[Lizzie G]

Hi people

I seem to be posting a lot on here this week as things have been trickier than usual! I was previously thinking maybe I had ineffective insulin that had been heat damaged but having a closer look at things I can see what is happening:

1) basal lantus at 14 units seems to be correct - negligible movement during the night and also day fasting shows the same (except in afternoon where I will drop a little but I know everything changes for me in the afternoon....like a werewolf or something!!)
2) it doesnt seem to matter what i eat but i am peaking VERY high. i used to always peak around 9(162), which by the way I thought was too high (where does anyone else peak 2.5 hours after food?), then i started getting some crazy readings. For example yesterday lunchtime i had a wholewheat bagel, green salad and some cream cheese. i had what i thought was the correct amount of insulin and 1.5 hours later was shocked to see myself at 14.1(254). my normal assumption would be that i hadnt taken adequate insulin to cover and i would pop in a couple of extra units, but i decided to leave and see. 3.5 hours after the meal i was at 6.1 (before lunch i was 5.7). any insights into what is going on here? to me it looks like the bolus doseage is correct but for some reason delayed.... if insulin has been damaged does it take longer to take effect or is my body just crying out to me to cut out the carbs (which isnt possible due to other lifestyle factors).

any thoughts?

[Gary_W]

The answer (IMO) is curves. Matching the curve of the insulin to the curve of the food absorbsion is always fun and mismatching causes those nice spikes.

The food curve is due to the amount of carbs and the glycemic index. Bagels are one of the most evil kinds of bread going, as in they whack into your system at close on the speed of light. Whilst I like bagels, I don't do them often and if I do I accept that my 2 hour number may be a little high. I'm guessing that's the same with you; you carb counted just fine, as your number came right when the insulin eventually caught up.. If you don't already have one, you can get books with GI / GL values in them as well as carb values. Very helpful, though GI is just a guide IMO. It will tell you what is LIKELY to be good or bad in terms of rapid rises. As we all differ, some can cope with certain foods better than others. No idea why, but it's true

What insulin are you using? I changed from Novorapid to Apidra last year. Apidra peaks quicker and (in me and many others here) tends to cope better with the high GI foods and hence minimise the 2 hour peaks. The downside is when you eat a high protein / high fat meal you may well find you'll need to split your Apidra dose otherwise you'll go hypo after an hour and then high later on... I know this can be the case with other rapid insulins, but in me it is even more important with Apidra.

Gary

[Lizzie G]

thanks Gary....I was thinking it was something of the sort (although for inexplicable reasons plain unsweetened supposedly low GI oatmeal disagrees with me too!)...i was thinking of asking about a switch from novo'rapid' - i think it lasts about 3 hours for me which is no good when you lead an active life (really screws things up when you take exercise even after 3 hours when you consume chocolate right before sport after!). the one thing i have done which seemed to improve things a little was to take the novo about 20 mins before food, would you recommend this or is it a risky strategy? i also notice that high GI foods containing plenty of fat, such as chocolate, have far less of an impact than bread - a mixed blessing... i think im going back to my lentil curries.......!

[ant hill]

Originally Posted by Lizzie G

Hi people

I seem to be posting a lot on here this week as things have been trickier than usual! I was previously thinking maybe I had ineffective insulin that had been heat damaged but having a closer look at things I can see what is happening:

Hi Lizzie , It will be good if our insulin would act at the time that we eat but the onset of insulin is not as fast that we would like.

1) basal lantus at 14 units seems to be correct - negligible movement during the night and also day fasting shows the same (except in afternoon where I will drop a little but I know everything changes for me in the afternoon....like a werewolf or something!!)

Are you just having the one Lantus shot to cover 24 hours?

