Novalog takes forever to start working

[networkguy]

OK a little backgound. T1 for 42 years on MDI. I use Novalog as my fast acting. Its been several years since I did this, but have been feeling like Ive really been spikey alot, so did a test today.

9:00 BS 212 took 16u novalog to cover a small breakfast and lower BS. Havent eaten yet.
at 30 mins: 207
at 60: 189
at 90 mins 177

What the ****? 90 minutes after shooting 16u and its only dropped 30 points? Im normally under very good control, but like I said Ive been feeling spikey lately. And its my bad I didnt check this sooner, I know. My A1C's are normally between 6.5-7, I use 32u of Lantus/day in a split dose, and about 25-50u/day for Novalog.

Anyone else like this?

[UltiMica06]

I use Novolog daily....It works Really well for me...Sometimes I over dose!...LoL..

Yea I think Novolog works well....Maybe watch what kinda of Carbs you eat????

[networkguy]

I try to eat as many complex carbs as possible, usually not more than 100g/daily, and high protein. Mind you these are fast BS I posted.

[Subby]

I get major holdups with large doses of rapid. As in, up to 2 or even sometimes 3 hours. Turned out that means anything from 2 units up at any one time. If I keep it below that, or use square (slow release) on the pump, I largely get around the issue and see consistent onset of action within 40 min at the outside.

It's the old absoption issue, taken to the extreme for my body. First things to do might be to try different length needles and different sites. What I found was that none of that helped. I simply have to keep it below 2u per injection if I want reasonable action. As said, that's easy on the pump. When I need to take an injection, I'll take a series of mini injections, 2 units each. Trying this method might be a way to test this theory for yourself. If similar "pooling" or getting trapped is a problem for you, your threshold could be anything. Experimentation would be the key to checking this out. For example, it could be that splitting your 16u dose into two, does the trick.

[DCaplinger]

I have to agree with Subby. Try using multiple depths and sites on your injections. That may help with the odd absorbing. Another thing you could try is taking some of it IM instead of all of it SubQ. Be careful though, you could go prematurely hypo if you go IM without being used to it.

I give all my shots IM now.

Regards,

D

[networkguy]

Good advice. I'll play with depths.

DCaplinger: I was under the understanding the xxxlog's shouldnt be injected IM?

[DCaplinger]

I am very highly insulin resistant. However, I get much better results if I take it IM. I take both my Levemir and my Novolog IM. Of course, I'm also a licensed EMT who has a lot of experience with dealing with IM medicines.

I doubt my Endo would like the fact that I give it IM. However, I've been doing it for some time now. I no longer have "lumps" building up in the fatty tissues where I used to inject SubQ.

Another reason why I started giving my shots IM is the shear amount of insulin I take at one time. I take 90 - 100 units of Levemir per shot, twice daily. I take anywhere from 20 - 80 units of Novolog at one time. I had too much problem with leaking when I was doing it SubQ.

EDIT: Also, since I started giving my injections IM, my post-prandial highs have been much lower than they used to be. For instance, 2 hours after eating I used to run as high as 300, now with the IM shots, they are usually in the upper 100's, near 180 or so. Still not perfect, but much better controlled than it used to be. I've also been able to drop my ratio from 1:1 to 1:1.5 or 1:2 depending on what I've eaten.

Hope that answers the question.

Regards,

D

[networkguy]

Thx man...I used to give Regular IM so may try Novalog...see how it affects me.

[xMenace]

It may also be poor abosrption from your basal insulin. Of course you rotate well, right? Maybe try some new spots.

[jenb]

Have you tried opening a new vial or pen of Novolog? I've had a few problems with unstable pens and usually change mine if I have highs that I have trouble correcting.

Jen

[6angels]

What does Im mean? Novalog takes forever to work for me also.

[DCaplinger]

IM means Intramuscular. It means to give the shot into muscle, instead of into the fat deposits just below the skin. Shots given into the fat below the skin are called SubQ (Subcutaneous).

EDIT: I would NEVER recommend trying to give fast acting insulin IM without talking to your physician about it. Absorption rates increase significantly when insulin is given IM. Taking a fast acting insulin IM when not eating enough fast acting carbs can lead to a dangerous hypo.

Regards,

D

[Gary_W]

The thing I would note is that you had a fairly high BG reading before you started...

For me, anything over a 10 in UK terms (180 in USA terms) gets me into the territory of insulin resistance and then none of the usual rules apply. At this point, I do have to hit it harder than you'd reasonably expect otherwise it takes forever to go down. If I eat when I'm up there, it's a train wreck - If you start high, even a small breakfast will make you higher still as the insulin just can't get a grip on the numbers no matter how much you inject.

If you still have the problem with it taking ages to work when you start from a really nice, low number then yes you may have absorbsion problems etc. But IMO you need more data before you try to fix something that may be easily explained.

