Is this a scar tissue problem

[Oradev]

Here is my situation. I am very thin and have been diabetic for around 15 years and have almost exclusively used my stomach.

I currently use Novolog for meals. When I take my bolus, I usually use a 1/2 inch syringe. I pinch and then inject. Now, then insulin seems to kick in very very fast. After my lunch, my sugars are very low but then "always" go high around 3 hours after. I've tried switching up my I:C ratio, eating a very low fat/protein lunch, and even eating less with no success. I'm wondering if I'm actually getting under the subcutaneous tissue when I inject. When I inject this way for a correction my sugars fall very very fast.

Well, two days again I started on a Novolog pen with 1/3 inch needles. When I inject in my stomach using these needles, my sugar goes crazy high (<200) after my meal using the same I:C ratios. Has anyone had this problem with using a shorter needle? Does this mean that I have absorption issues (scar tissue) if this is happening? I'm just wondering if it's the needle length or if it's absorption issues.

[Oradev]

My sugar goes crazy as in greater than 200, not less than 200.

Adam

[Oradev]

After reading some old posts I think that my issue might be with the short (1/3 inch) pen needles. A lot of people have had issues with the short pen needles.

[Subby]

I agree, this issue is just likely to be you are reaching a less useful layer of fat. Stick with the longer one.

I was just replying to your other post about your going low issue but you've put some more info here that makes me think.

Going back to your I:C ratios and trying different ones, it's useful to think of insulin as having absolutes if you go in either direction.

In one direction, too much, you get lows. But it is also followed by highs, due to a reactive liver dump.

In the other direction, zero insulin, it's up up up all the way, for us t1s.

My question is, when you experimented with putting your I:C up, did you get to the point you stopped seeing lows 2-3 hours after your lunch? Because that's a point the situation dictates you WILL reach if you keep lowering your dose.

You've answered a question here I was wondering in your other thread: you bounce back high in the hours after going low. It sounds possibly like a liver response of glucagon to a low BG, leading to hours of highs. Again, pointing to the possibility, of too much insulin in the first place. You won't know until you lower your I:C ratio and keep going to the point you don't see the 2 hour low in the first place.

[Oradev]

Here is what happened at lunch yesterday. My basils for the most part are fairly level.

12:00 noon - bs of 126, ate 95 carbs, took 7 units of Novolog
1:00 - bs of 137
2:00 - bs of 137
3:00 - bs of 228!! This is why I'm wondering if my dose is running out.

Here is what I ate:
Turkey breast w/ American cheese on Multigrain bread. (30 carbs)
Granny smith apple (10 carbs)
Kashi Flax seed bar (25 carbs)
3 Fat free fig neutons (30 carbs)

It doesn't make sense to me because of the low fat/protein lunch that I am eating. I do not have digestion problems at all. Maybe the higher fiber (Bread, Apple, Kashi bar) is slowing down my digestion, but I really don't know if that is it.

[Subby]

You are right it is very confusing yes! I have to say these are exactly the problems I tended to get on MDI and could not solve to my satisfaction, but did with lots of experimenting with the pump. I hope MDI allows more solutions for you than for me.

As for this meal... I do note you didn't go low at 2 hours, you had what appears a good result with your bolus, probably for 3 hours. Then at 4h as the bolus is probably gone, you go up.

So that's obviously not one of the meals you get the problem of a hypo at 2 hours... If you can remember, maybe take notes of one of them when it occurs, and post them here.

This either suggests something with the food causing the issue, or (sorry to come back to it) your basals just not up to the job at 3- 5 pm. Some people, get periods of resistance in the afternoon (I get resistance right up to 5pm, then it drops right off, my basal rate has to progressively go up after lunch, then has to be cut by 30% within an hour, to maintain good BG). The only way to sort that out is basal testing.

As for the food, I can only speak for myself. Apples I find extremely variable and often lead me to highs I cannot predict. They can be quite high GI. I love them but I can only eat very small firm ones very occasionally. Turkey and cheese, may definitely have slowed your car absorption rate down. If you were using the pump, I'd be suggesting, "dual wave THAT meal (try 50% now, 50% over an hour) and see how you go!" With MDI, you don't have that option... splitting the dose may have given you a better result.

So after all that rambling, my reading of this meal is: Meal may have outlived your insulin, yes, but good first 3 hours. Extended life of carbs effect not too suprising, turkey and cheese can definitely slow it down, even if it wasn't obviously a fatty meal. You might indeed find that many foods outlive your Novorapid action - the answer can't be to defer the injection since that means they will get away on you at the start. See if you can pinpoint some foods that do that more than others. If on pump - try squaring or dualing the bolus. If on MDI could try splitting the bolus.

