new to NovoRapid

[jspirit]

Hope someone can help:
Have been on Levemir for almost a year. Usually take between 8-10 units once a day or split into two doses.
Just started on NovoRapid. Take about 4 units with lunch and 4 units with supper.
If I find that I am eating more than I anticipated, or let's say I'm at a party and try a taste of dessert, can I add another unit or two to cover that? If so, how soon should that be done?
Thanks!

[poodlebone]

Yes, you can take more to cover extra food. Most people use an insulin:carb ratio to decide how much insulin to take based on the grams of carbs they'll be eating. That ratio is different for different people. It sounds as if you take a set dose no matter what you eat, or you eat basically the same amounts at each meal. If you learn carb counting and work with your doctor or educator to figure out proper insulin:carb ratios you'll find dosing for food to be much easier.

So, one person might have a 1:10 ratio, which means that they take 1 unit of fast acting insulin for every 10 grams of carbohydrate that they eat. Someone else might have a ratio of 1:7, or 1:25. It's hard to recommend how much extra you should take without knowing how much you're eating in the first place to go along with those 4 units of NovoRapid, and if those 4 units are giving you good results.

[FatCatAnna]

Just curious - do you not take the appropriate insulin based on the amount of carbs you are eating? I am presently using an insulin pump - and before that multiple injections (MDI as they call it in many forums). When I was MDI - I would test my BG first - see where it was - and then inject the appropriate amount of NovoRapid to take care of the food as well as any correction needed for my BG. Generally 1 unit of insulin takes care of 15 grams of carbs - but like in my case - and others will say the same - it varies - as to how your body handles the insulin you inject (e.g. perhaps you would need less, like 1 unit takes care of 12 grams). When I went onto the pump - because I had been MDI this way for 5 years prior - it made the transition to pumping abit easier - but was still like learning how to be a new diabetic <lol>.

Do you take a long acting insulin? To maintain your BG during the times you don't inject with the fast acting insulin at meal times. I was using Lantus - twice a day (6 units at bed time - and then 10 units in the morning).

Hope this helps Jspirit! If not ask more questions - am sure others will join in and maybe offer better advise then I can.

[Subby]

Jspirit, it sounds like you are currently on set dosages, is that correct? And you may puit it up or down a bit, but it's pretty much guesswork?

Learning how to use carb counting and I:C method of dosing would be the best bet both for better results, and let you bolus for whatever you eat at whatever time, such as your dessert question.

Some people do seem to get by pretty well on set dosages after years of familiarity. I wasn't one of them. For the rest of us, picking up a system that makes dosaging more logical and consistent, may not be perfect but can help a great deal.

[jspirit]

Thanks to the fellow d's who replied.
I was lucky to get an appt. on Tuesday ( in 4 days ) with my nurse and dietician so hopefully I will leave there with more specific instructions.
Tough night last night- went low twice and must have measured 6 or 7 times so pretty tired today. I think the NovoRapid helped with my lunch and supper, but maybe then I shouldn't have taken the extra Levemir at 6 pm. I was on 9 units a day, and recently tried splitting it 6 units at 9 am and 3 units at 6 pm.
Does the addition of NovoRapid with meals help to reduce the need for as much Levemir for long-acting?
BTW- I do eat the exact same breakfast and lunch everyday- just vary my dinners.

[Subby]

I hope your health team are progressive and will willingly teach you the carb counting method. I hear you that you have the same break and lunch... but if you vary at all, such as your dinner, desserts, or even sizable snacks between meals, you will benefit from a better system than guessing - such as carb counting. Hand in hand with I:C ratio carb counting, is the similar "Insulin Sensitivity Factor" Correcting... allowing you to get down from a high BG with no food involved. Both these things together complete your basic bolusing arsenal!

The ideal situation is that your short acting does not interfere with your basal. So, no, it shouldn't reduce the need for long acting as such.

That said, again an older approach is to consider the use of boluses to be like waves joining up through the day, meaning that emphasis is placed on boluses during the day for overall control, and basal questions get mainly relegated to the night.

Beware such an approach if you encounter it. It can really confuse things! The best idea is to get your basal right with food out of the equation (the idea of basal testing is one worth looking into) and then you have a level playing field to finely tweak your boluses so that they primarily account for your food ingestion, and no more.

If your basal has been working for you and you are suddenly finding yourself going low on adding rapid acting, it may well be your rapid acting doses that are the problem. Then again, if your basal was actively lowering your BG from highs now dealt with using the rapid acting, it may well be expected that it is now too much! Again underlying the use of 'basal testing", testing basal during short periods of fasting.

Again, the carb counting method gives a consistent, logical and practical way in which to tweak and finely tune your dosaging consistently across the board. Guessing up or down while juggling a variety of meals and boluses is... well... guessing.

[owlyn]

Just to elaborate on what the others have said...

The insulin gto carb ratio is half the equation. You also need to determine your insulin to BG ratio. It all works together. In my case, it goes like this:

1 unit rapid acting insulin (Humalog in my case, but could be Novolog) = 15 grams of carbohydrate = 30 points of BG level. So, as an example...

let's say it's before dineer, andd my BG is 180. Well, 1 unit brings my bg down 30 points, so I need 3 units to get it down to an acceptable 90. Then, I am about to pig out on a plate of spaghetti. I know that this will be about 90 grams of carbs, so 90 grams of carbs/15 grams of carbs per unit of insulin = 6 units of insulin. So, I will need 3 + 6 = 9 units. BUT- if I know I will walk for an hour after eating, I only need 1/2 my dose, because from experience I know that an hour of walking reduces my insulin need by half. So, I will take either 4 or 5 units, depending on the phase of the moon or the price of tea in China (I use pens that don't do half units, and it's all a giant estimate anyway).

And none of this has any effect on you Levimir dosage. In fact, it's the other way around- your Levimir dosage will affect your ratios.

[sparrow1]

Someone posted this terrific tool a while ago, and I carry the spreadsheet with me all the times. Once you figure out your I:C ratio and your sensitivity factor (Insulin to BG ratio) this eliminates the confusion of doing the math for figuring out how much NovoRapid you need.

Integrated Diabetes Services - Diabetes Management (http://www.integrateddiabetes.com/tools.shtml)

[jspirit]

Thank you everyone.
I had my appt. with my " team" and they put me on 2 units at lunch and 2 units at dinner, based on my weight and carb intake. Guess that's why 4 units sent me low. They explained about the carb ratio and said 1 to 20. For now. As we all know, this is an ever-changing situation!
Staying on the same Levemir and so far, no lows the past 2 nights! What a relief!