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dsingpiel

Question about taking "extra" insulin injections

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I have type 2 diabetes and use glucophage, Lantus long-lasting insulin and quick acting Lantus insulin with meals. My question is this: if, for instance, I take my normal insulin with supper, but then get talked into a humungous lucious banana split about 8 pm (they held me down.) Obviously, my blood glucose level goes sky high. I can just let it go, knowing it will drop by morning--probably still high- but closer to where it should be. This is what I would do, but I can't help but wonder why it would be wrong to give myself another injection to deal with the unexpected "food." If I weren't diabetic, my body would automatically make more insulin to deal with the need. Wouldn't additional insulin via injection do the same thing and eliminate that high?

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Yes, that is what most people on MDI (multiple daily injections) do. You said you take fast acting Lantus before meals but there's no such thing. You probably take Novolog, Humalog, Apidra or Regular before meals. How do you determine the dose of fast acting insulin that you take? Is it a set amount, a sliding scale or do you count carbs? The best way to deal with taking an injection for extra food is to know your insulin:carb ratio and know the number of grams of carbs you're eating.

 

Of course, some people here would tell you that you just shouldn't eat the banana split. Me, I'd calculate the carbs and bolus for them.

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Thanks, Poodlebone, for your response. You're right about the insulin before meals, it's Apidra--seems Apidra and Lantus are both Solostar products, thus my mis-statement. I work on a sliding scale based on the carbs I'm eating. That works pretty well, but there are those times when I goof up. The lows are pretty easy to deal with for me, but the highs haven't been. If I could feel comfortable taking an extra dose of insulin at those times, I'd feel better about them. I know, the best way to deal with them is to plan and inject more carefully. In a perfect world, I would, but this isn't a perfect world, and I frequently mess up. I've wondered for a long time: If my non-diabetic body would just produce more insulin, what's the problem with my just taking more, even though it's not a regular meal-time dose? Sounds like you're saying to go for it.

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Yes, I agree with Liz. The fast acting insulin is your meal time insulin. No matter which brand you use. As such you take it based off how many grams of carbs you are eating. For us on the pump, we just punch it in and it will inject more insulin based of preset ratios.

 

Now can we share the banana split :)

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Yes, additional Apridra would be appropriate for that yummy little treat. Remember, though, that you may still have some Apidra on board (this is referred to as bolus on board, or BOB), so don't overdo it. Gary Scheiner's great book Think Like a Pancreas would be a good reference for you. He goes into some detail about calculating BOB and adjusting for it. Although Apidra clears a little faster than either Novolog or Levemir, I think BOB would still be a consideration.

 

By the way - you can also correct unexpected highs with little boluses of fast-acting insulin. Scheiner's book addresses this too.

 

Jen

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Remember; if you are trying to loose weight - "less is more" when it comes to insulin..

 

If you take too much - you'll crave food (because your BGs are generally low) - so you eat... and take more insulin.... etc.. Vicious circle!

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What I do is simple....since I take Novolog before a meal, I count the carbs in the meal, then take the amount of Novolog I need to cover that many carbs. If I were to eat something that I had not planned for after the meal....like the banana split you mentioned, I would just determine the carbs in the banana split and take a second shot of insulin to cover those carbs.

 

For me, it works out the same.....I take about 3/4 of a unit of insulin for every carb I eat, so if the meal alone had 40 carbs in it, I would have taken 30 units of insulin. If the banana split had 40 carbs in it, then I would have taken a second 30 unit shot of insulin. That totals 60 units of insulin for me.

 

If I had know beforehand that I was going to eat the banana split, then that means that the meal and the banana split had 80 carbs, so I'd have taken the 60 units of insulin before I ate. Either way, I'd still have taken 60 units of insulin.

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What I do is simple....since I take Novolog before a meal, I count the carbs in the meal, then take the amount of Novolog I need to cover that many carbs. If I were to eat something that I had not planned for after the meal....like the banana split you mentioned, I would just determine the carbs in the banana split and take a second shot of insulin to cover those carbs.