2) it doesn't seem to matter what i eat but i am peaking VERY high. i used to always peak around 9(162), which by the way I thought was too high (where does anyone else peak 2.5 hours after food?), then i started getting some crazy readings. For example yesterday lunchtime i had a wholewheat bagel, green salad and some cream cheese. i had what i thought was the correct amount of insulin and 1.5 hours later was shocked to see myself at 14.1(254). my normal assumption would be that i hadnt taken adequate insulin to cover and i would pop in a couple of extra units, but i decided to leave and see. 3.5 hours after the meal i was at 6.1 (before lunch i was 5.7). any insights into what is going on here? to me it looks like the bolus doseage is correct but for some reason delayed.... if insulin has been damaged does it take longer to take effect or is my body just crying out to me to cut out the carbs (which isnt possible due to other lifestyle factors).

Liz, I see that the cheese is getting the BG's a workout and the bagel is also the BG mover too. Buy the way seems to be very nice MMMmmm I think to have that too for lunch.
Have you tried the dual bolus like half the dose and split it an hour from each other. I get to do that with pizza as the base that uses pure white dough and that keeps me high for quite a while.
Now you got me thinking of getting some bagels now. YUM!!!

Also, What was your fasting BG, If it's high then bolus and wait half an hour and the low BG and have your bolus and eat immediately.

[xMenace]

Curves!

In my testing whole wheat bread doesn't behave much better than white bread. My BGs shoot straight up, within 15 minutes. I try to pre-bolus anyway, but it is imperative with something like a bagel.

Bagels are also very high in carbs. I'd have to read the label, but one is prolly like 3 or 4 slices of bread.

You don't mention breakfast. If you skip it, that can cause lunchtime spikes too. I've tested that enough

Try picking a standard lunch and test it every hour or half hour to build a fuller profile. Then plot it on a graph. Now try things to make the graph flatter: pre-bolus, lower GI, and less carbs. It's a worthwhile exercise.

[Gary_W]

Hi Lizzie,

Many people here pre-inject; it is all about learning how quickly your insulin works in you. If you can break down how many % go per hour then it helps a great deal. Not only does that tell you whether you need a correction shot at hour 2, but it also helps in terms of 'how long before eating can I safely inject?'. Novorapid does seem to take 20 mins to 30 mins to do anything (at least it used to in me) so pre-injecting for that reason alone is good. Obviously do it in a safe place and test lots until you're used to it.

I'd be amazed if Novorapid only lasts 3 hours; in most people, it's still quite fiesty at 4 and is just about gone by 5.

In me, Apidra seems to do 35% of its work in hour 1, 35% in hour 2, then 20% and then the last 10% is gone by hour 4. Now if you can find a food that fits that profile you're quids in When I first changed to it, I pre-injected one day, ate breakfast and came the closest ever to passing out. The insulin had got a long way ahead of the food. Vision altering, leg shaking, nasty experience.... Go careful if you change as the rules may be different for you.

High fat does indeed slow down the GI. Hence the problem many folks have with pizza; lots of bread which absorbs in a weird way due to the fat and cheese and therefore hangs around far longer than it should.

Gary

[xMenace]

Originally Posted by Gary_W

I'd be amazed if Novorapid only lasts 3 hours; in most people, it's still quite fiesty at 4 and is just about gone by 5.

It goes a good six hours, but the last tailing two are miniscule.

I find this chart helped me understand the action. N and H are pretty much the same.

[Lizzie G]

Originally Posted by ant hill

Hi Lizzie , It will be good if our insulin would act at the time that we eat but the onset of insulin is not as fast that we would like.
Hi Pete

Im hopeless on working the multiquote thing so please excuse lack of appropriate font changes and punctuation!

Are you just having the one Lantus shot to cover 24 hours?

Yes - im doing one lantus at around 8pm (14units). Iv not really expereinced any problems with this like some mention and actually find that im naturally lower in the late afternoon...i do get a natural pick up around 6ish but it fits in nicely with when i exercise normally....do you have problems yourself with it lasting out the 24?


