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Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason?

Aug 2012
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Practicing since : 1999
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I am a type 1 diabetic since 6 years. I take human mixtard 30/70. My last HBA1c was 6.7.
Some times I feel that I urinate more even though my blood sugar is below 150. What could be the reason?
Posted Thu, 14 Feb 2013 in Diabetes
Answered by Dr. Madhuri Patil 33 minutes later
Hi XXXXXXX. Thank you for the query.
Very good to know that you are managing your sugars, or rather your HbA1c at 6.7% with Inj Mixtard which is rare.
Now the excess urination happens when you tend to drink more of plain water, have excess of calcium in the body, are working in cold environment, if the volume of urine is less but frequency is more then it is more due to diabetes insipidus where the concentration of blood and urine are not in sink and you tend to drink more water and urinate in large volumes. Some medications also tend to make you urinate more. So please let me know:
- Is the volume of urine usual or less
- Do you also have burning sensation while passing urine
- Do you take any medication other than insulin
I can answer you based on your answers.
When you say this happens only sometimes even though your sugar is normal at that time, you should understand that inj Mixtard does not cover your sugars uniformly all through the day. Sometimes the sugars tend to go beyond 200 and 4 to 5 hours following that (even when when you see blood sugar is about 150), your body is busy excreting the extra sugar through your urine.
Hence you can think of basal bolus pattern of insulin where you take NPH insulin as a basal insulin once or twice a day and Short acting insulin to cover sugars coming from your meals. This will give uniform sugar patterns and HbA1c less than or equal to 6.
Anyway, I shall wait for your reply and we will discuss about the excess urination further. Take care.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 13 minutes later
The volume of urine I think is normal. There is no burning sensation while passing urine, and apart from insulin I take some multivitamins. But I do think that I drink more plain water(about 4-5 litres). I am confident about the uniformity of my blood sugar levels. Because I am aware of the pattern that it follows. I have observed that human mixtard lowers the blood sugar at the rate of 50 mg/dl per hour once it has reached its peak point 2 hours after meals. so if my sugar level aftter 2 hours of my lunch is 150 I am sure that 95% of the time it will be 100 after an hour. I get concerned if I tend to urinate twice or thrice within this period of time.
But again because I am a diabetic I do tend to overthink about my urination frequency sometimes.
You mentioned about the Bolus insulin. I think that might require me to take multiple shots within a day? I would love to have an HBA1c below 6. Kindly also let me know more about Bolus insulin.
Answered by Dr. Madhuri Patil 27 minutes later

Driking 4 to 5 litres is a bit more for you. Please try to restrict fluid intake to 2 to 3 litres and see the difference. If you feel thirsty very much then we will need to do some tests like calcium profile and blood and urine osmolality tests.
Yes, the basal bolus therapy needs you take multiple insulin shots throughout the day- somewhere between 4 to 6 depending on how much flexible you want to stay.
I will say if you are sure of uniformity in your sugar patterns and if you have discipline to follow your routines then please DO NOT CHANGE your medications. But I shall tell you about it as you want to know more:
The bolus insulin can be the short acting insulin (soluble) in your mixtard which makes 30% of it. Instead of taking Mixtard 30/70 in one go, you are supposed to take the soluble insulin only when you eat major meals and the NPH (which makes 70% of the mixtard) insulin at 10 pm. Some people also need a small dose of NPH insulin in the morning hours. This pattern takes care of sugars coming into your blood from both the sources: liver (the basal insulin) and the food (the bolus insulin). This pattern lets you be flexible in case you need to eat more or less, you can change the dose of bolus insulin more or less according to your ratio of food sugar to bolus insulin units.
This patterns also lets you be flexible in case you have to undergo unplanned exercise like walking extra of 15 minutes or running for 5 minutes to catch a bus/ train or stay empty stomach for some unavoidable reason by reducing your bolus doses with known proportions. YOU NEED PROPER TRAINING IN DOING THESE MANIPULATIONS. But it's worth it once you learn about it. We call it flexible insulin therapy and not just basal bolus therapy. In place of soluble short acting insulin you can go for ultra short acting insulin (which is a little expensive option) to avoid waiting 30 minutes before the meals and also to chose if you want to have the snacks or not.
