said. They won't give a type2 a pump. The cost is too high and there is somewhat a stigma associated with that disease. (Edit to clarify that Type 2 has a medical stigma that they should not be given insulin to treat the disease, as even medical professionals feel that it can be treated exclusively for diet in all cases. This is at least in my opinion incorrect, but not relevant to this overall discussion)

culdeus said:

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titan said:

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EMY92 said:

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That makes it more challenging. If they are still producing insulin, just not enough, then they are still type 2. An insulin pump will not be prescribed for that. I have a friend in that situation.

The insulin pens are the easiest, most portable solution in this case.

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Oh, so is Type 1 the complete inability to produce insulin? I thought a three-shot regimen each day set to the results of a blood sample device (actually four because there is one has to take without blood sample test first) meant it had gotten worse and changed.

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It could be several things. Sounds like he has type 2 and it got much worse. Having three shots a day and long acting shot also has me thinking not type 1.

I mean type 1 more or less have to be ready to treat at any time.

As someone else said. They won't give a type2 a pump. The cost is too high and there is somewhat a stigma associated with that disease.

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Okay, from you description that sounds correct -- -2 that has become worse. But why on earth would the type 2 have a "stigma"????????

But the bottom line here is the pump is only for Type 1 --that's the opposite would have assumed.

btw, the worst "stigma" is "Oh, you have an insulin pump? You must have diabetes really bad!"

StoutAg said:

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btw, the worst "stigma" is "Oh, you have an insulin pump? You must have diabetes really bad!"

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Well culdeus said the stigma was with Type 2, the less severe one, which was a bit puzzling. Stigma with either would be puzzling.

titan said:

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StoutAg said:

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btw, the worst "stigma" is "Oh, you have an insulin pump? You must have diabetes really bad!"

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Well culdeus said the stigma was with Type 2, the less severe one, which was a bit puzzling. Stigma with either would be puzzling.

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There is a stigma associated with type2 in that it can be managed with diet alone. It can be hard to find doctors that are willing to treat it with insulin as a result, at least until the A1C approach stupid high levels.

This is changing somewhat. It's actually a not insignificant part of why insulin costs are going up. More type2s are using it.

culdeus said:

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titan said:

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StoutAg said:

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btw, the worst "stigma" is "Oh, you have an insulin pump? You must have diabetes really bad!"

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Well culdeus said the stigma was with Type 2, the less severe one, which was a bit puzzling. Stigma with either would be puzzling.

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There is a stigma associated with type2 in that it can be managed with diet alone. It can be hard to find doctors that are willing to treat it with insulin as a result, at least until the A1C approach stupid high levels.

This is changing somewhat. It's actually a not insignificant part of why insulin costs are going up. More type2s are using it.

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Oh, I see now. Well its certainly not diet in this case. The guy is an ectomorph virtually. No real extremes in any of his eating or diet. But the diabetic risk runs in the family strongly.

If A1C is the so-called blood sugar level being too high when near 600 when it needs to be more like 170, that's it.

600 is going to hospitalize you. 170 isn't safe long term either but baby steps I suppose.

A1c is basically a 3 month blood glucose average. 5.5 - 7 is normal.

I try to keep my BG readings around 100. My A1c below 6.

Don't know what type doctor they are seeing, but a good endocrinologist is what I would recommend.

Thanks, very informative.

I would say blood glucose levels in the 170 range are also too high. Wvwryone is different, but for me, I keep my A1Cs in the upper 4 range. 4.7 was my last A1C.

RightWingConspirator said:

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I would say blood glucose levels in the 170 range are also too high. Wvwryone is different, but for me, I keep my A1Cs in the upper 4 range. 4.7 was my last A1C.

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Interesting. The doc wanted the blood glucose reading to not be lower than 70 and not be higher than 170. Apparently anywhere inside that range will suffice. But this is the blood glucose meter Accu-Chek so may be different. Its not my doctor and there are details may not know; this is second hand info.

170 to 70 is the original range that I was given to shoot for when I was first diagnosed with type 1. If this individual is newly diagnosed or pursuing treatment for the first time, it's not a bad place to start. As they start to figure out the amount of insulin that they need, their diet, exercise, etc, they should start to aim for tighter control. An a1C between 4.5 and 6.0 would be ideal IMO.