Also, a final suggestion for something to try, that really was a high carb meal you ate. Really cut those carbs down for a few days and see if it all works a bit better, as an experiement. I'm not saying "go low carb diet" as such, but keeping the carbs to say 35g maximum (just an example) per meal is what some of us find is the absolute best way to get better predictable results from our insulin. Nice to see meal boluses less than 5u too, there is less variation in the response to the insulin, "smaller numbers, smaller mistakes" to vaguely quote Bernstein and probably a few others.

[Oradev]

Thanks Subby! For lunch, what do you normally eat? I guess I should get rid of the Figs for now (that will subtract 30 carbs).

[Oradev]

Also, what do you think of me trying a Humalog mix (75/25) at lunch? Has anyone tried this insulin?

[cwathne]

Also, what do you think of me trying a Humalog mix (75/25) at lunch? Has anyone tried this insulin?
I'm on Humalog and Humalin N. I find that Humalog does a great job at remaining effective for the same amount of time that the meal is affecting my blood sugar levels (usually higher protein/complex carb meals).

[Oradev]

Also, what do you think of me trying a Humalog mix (75/25) at lunch? Has anyone tried this insulin?

Nevermind, I just found out that the Humalog 75/25 mix is 75% NPH and 25% Humalog. I would prefer an insulin that is 75% Humalog and 25% Regular. That would be nice. Does anyone know if you can mix the two?

Adam

[Maddogg]

I'm on Humalog and Humalin N. I find that Humalog does a great job at remaining effective for the same amount of time that the meal is affecting my blood sugar levels (usually higher protein/complex carb meals).

Thats exactly what I'm on and I works great most of the time. I've always had a bigger problem with Humalin N than the Humalog. I've run into a couple of bad vials of Humalin N that just didn't work even after increasing the dose dramatically. Humalog on the other hand has always been effective and reliable for me. Both of them are extremely effective and efficient if you're a very active person. I used to be a full time labourer and I wa taking very little insulin (less than half my usual doses) and sometimes I would still get hypos...

Nevermind, I just found out that the Humalog 75/25 mix is 75% NPH and 25% Humalog. I would prefer an insulin that is 75% Humalog and 25% Regular. That would be nice. Does anyone know if you can mix the two?

Adam

That would be a wonderful mix to have! Especially for people with irregular schedules and what not...

[Subby]

Hey Adam, no worries with the chat, remember that I can only throw ideas at you to explore, and possibilities at you about what certain foods do and it may or may not apply to you, we are all different and that goes for both insulin and food reactions. Keep trying different things! That's the way to make progress...

I think it's a good move to try cutting out the 30g of prunes and see how that goes next time.

The kind of things I might have for lunch: If I am going a bit more carbs (less and less these days), I might go:

A humungous salad sandwich on mulitgrain/low gi bread (heaps of veggies) and a glass of water or now and then, milk.

4 vita wheats (low GI crispbread) cheese, small serve of baked beans or other beans, homemade veggie soup (such as celery or mushrooom or pumpkin)

Salmon or tuna fillet, mixed vegetables.

Salad with anything and everything for nutrients and to bulk up. No sugary dressings though. (Though I love caesar salad myself and indulge more than I should: bolusing for the dressing and croutons covers me ok)

Perhaps a small pear or small nectarine (these don't spike me): fruit needs to be something that you know for sure does not spike you individually.

As an alternative to water, I really like to drink very diluted cranberry juice - it's not the light or diet stuff, I don't like the flavour of that. It's about a shot of normal crannie in a big glass of cold water, about 6g carbs which I can handle easily, and I find delicious myself. Kind of like a cordial idea, much less carbs than normal cordial, and not with all the nasty addictive and strange side effect properties I find with cordial normal or diet.

So those are some kind of "mid carb" lunch ideas. It really helps to like veggies or work on cultivating the taste! now that I have carb cravings pretty much in check (by making sure I don't eat too much at any one time) I get big cravings for veggies if I don't get them.


Nevermind, I just found out that the Humalog 75/25 mix is 75% NPH and 25% Humalog. I would prefer an insulin that is 75% Humalog and 25% Regular. That would be nice. Does anyone know if you can mix the two?

Adam

Eddy is the mixmaster around here, he might be able to give you ideas! I don't know if Humalog and regular can be mixed in the same syringe by hand.

In the context of getting a bit more longevity over a meal, I'd stay away from mixes with NPH full stop. They'll just bugger with your basals for maybe 15+hours. As a general rule it would be good to stick to sorting your basals out seperately to your boluses, that's the whole direction that modern, better control has come from....