Liz, I see that the cheese is getting the BG's a workout and the bagel is also the BG mover too. Buy the way seems to be very nice MMMmmm I think to have that too for lunch.
Have you tried the dual bolus like half the dose and split it an hour from each other. I get to do that with pizza as the base that uses pure white dough and that keeps me high for quite a while.
Now you got me thinking of getting some bagels now. YUM!!!

i do a dual bolus with a big meal like pizza sometimes, mainly due to the whole restaurant factor - its always guesswork and its more down to caution....if im in a restaurant eating pizza chances are i'll have a couple of glasses of wine which bring me down, but i havent tried 'at home'. today im having low GI oatcakes (dont know if you know oatcakes but they're not a cake they are a biscuit!) and i have bolused a half hour before, at which time i was at 5.0 (90) and just about to eat and experiment! so, if i were planning to eat something bagel based and for arguments sake i knew i needed 5 units to cover it. if my pre meal BG was say 5.6, would it be an idea to take say 2 units 45 mins before and 3 with the food?

Also, What was your fasting BG, If it's high then bolus and wait half an hour and the low BG and have your bolus and eat immediately.

fasting BG this morning was 6.3 (113) which was same as when i went to bed (maybe a little higher than some might like but i tend to eat late at night so sometimes hard to tell whether im still going down from novo!)

[Lizzie G]

Originally Posted by xMenace

It goes a good six hours, but the last tailing two are miniscule.

I find this chart helped me understand the action. N and H are pretty much the same.

this chart is great - thanks! yes, agree with you all that probably lasts longer than 3 hours, but effects definitely dropped off for me then, i agree with the graph!...thanks everyone

[Lizzie G]

well - did the half hour before food bolus, low GI/GL lunch, and 2 hours after food im at 7.1(128)...IMO im doing good...lets just give it another couple of hours and see whether i go low or not LOL....the neverending fun!

[JJM335]

Lizzie:

There's another possibility which is that you are for some reason more insulin resistant in the afternoon. You are eating 1 bagel, which should be about 50 g carbs. I don't know your numbers but with me I work on 4.5 g per 1 mmol, so with no bolus you would expect a rise of about 11 i.e. 5.7 + 11 = 16.7. Since you went to >14 this implies that your bolus had almost no effect whatsoever in the first 2 h and then worked "all at once" over the next 90 mins.

I don't want to exclude any of the other posters' ideas, just that you might consider that it is actually some sort of basal abnormality. Do you exercise at lunchtime? I see similar spike effects after a hard session in the gym.

Joel

[xMenace]

Originally Posted by JJM335

Lizzie:

There's another possibility which is that you are for some reason more insulin resistant in the afternoon. You are eating 1 bagel, which should be about 50 g carbs. I don't know your numbers but with me I work on 4.5 g per 1 mmol, so with no bolus you would expect a rise of about 11 i.e. 5.7 + 11 = 16.7. Since you went to >14 this implies that your bolus had almost no effect whatsoever in the first 2 h and then worked "all at once" over the next 90 mins.

I don't want to exclude any of the other posters' ideas, just that you might consider that it is actually some sort of basal abnormality. Do you exercise at lunchtime? I see similar spike effects after a hard session in the gym.

Joel

For many if not most of us, our basal needs drop off dramatically in the afternoons. This would explain your tendency to drop. With MDI I almost always needed a snack in the afternoons. With my pump I can tailor to my needs.

Some afternoon basal testing would be worthwhile.

[Eddy]

Originally Posted by Gary_W

I'd be amazed if Novorapid only lasts 3 hours; in most people, it's still quite fiesty at 4 and is just about gone by 5.

<insert favorite expletives of amazement>

That's about what N does in me.

Novorapid is really whaling on me after 50 minutes, and [practically] gone after 1:15. Humalog was about 10-15 minutes slower, but felt like an adrenaline surge when it hit.

I knew that I was at the faster end of the insulin activity scale... but I guess that I'm an out-and-out freak.