If they are not currently seeing an endocrinologist, they should see on ASAP. If they had blood sugar of 600, I would think that they should be on insulin. Blood sugar is lowered by insulin and exercise. It is raised by carbohydrates and adrenaline. Over time, your family member should be able to gain better control if they are disciplined and develop a good routine.

Also, if the individual can get a continual glucose monitor (CGM), I highly recommend it. This is a senor that is worn on the skin that continually checks blood sugar levels and send the number to the users pump and/or phone. It's made a big difference in how tight my control is (down from A1C in the low 7s, high 6s to high 5s).

Quinn said:

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Also, if the individual can get a continual glucose monitor (CGM), I highly recommend it. This is a senor that is worn on the skin that continually checks blood sugar levels and send the number to the users pump and/or phone. It's made a big difference in how tight my control is (down from A1C in the low 7s, high 6s to high 5s).

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Thanks, I will tell him. That's a good option.

One question on the prior:

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170 to 70 is the original range that I was given to shoot for when I was first diagnosed with type 1. If this individual is newly diagnosed or pursuing treatment for the first time, it's not a bad place to start. As they start to figure out the amount of insulin that they need, their diet, exercise, etc, they should start to aim for tighter control. An a1C between 4.5 and 6.0 would be ideal IMO.

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That sounds like exactly the circumstance, as I know it just changed /manifested. They don't want it going below 70, so what does your 4.5 or 6.0 refer to ? It sounds devastatingly low -- is it a different calculation?

6.0 - 4.5 is the A1C number that is roughly a three month average blood sugar. There are better measures (Time in Range), but A1C is the one that all docs use (at least everyone I've seen). a 6.0 A1C is approximately a 125-130 average blood sugar. 4.5 is approximately an 80-85 average. The 6-4.5 target is probably an aggressive target for this individual, but something to look toward for the future.

Quote:

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That sounds like exactly the circumstance, as I know it just changed /manifested. They don't want it going below 70, so what does your 4.5 or 6.0 refer to ? It sounds devastatingly low -- is it a different calculation?

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Think of the 4.5 to 6 as an average taken over a 3 month period and is based on a clinical blood draw. In general, time above 140 begins to index this number higher. With the advent of CGM systems there are much better ways to measure diabetic control like time in range and velocity figures. A1C is a good way to diagnose still.

The two digit number is a snapshot of that moment in time. A value below 70 will begin to feel uncomfortable, and at 55 it will be quite uncomfortable, by 45 there will be similar symptoms to feeling drunk and dizzy and will require immediate action.

Those who keep a more tight control can (in general) tolerate a lower blood sugar without feeling the need to treat it straight away. At first your friend likely will start feeling low in the 80-100 range which is fine.

Technology for all this stuff is advancing quickly. If he's really seen a 600 on a blood draw he needs to see an Endo and get on a plan to get CGM and likely a pump. A combination of omnipod and G6 is what I'm most familiar with but there are many other brands.

One thing about omnipod is if you wear it on your arm, there is a similar looking device that delivers chemo now from that location, so you have people thinking that you must have cancer and it is not unusual for people to offer you encouragement in public to that effect (which is funny). This thinking is accelerated if you are also bald or shave your head.

Quinn said:

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6.0 - 4.5 is the A1C number that is roughly a three month average blood sugar. There are better measures (Time in Range), but A1C is the one that all docs use (at least everyone I've seen). a 6.0 A1C is approximately a 125-130 average blood sugar. 4.5 is approximately an 80-85 average. The 6-4.5 target is probably an aggressive target for this individual, but something to look toward for the future.

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Quinn, culdeus,

Ah, now I see. As surmised, its an extrapolation of the other figure. 125-130 makes sense if someone is trying to come down from 170 toward 70. Does it get to where you can take less than three (or four counting the one that doesn't require a blood sample reading) a day. Thanks.

titan said:

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Quinn said:

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6.0 - 4.5 is the A1C number that is roughly a three month average blood sugar. There are better measures (Time in Range), but A1C is the one that all docs use (at least everyone I've seen). a 6.0 A1C is approximately a 125-130 average blood sugar. 4.5 is approximately an 80-85 average. The 6-4.5 target is probably an aggressive target for this individual, but something to look toward for the future.