In general, it keeps the sugars in very nice control, it reduces the need of checking sugars frequently once you learn the techniques and it give a lot more flexibility in your life about eating food- type, quantity and timings and also exercise- type, intensity and duration.
I hope you got an idea. Get back for any further query. Take care.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 35 minutes later
That sounds good. But I think that I am pretty satisfied with my blood sugar control. I have an office job so find eating snacks regularly much easier than taking multiple shorts a day. The only problem that I face sometimes is hypoglycaemia during the night. Generally to take care of my dinner I take 14 units of 30/70 at night. That leads to a sugar level of around 150-180 two hours after the dinner. then I have a bedtime snack( a glass of milk and an XXXXXXX or a few biscuits) but sometimes that leads to low blood sugar during the night or fasting blood sugar of less than 70 in the morning. If I reduce my night dose from 14 to 12 units the low blood sugar problem during the night and in the morning is solved but it rises to around 250-280 two hours after the dinner. In that case I skip my bed time snack. I do realise the seriousness of low blood sugar and I try my best to avoid it. It almost never have that during the day since I always keep track of my sugar levels, but the night is a bit of a problem. If you could give some advice regarding this without any major changes in my insulin type, it would be very helpful.
Answered by Dr. Madhuri Patil 3 hours later
You can handle it in ONE of the following ways:

1. Continue taking 14 units of Inj Mixtard 30/70 and increase your snack like this: Along with a glass of milk and biscuits, add two more of the same biscuits OR add one dry fig or two dry dates to the XXXXXXX you eat with that glassful of milk.
2. Change the evening injection to Inj. Humalog Mix (25/75) and continue your same routine
3. Instead of inj Mixtard, Take injection Actrapid (soluble) 4 units MIXED with Inj Insulatard (NPH) 9 units before your dinner and continue your same routine

If these things do not work, let me know. We shall review the carbohydrates in your food and discuss more.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 10 hours later
I think the third option will be best suited. I discussed this possibility with my doctor but he said that since my HBA1C's are good, he does not reccommend any major shift in my medication.
In the morning I take 46 Units of Human Mixtard 30/70. Some times due to unavoidable circumtances(an outing with friends, a birthday party or an office gathering) I have to take more than my scheduled snack in the evening and after that naturally my blood sugar rises. Suppose my BG 2 hours of evening snack is 300. In that case I just skip my dinner and my evening injection, and I have observed that by the morning time the sugar levels come down to 100-130. So may be the effect of my morning injection stays there for 24 hours( I am not sure but it is just an observation) . I was wondering that will it be a good idea to to take just Actrapid for dinner at night as the Basal component of my morning injection is still working? Because to be very honest I don't like taking a heavy bedtime snack, but sometimes I have to eat forcibly because I know that if I don't, my blood sugar would get low during the night.
Answered by Dr. Madhuri Patil 46 minutes later
The NPH part of the mixtard works for XXXXXXX 14 hours. The duration increases in case you have exerted a lot on that particular day.
In your case when you say pre-dinner sugar is 300 and you avoid taking injection as well as you avoid your evening meals and in spite of that your morning sugars are less than 150 then I would like to ask you: Is the type of your diabetes confirmed to be type 1 diabetes for sure? To confirm the type you need to take certain tests when clinical judgement does not help. This is true when you can manage with only inj Mixtard. A person with type 1 diabetes is having near total deficiency of insulin and hence managing with only Mixtard is rare. Please make sure you have confirmed diagnosis of the type of diabetes.
Were you overweight at the age of 19 years when you got diagnosed with diabetes? Do you have family memebers- mother, sister, brother, uncles, father with diabetes? Do you have family members with high blood pressure and cardiac dieases? Please answer these questions.
If you feel like having dinner then follow the third option and do not rely only on Actrapid as the delayed breaking down of food will increase your sugars in early morning hours.
