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On diagnosis as a Type 1 Diabetic in February 2001 I immediately started a two injection per day regime.
About a year later I heard about the four injection regime and it was suggested by my Diabetic Specialist Nurse that I try it. Stubbornly I refused point blank as I had major reservations about changing to four injections a day. For me, it wasn’t the thought of having more injections - I simply wasn’t convinced that it would suit my busy working lifestyle and, rather ignorantly thought it didn’t sound right to be injecting yourself when working!
After a period of several months during which my control began to deteriorate, I finally got to see a new Diabetes Specialist Nurse who has also been a diabetic herself for thirty-eight years. I felt more comfortable listening to a fellow diabetic and I decided to give the four injection regime a try in November 2004. I have to say that it is so much better; I just wish that I had changed sooner (or better still, started on four injections right from the beginning!) I now hope to persuade other diabetics to give it a try.
So, if you are undecided, wavering, or simply concerned about changing, I will set out the advantages and my previously perceived disadvantages for you – some may well be very familiar to you and you will soon see for yourself that the advantages outweigh the disadvantages by a colossal margin!
As I mentioned earlier, I personally don’t have a problem injecting myself – if the right technique is adopted and you have the right size needles for your body type, then the injections should be painless. If your injections are not painless, that is the first thing you need to overcome – as they should be! You may benefit from reading the article on injection techniques on my website by navigating to the advice section and/or refer back to your diabetes specialist. Whilst my reservations about trying four injections were not based on having to inject twice as often – I can see that it may be an issue for others and of course on paper, it does sound terrible! But – please read on!
My main concern was that I have a busy and active job, with irregular work patterns and I didn’t want to be injecting insulin when working. But, as I listened to the nurse explaining the four injections regime, it soon became apparent that my concerns were totally and utterly unfounded!
The rapid insulin that you inject prior to a meal on a four injection regime works for that meal and then tapers off over the next two to three hours. You have three quick acting injections each day; one to cover breakfast, one to cover lunch and one to cover dinner and then the fourth injection is of slower background insulin normally just before bedtime. The background insulin works between meals and overnight. The system works superbly! (There are more alternatives to this regime should it not suit you completely and your diabetes specialist nurse will guide you – it is important to remember that I am a patient rather than a medical professional and my advise is drawn solely from my own experience as a diabetic)
You will need an extra pen device and of course a supply of the two different types of insulin. A good tip here is to store the second pen device (the one that you use at night) in its carry case to help you know which one is which at a glance – although the different insulin’s are all clearly marked and colour-coded.
Now, I should point out that obviously everyone is different and what suits one person may not suit another, but here are the advantages as I see them, in changing to four injections.
• You have far greater control of your blood sugar levels with four injections! I saw a huge improvement in my levels after only one month!
• You don’t have to wait a set time after an injection before eating! You simply inject prior to eating! (That is, once your food is ready to eat and in front of you - you can inject) Gone is the worry about getting food on time! Gone is the hassle! You are in control! Eating out is far easier and eating in is far easier! It is worth changing to four injections solely to benefit from this! I personally excuse myself to inject rather than injecting at the table as this could offend some people. I carry a sugar source in my pocket for emergencies at all times. This gives added reassurance in case I get locked in a toilet or some other daft thing happens after I have injected! You never know!
• With four injections your body is getting insulin more often, which in turn helps reduce tiredness as the insulin is working to provide energy. I am certain now on looking back that when I was on two injections a day, it felt that I was starving myself of insulin and running my levels too high between doses. The four injection system is designed to be closer to normal insulin production or at least closer than the two injection system!
• Night time hypos are very rare on the four injection regime as the rapid injections are designed simply to cover your meals whilst the insulin you inject before bedtime trickles in the background over a 24 hour period.
• If you do go low and then after taking corrective action end up high later on – it is never that long before your next injection of insulin which means that you don’t stay high for as long as you would have done on two injections. Whilst on the subject of low blood sugars – you will also find it beneficial to experiment in not going mad to correct them! I have found that half a small bar of chocolate plus some longer acting carbohydrate (such as bread) works better than a whole bar of chocolate. (I know that it is tempting to rush into correcting a hypo – and at the time the only thing on your mind is pushing your level up as quickly as possible - but a bit of common sense does help avoid excessively high levels later on. Again, when treating Hypo’s it takes different amounts for different people, so you must do what is right for you)
• You have total flexibility over the amount you eat and when you eat it! You can simply inject according to your requirements – and this really helps anyone with a fluctuating workload or appetite. If you need to delay your lunch or indeed wish to eat it earlier or later you simply inject and eat when you want! Now, I must point out that this system of injections is not a licence to eat more or eat the wrong foods as that would obviously be counterproductive!