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Quinn, culdeus,

Ah, now I see. As surmised, its an extrapolation of the other figure. 125-130 makes sense if someone is trying to come down from 170 toward 70. Does it get to where you can take less than three (or four counting the one that doesn't require a blood sample reading) a day. Thanks.

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No. The treatment plan of bolusing for a meal in response to a blood sugar reading will always be a thing. Even in closed loop systems bolus discipline is the single biggest thing that impacts your control and outcome.

culdeus said:

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One thing about omnipod is if you wear it on your arm, there is a similar looking device that delivers chemo now from that location, so you have people thinking that you must have cancer and it is not unusual for people to offer you encouragement in public to that effect (which is funny). This thinking is accelerated if you are also bald or shave your head.

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Now I'm definitely never going with an omnipod! Never thought about that - I shave my head.

culdeus said:

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titan said:

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Quinn said:

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6.0 - 4.5 is the A1C number that is roughly a three month average blood sugar. There are better measures (Time in Range), but A1C is the one that all docs use (at least everyone I've seen). a 6.0 A1C is approximately a 125-130 average blood sugar. 4.5 is approximately an 80-85 average. The 6-4.5 target is probably an aggressive target for this individual, but something to look toward for the future.

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Quinn, culdeus,

Ah, now I see. As surmised, its an extrapolation of the other figure. 125-130 makes sense if someone is trying to come down from 170 toward 70. Does it get to where you can take less than three (or four counting the one that doesn't require a blood sample reading) a day. Thanks.

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No. The treatment plan of bolusing for a meal in response to a blood sugar reading will always be a thing. Even in closed loop systems bolus discipline is the single biggest thing that impacts your control and outcome.

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Interesting they call it bolusing (I know what bolus is -- interesting to invoke the clinical term) - so the need to take insulin just prior to the meal, before the "bolusing"... is just a constant. And presumably then, even if just eat two meals a day normally, with this regimen you have to start adding a third.

Not sure if I'm reading your post incorrectly or not, you typically will take a "bolus" of insulin pre-meal. The idea being that by the time it takes effect you are eating and your sugar is rising, and it has its peak effect about the time your blood sugar would normally peak following this meal. You usually increase/decrease the pre-meal bolus based on how many carbs you're going to eat.

Your basal insulin is either a very long acting insulin that doesn't have a peak effect that you take once a day, or it's a steady stream from the pump. The advantage of a pump is that if you don't calculate the correct amount of insulin for a certain amount of carbs you eat, you can simply adjust and give yourself an extra few units after the meal rather easily.

titan said:

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culdeus said:

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titan said:

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Quinn said:

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6.0 - 4.5 is the A1C number that is roughly a three month average blood sugar. There are better measures (Time in Range), but A1C is the one that all docs use (at least everyone I've seen). a 6.0 A1C is approximately a 125-130 average blood sugar. 4.5 is approximately an 80-85 average. The 6-4.5 target is probably an aggressive target for this individual, but something to look toward for the future.

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Quinn, culdeus,

Ah, now I see. As surmised, its an extrapolation of the other figure. 125-130 makes sense if someone is trying to come down from 170 toward 70. Does it get to where you can take less than three (or four counting the one that doesn't require a blood sample reading) a day. Thanks.

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No. The treatment plan of bolusing for a meal in response to a blood sugar reading will always be a thing. Even in closed loop systems bolus discipline is the single biggest thing that impacts your control and outcome.

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Interesting they call it bolusing (I know what bolus is -- interesting to invoke the clinical term) - so the need to take insulin just prior to the meal, before the "bolusing"... is just a constant. And presumably then, even if just eat two meals a day normally, with this regimen you have to start adding a third.

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I mean at first yes. This to me sounds like a case of Monogeneic Diabetes, they now can actually test for that with some special bloodwork. It typically presents in a couple forms, one a Type 1 diagnosis but the patient can maintain a very low A1C because they produce some background insulin basically "cheating".

So if you are thin, don't eat too much carbs, exercise it's possible to not be diagnosed with anything for years.

About 5% of Type1 have Mono. It makes life a little easier and coupled with a lower carb lifestyle you can see relatively healthy patient bloodwork with not too much effort and few lows even.

The probable official diagnosis will be LADA which is just late onset Type 1 for reasons nobody really understands.