Problems with Novorapid

[Dillinger]

Hello,

I'm on a basal/bolus regime and I've been using Novorapid as my short acting insulin for more than a decade.

I have a slightly weird relationship with it; in that I need to take about 1 unit per gram of carbs. Which is a lot. I'm on a pretty minimal carb diet but still take the levels of Novorapid that someone on a fully carbed up diet would take.

The strange thing is that my basal insulin, Levemir, isn't also high (currently split dose of 19 units; 10 am / 9 pm). So it doesn't look like generic insulin resistance. I started taking Metformin to see if that would have any effect and it has slightly reduced the general dose but not much; I'm happy to take it though.

Does anyone else have experience of this? Or have experience of insulin becoming less effective with you over time?

My consultant thinks that the high Novorapid levels are because the fat in my diet is increasing my insulin resistance and I know that has been discussed here before (with Phoenix for instance) but that strikes me as being pretty unlikely; as each meal I eat is not stuffed with fat and the same heightened levels are needed for protein based meals.

Thanks Hive-Mind

Dillinger

 

[CarbsRok]

My consultant thinks that the high Novorapid levels are because the fat in my diet is increasing my insulin resistance and I know that has been discussed here before (with Phoenix for instance) but that strikes me as being pretty unlikely; as each meal I eat is not stuffed with fat and the same heightened levels are needed for protein based meals.

Thanks Hive-Mind

Dillinger

I think your consultant is spot on as the same aplies to protein based meals as well with many type 1's.
If I eat a mainly protein meal I would need almost double the insulin than what would be needed for what I would call a balanced diet. Fat I find can be tolerated in moderate amounts going over my own limits, again the insulin needs increase to double what they should be.

The only way to find out though for yourself is to lower the protein and fat in your diet and balance your meals obviously watching how many startchy carbs you consume.
Try looking at the GL of foods to help you balance things out better with your insulin.

 

[Fallenstar]

Hi Dillinger
Sorry cant help with the Novorapid question, but like you I low carb ,higher fat...and I find I am on exactly the same overall dose of Bolus as when from time to time I have gone back to carbs making up a good proportion of my diet...It's just I don't get the post meals spikes now which I had to up my ratios for to try and contain these..and then found I would go low say 4 hours after a meal

Now low carb and higher fat I have a steadier BG profile but I do find ,which is probably the fat,that I do have to split doses ,have slight correction doses to stay on track...I used to Hypo a lot more doing this on Low GI and found big post meal spikes.

I am insulin sensitive, but carb sensitive too :lol: I'm just a sensitive soul :lol:

Do you mind if I ask why it worries you with the amount of Bolus you are on, so long as your control is good?

oh I forgot to add, I have only pretty recently changed to Novo rapid from Apidra. I found Apidra had a much faster acting profile than the Novo, it did not last as long for me but I would have described it as a "keener" Bolus. Maybe a change is in order. I needed less of the Apidra ,only a bit, compared to Novo.

Best wishes

 

[slimtony]

Hi,

It could be that the Metformin is better at boosting the effect of your Levemir compared to the Novorapid. The only way to prove/disprove this theory would be to try an alternative rapid insulin in the hope that you have more luck with it.

One other random thought is that it could be one of the supplements (omega 3, Benfotaimine and Vitamin D3) that you're taking interacting with the Novorapid (and/or perhaps the Metformin). Unless you feel they're essential, I'd recommend a short break from taking them, just to see what happens. I've had run-ins in the past with supplements that were supposed to be 'all good'.

All the best.

 

[noblehead]

Hi Dillinger,

I remember you saying before that you need 1 unit for every 1g of carbs, has your consultant not suggested changing your QA insulin to see if this helps?.....it might be worth a try and you certainly don't have anything to lose!

It's interesting what your consultant says about the fat content in your diet increasing your resistance (not heard of this before), have you tried reducing the fat content of your diet for a few weeks to see if this improves your insulin sensitivity?.....again worth a try to see if there's any truth in what your consultant is saying.

I've been on Novorapid near enough since it was first introduced having previously been on Actrapid, I've not experienced any form of resistance in that time and find it (together with lantus) the best insulin's I have been on to date, were I in your shoes then I'd certainly look at the possibility of an alternative insulin just to see if this improves matters for you.

Best wishes!

