what would you do?

[dbc]

When your insulin "doesn't work"??

Like today, lunch was a pretty well defined 30g of carbs (lo-GI bread) and cheese. My I:C ratio is around 1:11-12, so I injected 3U apidra & expected to maybe counteract being a bit low in the afternoon. But at the 2Hr mark I'm 11.8!!! (was 5.7pre-meal)

So now, what to do: inject 1 or 2U for correction and risk a rapid onset hypo later? or wait for the insulin to kick in and ride out the high?

Just interested to hear how other folks handle this situation. It's something new for me - has happened maybe 3-4 times in the last four weeks, never noticed it before.

I inject apidra in the abdomen, and move randomly around left to right as far as possible. I'm convinced the insulin is still good, which only leaves me with unpredictable absorption... - or am I missing something?

And if it is unpredictable absorption, what to do???

[Subby]

Ahhhh... such lovely questions....

I go off experience in making such decisions as to whether to be aggressive or whether to wait. I know that I can afford to be quite aggressive, from knowing how things do usually end up panning out in such a situation.

Which doesn't help much here, because you haven't had much experience of this situation happening yet.

But I guess in that "unknown" situation this is what I tend to do:. Make a punt (either, that the insulin is just a bit held up and so either don't correct for now, or correct minimally, OR, that it's really not done the job and won't get there, so correct more aggressively) and then test hourly over the next 3 or so hours to see how it plays out, being prepared to catch the hypo early.

That way I might have a chance to learn something.

If it's looking/feeling like unpredictable absorption, my thought is you might need to start getting more discriminatory about certain areas of your torso. Chances are you may have good spots and worse spots. It might be worth experimenting and branching out, the butt I always found very reliable. It might be worth trying different length needles.

Anything else going on? Diet change? Weather change? Job change? Stress? Time of day? How do you think your basal is covering? Guess you've got the possibility of dramatically shifting insulin needs, too. Fun!

[TommyC1]

I'd do the correction and make sure I was prepared for any lows that might result.
Most times if my standard ratio leaves me high, corrections do not result in lows. If anything I may need to correct again at 4 hrs. YMMV.
And yeah it might be absorbtion or insulin resistance or it might be the old liver dumping due to infection or stress or phase of the moon or who knows what.
If anybody can tell one from the other I'd love to know how?

Tommy

[jenb]

If I'm high at 2 hours I do a correction, being sure to deduct any bolus on board. At 2 hours I have about 30% of my bolus remaining, so assuming I'd injected 2 units of Novolog for lunch I'd have .6 units remaining. (Glucose from the meal would be gone unless I'd had lots of fat too, so I wouldn't expect to go any higher.) 1 unit of Novolog reduces my BG by 50 points. If my target BG were 100, I'd need to drop 112 points from 11.8 (212?) which calls for a 2.25 unit correction; Subtracting the .6 unit BOB suggests a net correction of 1.65 units. I'd do 1.75 units and test again in an hour. This strategy works for me, but of course, YMMV.

Jen

[dbc]

Thanks everybody! Subby: nope, not much has changed in life in the last month or so, so I can't correlate with anything to explain this (would be nice, though. . . . ). I did a basal check last week: it's pretty stable, with a tendency to drift lower in the late afternoon, but still was within 5.8 to 4.4 over the day. Want to repeat the test next week to check for consistency.

An update on what transpired yesterday:
13:00 5.7 - before meal of 30g CHO, 3U apidra
15:00 11.8 !!! - 1U correction (normally expected to be ~7-7.5)
16:30 6.6
17:30 6.1

I'm going to do exactly the same today, see if there's a repeat of yesterday's performance. Hopefully it was "just one of those things" and I can carry on as normal.....

[CountYourselfIn]

I know that rapid takes 2hrs to show any significant results in me. I always wait 2hrs from injection to see if I need to top up or redo the whole bolus.

Usually get weird results when I use a new site.