Get your GAD, IAA antibodies, TSH, FT4, Anti TPO tested and this is the best time to do Glucagon stimulated C-Peptide test. All these tests will give you confirm diagnosis. In case it is type 2 diabetes, you can then manage it with oral medications also. You need to see an Endocrinologist's centre to do these tests if the lab is ordinary one around you. Take care.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 19 minutes later
I was diaganosed with diabetes at the age of 19 yrs. My Parent or any other close relatives do not have diabetes(niether type 1 nor type 2) or any other of the conditions you mentioned. My paternal grandmother had type 2 diabetes and heart problems. I was not at all overwieght. right now my wieght is 69 kgs and my hieght is 5 ft 9 inches. But I was very highly stressed during that time. I was preparing for my engineering entrance exams and that was a very tough time for me. I clearly remember that I started to exhibit the symptoms of diabetes after a severe stomach infection when I was 19. When my diabetes was detected my random blood glucose was 605 mg/dl. The doctors were almost sure of the type of my diabetes hence they never asked me to undergo any tests to confirm that. But yes, I have often observed that on some days my blood sugar stays surprisingly in control even though I overeat. But on the other hand there are also times with small amounts of diet the glucose levels soar high. The reason my blood glucose is well controlled is my discipline and frequent checking of blood glucose. I am very serious when it comes to my health. I do not want to have complications at any age and certainly not at such a young age. Shall I change the type of insulin by myself on your advice or should I go see a doctor in person?
Answered by Dr. Madhuri Patil 1 hour later
XXXXXXX, I still have my doubts about the type of your diabetes. It is not type 2 diabetes for sure, but it can be secondary to pancreatitis also, if not type 1.
When you say some day's heavy meals do not let your sugars go high and sometimes even a few carbohydrates take your reading too high: it's feature of fragile diabetes seen in secondary to pancreatitis or even in stress induced diabetes.
I would say, when you are so nicely controlled and so nicely motivated to take care of yourself, do not worry as of now and please do not disturb your discipline due to my comments.
You can very well change the insulin on yourself as it is part of self management of diabetes. For prescription you will need to see the doctor in your area.
In future, do get your tests done which I have mentioned to you along with one abdomen USG and abdomen X- XXXXXXX in standing position. You can do this when you earn enough money for yourself as they are certainly expensive tests compared to your routine tests. Doing the tests will not only tell us the precise type of diabetes but also it will help us in what to expect in future.
As you know well, keeping your sugars at their best control is the key for living normal and long life.
Now coming back to your sugars: Do not let your sugars go high due to your evening snack, but take a small dose of inj Actrapid for that particular day's heavy snack. you will not see high pre-dinner sugars. you can take 3 to 4 units of Actrapid (again adjust doses by monitoring) at that time and then, If you do not want to have dinner, taking only NPH insulin- say 5 to 6 units at 9.30 pm will give you good fasting reading. You can further adjust the doses as I am telling you this based on the information I have about you. If you break your insulin doses into multiple shots, you will need even less number of units of insulin through out the day.
Take care.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 2 hours later
Hmm. I think I will give Inj Actrapid a try. Is it available by the generic name or is there a brand that I need to buy? Also let me know by what name can I purchase NPH. As you mentioned, if really it is not type 1 diabetes but pancreatitis, how will that affect my way of life? Is it curable or will I just have to change my insulin regime?
Also now that you mentioned it. I remember that when I was diaganosed 6 years back, I had an abdominal CT scan which was perfectly normal.
Answered by Dr. Madhuri Patil 2 hours later
Inj Actrapid itself is the brand name of soluble insulin which is the short acting part of insulin Mixtard. Inj NPH is avalaible in the name of Insulatard or Huminsulin N.
If a person has diabetes secondary to pancreatitis then he/she needs less and less insulin and has frequent hypoglycemia episodes, can have lose stool (stools which generally float in the lavatory) episodes, weight loss (generally skinny person), and other vitamin deficiency features. Hence the management is different than that of type 1 diabetes where you just need to replace insulin round the clock.