Gary

[Subby]

The thing I would note is that you had a fairly high BG reading before you started...

For me, anything over a 10 in UK terms (180 in USA terms) gets me into the territory of insulin resistance and then none of the usual rules apply. At this point, I do have to hit it harder than you'd reasonably expect otherwise it takes forever to go down. If I eat when I'm up there, it's a train wreck - If you start high, even a small breakfast will make you higher still as the insulin just can't get a grip on the numbers no matter how much you inject.

If you still have the problem with it taking ages to work when you start from a really nice, low number then yes you may have absorbsion problems etc. But IMO you need more data before you try to fix something that may be easily explained.

Gary

Them's words of wisdom. I also find that highs will create increasing resistance, the effect probably starting at about 10 mmol/l. I didn't notice the higher numbers, myself. What I would like is a program to go through and convert all mg/dls to mmol/ls on the page, I just can't get a good feel for mg/dls without converting.

[TommyC1]

Same here.
If I'm up around 180 or higher the novalog doesn't seem to work as well or as quickly as when I start lower.
If I'm high I try to bolus at least a half hour before I eat and I try to eliminate at much carb from my meal as I can/am willing to.
It always comes back to testing often and correcting agressively (in either direction).

Tommy

[DCaplinger]

It always comes back to testing often and correcting agressively (in either direction).

Amen! Testing is the key. Test, test, test. I have a prescription for 10 test strips per day. Some days I use 4, some days I use 12. It all depends on what my numbers are doing.

You also have to be comfortable with your correction scale. If you don't know how to do a correction bolus, ask someone here.

Just to lighten things up a bit, when I was first diagnosed, my diabetes education nurse swore that you only take a correction dose with your pre-prandial shot. That is a concept the same nurse reiterated when she called to tell me there were no changes when I turned in my last rounds of sugar results. If I only corrected pre-prandial, I'd never get out of the 200's. LOL. I tried explaining the concept to her, but the whole thing seemed foreign to her. :o Poor gal. Hehehe.

EDIT: Just FYI, I donate my extra supplies (lancets, test strips, etc) to: Ashley's Diabetes Information Center (http://www.elviradarknight.com/diabetes/donatesupplies.html)

Regards,

D

[Delphinus]

I might try some of these suggestions.

I found my numbers were better when I was taking Humulin R, which is slower acting then my current bolus insulin, which is Humalog.

Subby you mentioned in one of my posts I may want to try pre-bolusing.

I really never got around to it as I can never wait and just eat right away. Hah... I will start today tho.

I might also try smaller doses, diff depths, and vary my injection sites some more.

[Subby]

Well Jason, it depends on when you are getting the spike. If it is relatively early, prebolusing is definitely worth trying, before putting your I:C ratio down (doses up), which is the next logical move given generally high outcomes from a meal/bolus battle.

[Shubert]

Quote from DCaplinger:
I've also been able to drop my ratio from 1:1 to 1:1.5 or 1:2 depending on what I've eaten.
I've always been curious about other people's carb ratios. I have been reading lately on here of people only needing to take a few units of Lantus a day and a few units of Huma/Novalog per meal. I always thought I was just a "bad apple" of the diabetics with a 1:5 carb ratio having to take 35 units of Lantus a day and upwards of 30 units of Humalog per meal, sometimes 40 if I feel like eating a lot :)

[DCaplinger]

I always thought I was just a "bad apple" of the diabetics with a 1:5 carb ratio having to take 35 units of Lantus a day and upwards of 30 units of Humalog per meal, sometimes 40 if I feel like eating a lot :)

I like to say that I suffer from double diabetes. I am a totally insulin dependent Type 1, and I suffer from EXTREME insulin resistance like a Type 2. I have insulin resistance because of my weight, which shot up when I first started taking insulin and quit smoking at the same time. Slowly, I'm losing the weight.

I started spilling ketones this morning again. I have a Endo appt tomorrow, I'll talk to him about it then.

EDIT: Oh, and I'm now up to 185 units of Levemir a day and up to 160 units of Novolog.

Regards,

D

[OctShadowz]

I had the same issue and I just switched to Novalog. My doctor says that it takes at least 2 to 3 hours for the insulin to start kicking in and also it depends on where up take your injections at. The arm and leg pumps insulin into the body faster due to the fact that well you are always moving the muscles in these areas. If you take in the stomach it will take longer because you don't really use the muscles in the stomach unless your doing crunches or bending down alot.

[networkguy]

Thanks everyone for the replies (although a few side issues were brought up hehe). I had another appt with doc yesterday (Im getting a pump so a few more appts than usual) and he told me no worries. Just adjust my timing. I think when I get my pump (hopefully next week) I will talk to him and my trainer about Apidra.