The above applies when my BG is at/near normal levels. If I go high, things take about 2.5 times as long.

Lizzie, do you know if starting BG affects insulin activity speed? If so, perhaps what you ate "got ahead" of the Novorapid, which then took a lot longer to catch up.

[Gary_W]

Originally Posted by Eddy

<insert favorite expletives of amazement>

That's about what N does in me.

Novorapid is really whaling on me after 50 minutes, and [practically] gone after 1:15. Humalog was about 10-15 minutes slower, but felt like an adrenaline surge when it hit.

I knew that I was at the faster end of the insulin activity scale... but I guess that I'm an out-and-out freak.

The above applies when my BG is at/near normal levels. If I go high, things take about 2.5 times as long.

If Novo really only lasts an hour and a bit in you, I'm starting to get why you dabble in so many insulins... My advice to you would be 'don't even sniff Apidra!'. Also, where on your body do you inject? Do you find certain sites slow things down? In me, my arms are a little quicker than my abdomen. I avoid injecting in my rear end as (a) it makes old ladies stare on busses and (b) it stays back there for days... Arms and abdo are a bit more reliable for consistancy.

My next thought would be the 'combo bolus' feature on pumps. On this here Animas, you can tell it how much of the bolus to give immediately and how much to give over an extended period. Other pumps do it a little differently I beleive, but on here you tell it what % of the bolus to give now and what % to give over the extend period. The percentage is variable in 5% steps and the 'extend' period is variable from 0 to 12 hours in 1/2 hour steps (and a funny little .1 hour interval to kick off which I guess is to stop a large dose hurting...). As you can vary the volume of insulin in 0.05 unit steps, you have huge control over exactly what goes in and how long it takes.

Due to the plumbers not turning up for a while, I haven't tested this in anger but I can see it being really useful. After the park today, I took my daughters to a little Indian restaurant that specialises in snack-style foods (samosa, pakora etc) and I ate loads. I needed 3 lots of Apidra to sort it over a loooong period. That kind of food is a long way from 'fire and forget' on a pump, but in theory it should be a little easier with the combo bolus.

Gary

[Eddy]

Originally Posted by Gary_W

If Novo really only lasts an hour and a bit in you, I'm starting to get why you dabble in so many insulins...

And I'm starting to get why folks think I'm nuts. I began on Lantus and Humalog. Changes have been strictly as-needed.

Originally Posted by Gary_W

My advice to you would be 'don't even sniff Apidra!'.

No doubt. I was a bit apprehensive about switching from Humalog to Novorapid... but hoped that Novorapid would be more stable and predictable. (It seems to be.) Yes, aspart is faster than lispro, but still manageable.

Originally Posted by Gary_W

Also, where on your body do you inject?

Bolus: abdomen, either toward the side, or in a straight line down from my nipples.

Basal: closer to the navel

Originally Posted by Gary_W

Do you find certain sites slow things down? In me, my arms are a little quicker than my abdomen.

I've tried bicep once, and pectoralis once. I was attempting to do an IM each time... but my 8mm needles really aren't long enough for that.

Originally Posted by Gary_W

I avoid injecting in my rear end as (a) it makes old ladies stare on busses and (b) it stays back there for days... Arms and abdo are a bit more reliable for consistancy.

Never tried the rear.

Originally Posted by Gary_W

As you can vary the volume of insulin in 0.05 unit steps, you have huge control over exactly what goes in and how long it takes.

You also see why I'm curious about diluting.

Originally Posted by Gary_W

I took my daughters to a little Indian restaurant that specialises in snack-style foods (samosa, pakora etc) and I ate loads. I needed 3 lots of Apidra to sort it over a loooong period. That kind of food is a long way from 'fire and forget' on a pump, but in theory it should be a little easier with the combo bolus.

Definitely. I can't imagine being stuck with one kind of bolus.