A diabetes due to pancreatic calculi (leading to pancreatitis) has been tried operatively and cured in some cases when the pathological parts of the pancreas were removed precisely and the other part started functioning normally. Very rare.
As I mentioned, you do not need to change the insulin regime in you except the one for evening snacks. But a person with pancratitis needs to be on more of short acting insulin boluses than the two times insulin regime to avoid hypoglycemia episodes.
If the CT was fine then you are unlikely to have pancreatitic diabetes. But your type of type 1 diabetes is rare. These days there are cases cited in literature that the process of destruction of insulin producing beta cells can be very slow even in people with type 1 diabetes and I feel you might be one of those kind of cases.
I would again say- do not think or worry much and manage yourself the way you were doing so far. make the suggested changes and get back for further fine tuning of the doses etc. if needed. Take care.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 46 hours later
Hi doctor,
I tried actrapid for the past two days. I took it only for the evening meal. I think that is working great. But I did not take any insulatard. I used to take 14 units of 30/70 mixtard at night before dinner. That would contain around 4 units of bolus and 10 units of basal. Those 10 units of basal used to give me hypoglycemia during night, so for the past two days I took 6 units of 30/70 human mixtard and 2 units of actrapid. It worked perfectly, my pre dinner levels were 90 and post dinner levels were 150. Then I just took a glass of milk before going to bed and my morning number was 100. I shall observe it a few more times during the coming days.

Regarding the frequent urination issue. I have observed that generally my urge to urinate is very mild but it is enough to make me realise that I need to go. During the morning I have to urinate for about 2-3 times within an hour. The first time is the amount of urine is more, but the other two times its less. Similar is the case later in the day....I do feel the need to go but the amount of urine is not much. I have reduced the intake of plain water, but I don't see much difference.

One more thing, I also have this habit to wake up at night to drink water. I almost never have to urinate during the night, but I do feel thirsty. I would also like to mention that I have had this habit of drinking water during the night since childhood. Even before I had diabetes. Can that be associated to this frequent urination??
Answered by Dr. Madhuri Patil 2 hours later
XXXXXXX, it's good what you are taking for the sugars and continue with that till your lifestyle allows you.
The habit of drinking water and also having glassful of milk at bedtime is the most likely reason for your urinary output. But still once you get urine routine and microscopic test done as you are saying the volume won't be that much many a times. Plus tests like serum and urine osmolality, serum sodium, serum potassium and urine spot sodium tests will help further to know if the urination issue is abnormal or not.
First of all, urinary output to be measured (say in plastic 1 L water bottles) for 24 hours and also your fluid intake (including plain water, milk, tea, other fluids in food like dal) to be measured in ML during those 24 hours. If output is more than input then it is a matter of worry and then we go for the above mentioned lab tests.
Let me know. Take care.
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Follow-up: Type 1 diabetic. Taking human mixtard. Getting urge to urinate. What could be the reason? 38 hours later
Hello, I have reduced my water intake for the past two days and shifted my glass of milk from bedtime to evening. I have been taking actrapid as mentioned above for the past 3 days for my evening meal, and surprisingly my frequent urination problem has dissapeard. May be my sugars used to be high during the night due to a heavy bed time snack, but because I took 14 units of 30/70 mixtard it gave me normal numbers in the morning and even low sugar at times. But things have got better and I don't have to urinate every half hour anymore :) ........ by the way, I would also like to know what exactly is considered normal frequency of urination?
Answered by Dr. Madhuri Patil 1 hour later
4 to 6 times a day with approximately 1.5 L volume.
Good to know about the reduced frequency of urine. In my first answer itself I had mentioned that high sugars make you pass more urine for 6 to 7 hours even after you get normal readings of blood sugars during that.
Now when you check the sugars, you should understand why you are checking them, what action you are supposed to take following a particular reading and that will help you for uniform readings of sugars through out the day. Understand the actions of different types of insulins.
As you noticed your total insulin requirement for the evening hours is lesser than what you used to take with Inj Mixtard. You can very well try split injections for daytimes also which will reduce the units of insulin required and also will give you flexibility in life.
Anyway, again I say your comfort at this stage is more important. Take care.
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