 

For me, it works out the same.....I take about 3/4 of a unit of insulin for every carb I eat, so if the meal alone had 40 carbs in it, I would have taken 30 units of insulin. If the banana split had 40 carbs in it, then I would have taken a second 30 unit shot of insulin. That totals 60 units of insulin for me.

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For me, it works out the same.....I take about 3/4 of a unit of insulin for every carb I eat, so if the meal alone had 40 carbs in it, I would have taken 30 units of insulin. If the banana split had 40 carbs in it, then I would have taken a second 30 unit shot of insulin. That totals 60 units of insulin for me.

 

.

 

Your insulin to carb ratio is much higher than mine. I take 1 unit of insulin for every 7 carbs. For 40 carbs, I would only take 6 units of insulin.

 

dsingpiel should talk to her doc and determine an appropriate insulin to carb ratio.

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Your insulin to carb ratio is much higher than mine. I take 1 unit of insulin for every 7 carbs. For 40 carbs, I would only take 6 units of insulin.

 

dsingpiel should talk to her doc and determine an appropriate insulin to carb ratio.

 

Don, her doctor can't tell her what she needs to take, that is for her to figure out on her own. As I have mentioned before, she needs to determine what her insulin to carb ratio is. To do that, she needs to start out by taking a BG reading before she eats, then take 1 unit of insulin for every 20 carbs she is about to eat and see how that works out. If after 2 hours after she's eaten, her BGs are still high, then the next time she should take 1 unit of insulin for every 18 carbs she is about to eat.

 

She would then continue to take 1 unit of insulin but decrease the carbs by 2....so that means she would next take 1 unit of insulin for every 16 carbs she is about to eat....then every 14 carbs etc., until she finds what her insulin to carb ratio is. Her doctor can't determine this for her, she has to do it herself.;)

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Your insulin to carb ratio is much higher than mine. I take 1 unit of insulin for every 7 carbs. For 40 carbs, I would only take 6 units of insulin.

 

dsingpiel should talk to her doc and determine an appropriate insulin to carb ratio.

 

I'm very variable.. For breakfast (4am thru 10am), I need one U for every 5g carb - after that, I'm okay at 1u/9g carbs. But again.. These ratios needs to be worked out

to be successful, and it is even more important if you try to tweak the settings on a pump.

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I take levemir, AM and PM, and novolog before each meal based on carbs I'm planning to eat. Snacks are treated the same way but you have to take into consideration when you took your last bolus shot. Novolog, which I'm familiar with, takes 2-4 hours to clear. So, if you have a snack 2 hrs after lunch yoiu must consider how much insulin is still in your system. Bottom line for me is 1:8 for meals, 2hrs later 1:15, 3hrs 1:10. Comes from trial and err and lots of testing.

 

Rick

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My current ratio's are 7g:1u at breakfast then 8g:1u there-after.

 

Taking that "extra" shot of insulin will become more comfortable, once you realise the benefit of doing it. There is no negative to doing so, other than a small inconvenience. Screw anyone who says, "you shouldn't eat the banana split", if you can cover for it, enjoy it! Insulin is a tool, you have that tool, so use it :)

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I appreciate the responses from each of you. It seems you all tend to agree that there is nothing wrong with taking another dose of insulin at those times when I've eaten or am going to eat something unplanned for. That's good to know. I do try to count carbs and adjust my dose accordingly before meals, and I have no problem doing that at other times. Thanks everybody.

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Maybe I'm wrong about this, but I don't see why there would be any insulin "left over" after I've bolused and then eaten. If I eat 40 carbs and take my 30 units of Novolog, then that entire 30 units of Novolog is going to be used up as it works on those 40 carbs. When the 40 carbs have been digested and turned into glucose in my body, the 30 units of Novolog will deplete itself as it aids in transferring the glucose into the blood cells. There won't be any Novolog left over once all of that glucose has been transferred, because if there was, then that excess insulin would make me go low.