• You can if you wish, eat first and then inject – this is handy if your sugar level is low before a meal!
• You don’t always need a bedtime snack! You will have to experiment here – but I have found that a small snack is sufficient rather than having a large bowl of cereals as I did when on two injections. So, on occasions if my level is eight or more I don’t bother with the snack at bedtime, but you must remember to have the night time injection! It STILL works okay without a snack – my level in the morning is very similar to that when I go to bed without having a snack. Good news if you don’t feel hungry before bed!
Here are the disadvantages:
• It does involve a bit of experimentation with meal sizes and units injected – but having said that, it doesn’t take long to master – hardly a disadvantage really – just a different way of controlling your diabetes! Initially, your diabetes nurse will start your new regime’s dosage low to let you gradually adjust and to know how much to inject – it took me about a week to settle into the system.
• I once missed a night time injection! I will admit that I did forget to have a night time injection on one occasion and that meant waking up with a level so high I won’t even tell you what it was! So, that is another thing to watch for if you go onto four injections – don’t miss any injections out! I have since invented a failsafe so that I don’t do it again! I have a card like the one below (I drew the cat by the way and you are welcome to print it out on card if you wish to adopt the same system!) I keep it by my nightlight so that I have to physically move it to turn the light on/off before going to sleep!
It works a treat!
I honestly cannot think of any more disadvantages and so I think you will agree that it speaks for itself!
As you can see from the above – there are very few reasons not to give it a try!
I hope this article has been helpful to you – but should you still have any concerns, contact your Diabetes Specialist Nurse or Doctor. In addition, I am more than happy to try to answer your questions – you can email me at the address below – but please remember that I am a patient not a doctor.
Very best wishes
Diabetes - From Two Injections to Four
by Paul Foreman
10 December 2006
I have just read your article and just wanted to let you know that it was like reading my own story. I was identical. I was actually on two injections for twelve years before I changed, I resisted just like you , but for a long time. Four is like a revelation. One thing to just let you know though, in case you don't. On the four regime, you don't actually have to take four. You always need the bedtime one, but the other three are changeable. If one day you don't feel like lunch and want to skip it, you don't take your insulin. The rule basically, is if you eat carbs or sugar, take it, if you don't, you don't have to. So for example, if you only have salad for lunch, you can skip the injection for lunch as there are no carbs. If you decide to have a chocolate bar in between meals, you can take an extra shot to cover it. (a flake bar has the same carb content as one slice of thick wholemeal bread). These are all things impossible on the two regime, but quite liberating on the four. You may already know this but I didn't get that from your article, so in case no one has told you I wanted to let you know. But yes, overall, it is soooo much better. Part of me wonders why they put people on two in the first place, if they just told you it was four from the beginning, you would have nothing to resist.
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4 August 2005
I've just seen your fantastic article on the 4 injection Basal Blous regime, I couldn't agree more with your views and advice.
I've been on the 4 injections since February this year and it has changed things for me. Like you I wished I had been on it from the start.
I was diagnosed some way back at the age of 4 (March 1984) so have seen many changes over the years. For years I was reluctant to go onto the pen as the thought of 4 injections was off putting. I have a real fear of injecting (funny really when you fear the thing that keeps you alive) but I've managed to get past my fear and it is so much easier now.
I was put on the pen only 4 years ago. I had a really serious attack and ended up in hospital after having to be revived in A & E
I was however for all that time until this year on a mixed 2 insulin regime. It was not until I went for my annual hospital check last November (after another 2 fairly serious hospital visits...) that I was informed that I was on the wrong insulin the last 3+ years.
It was kind of a relief as I had done everything right I think, but results were still bad. However they took time putting me onto the 4 and it wasn't until a January admittance that I switched. Not looked back since.
Anyway hope you're well and just thought I'd send you a quick email
Email: [email protected]
Please note: it is not being suggested here that you can miss injections on a regular basis - Craig is highlighting the flexibility of the 4 injection regime over 2 injections.
Paul - www.diabeticinfo.co.uk