 

The fact that Novolog lasts up to 4 hours doesn't mean that it will last that long, it just means that if it isn't used up, it can last that long. I don't know how it all works, but if my BG is at 75 before I eat, and I eat my 40 carbs and take my 30 units of Novolog, if the Novolog was to keep working after all of the glucose was transferred into my cells, I would go low. Since there is no extra glucose left in my blood from the meal, my glucose levels should be back at about 75 on it's own since that's where it started, so if the Novolog kept working, then it would take me below my starting point. I mean, there wouldn't be any extra glucose in my blood for this "extra" Novolog to work on, just the normal amount that's there when I don't eat and is the reason I started out at a 75.

 

Again, maybe I'm wrong but this is how I thought it worked.

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oooh I just bought this super cool carb counting book and I looked up banana split and it says: One serving of a Dairy Queen Banana Split is: 96 carbs & 510 calories.

:)

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WOW. it is funny how I have changed---the 510 calories is a bit, esp. for something that is not a meal, but the carbs??? Holy ****. 96. I don't eat that many in 2 days, sometimes 3. Wow.

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Hi,

 

There are a couple of reasons that you shouldn't eat that banana split (other than as a rare treat). One is that for most people, the insulin to carb ratio isn't perfect (or consistent), and this will lead to larger swings, which aren't healthy.

 

The other reason is true for everyone (or almost). If you eat a lot of carbs and cover with bolus insulin, you will gain weight. For most of us that is not a good thing. My weight has been pretty stable for many years, and not excessive. But it was only after dx, and covering with insulin that I gained about 15 pounds.

 

So for a treat - ok. But not as a general rule.

 

Best luck!

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Hi,

 

There are a couple of reasons that you shouldn't eat that banana split (other than as a rare treat). One is that for most people, the insulin to carb ratio isn't perfect (or consistent), and this will lead to larger swings, which aren't healthy.

 

Another problem with a huge banana split is all of the fat. It's a lot of fat and a lot of carbs and for many people that can mean unpredictable BGs for many hours after. Like pizza, Chinese food etc, the fat slows down the absorption of the carbs so you can have decent BGs 2 hours after eating, but 4 hours after eating you're sky high. This can be even more problematic for people injecting insulin. With a pump you can set a dual wave bolus and deal with the slower rising BG much better. With injections, you'd have to test a whole bunch of times and inject several smaller amounts if you want to avoid any huge BG swings.

 

If I ate a banana split and knew the exact number of carbs, I'd crash low right after eating if I gave all of the insulin as one injection. Later on my BG would be so high it would take multiple corrections that would most like lead to another crash. I think the individual's I:C ratios (and resistance) has a lot to do with this. A more insulin sensitive Type 1 might have a much harder time with a banana split than an insulin resistant person.

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I take levemir, AM and PM, and novolog before each meal based on carbs I'm planning to eat. Snacks are treated the same way but you have to take into consideration when you took your last bolus shot. Novolog, which I'm familiar with, takes 2-4 hours to clear. So, if you have a snack 2 hrs after lunch yoiu must consider how much insulin is still in your system. Bottom line for me is 1:8 for meals, 2hrs later 1:15, 3hrs 1:10. Comes from trial and err and lots of testing.

 

Rick

 

If you are taking an extra shot of Novolog to cover more carbs it's not necessary to account for IOB (insulin on board) only to count the extra carbs. If doing a correction shot to take down BG that is too high then IOB must be considered in order to avoid a low.

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Don't forget that if you go high (banana split or simply high glucose) you are doing damage by not bringing it down. That's why it's important to bolus when you eat something extra. Don't forget, that it's also a good way to gain weight, but if you don't indulge too often, it's not too bad a thing.

 

Cora

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