 

[phoenix]

Doesn't Bernstein advocate the use of regular insulin and not more than 7 units in each injection?
I think if you look up Katherines posts you'll find she used quite a complex insulin regime for her son.

 

[Fallenstar]

I have never read Bernstein...I ought to :wink: But from reading bits on this forum he seems like quiet a controversial chap!
It's interesting Pheonix that you mention the poster Katherine who uses his ways to treat her sons diabetes and the "regular use" of insulin. By this do you mean a split dose type thing? because that is how I do it really, split Bolus ,small corrections.
It works for me and I just do what I do ,and it has naturally evolved this way for me to get good control,but I must stop being an ignoramus and read about this Bernstein.
I will take a look at Katherine post, do you have a link at all to these Pheonix, they would interest me,thanks

 

[CarbsRok]

Even using regular insulin does not solve the problem. I use it and a pump. High fat and protein meals need more insulin then a well balanced meal in mine and many other type 1's cases. People with type 2 diabetes from what I can gather seem to tolerate higher fat and protein meals.

 

[Fallenstar]

Hi Carbsroc
I know , I find I need around the same amount of Bolus for a carb meal as a protein fat meal..Its a bit like comparing apples and pears though. On DAFNE we were taught as a group that Basal will take care of protein based meals and not to Bolus for them, because I had already been low carb for a long time I knew this was not the case.....and I have to Bolus the same ,as you and many others have found for protein based meals..but I do need to stagger injections. This is not for everyone, and maybe not everyone who low carbs with Type 1 needs to....but it works for me.
There is no way though my basal would take care of my diet.

 

[CarbsRok]

Hi Carbsroc
I know , I find I need around the same amount of Bolus for a carb meal as a protein fat meal..Its a bit like comparing apples and pears though. On DAFNE we were taught as a group that Basal will take care of protein based meals and not to Bolus for them, because I had already been low carb for a long time I knew this was not the case.....and I have to Bolus the same ,as you and many others have found for protein based meals..but I do need to stagger injections. This is not for everyone, and maybe not everyone who low carbs with Type 1 needs to....but it works for me.
There is no way though my basal would take care of my diet.

Yep it is def a case of everyone is different
Basal is that and only that.
Using a pump when you basal test you skip meals to do this so how anyone can then say your basal will take care of fat and protein is beyond me :crazy: There is the favorite advice given out as well ... it's ok to have a 10 gms of carb snack without bolusing. If your basal is is right then you need to bolus. If the bolus isn't right and you don't eat the snack do you then go hypo?

 

[noblehead]

Even using regular insulin does not solve the problem. I use it and a pump. High fat and protein meals need more insulin then a well balanced meal in mine and many other type 1's cases.

I don't find that I need more insulin covering a fat/protein meal but the difference is minimal, for example a breakfast of 3 scrambled eggs and 2 rashers of bacon would require 4 units of insulin as where my normal breakfast of Scott's Porridge Oats with blueberries, pumpkin seeds & low fat yogurt (40g in total) requires 5 units.

When I briefly experimented with low-carb (50g) I found I novorapid worked too fast and would often cause me to hypo within the hour but would raise my bg 3-4 hours later, splitting the dose was the only solution but I wasn't keen on stacking insulin, were I ever to try it again then I would look for an alternative insulin with a slower action than novorapid.

 

[Fallenstar]

Hi Noblehead
I'm very similar to you , though for the porridge and fruit and yoghurt, I think I would need a lot more. I used to find milk would spike me..mix in the carbs and it was a shocker for me. I'm sure it was the casein :think: But also I'm Celiac and think oats are a no no for me too. A lot of celiacs can have oats

I do find that I do get a very quick initial rise, even from say an egg, So I have found Novo works brilliantly for me, as it needs to kick in fast with me whatever I eat...but stay as a slow burner, but that 1 unit increment to much on protein based meals ,is TOO much...so I nurse it and it works well. And as of 6 months on the new ones, no freaky lows ,so no stacking up....

I did struggle with this on Apidra...as that has a much quicker stronger action,well it did with me and a shorter profile ,so for the low carb approach it was the wrong insulin for me...but I do still need a fast acting one...interesting what you found though

 

[Dillinger]

Thanks everyone,

I think a change of insulin might be worth a go; but I see that there are problems with the availability of Apidra at the moment which is frustrating.

Noblehead; that's very interesting about the eggs/bacon dose. I'm pretty much on the same levels; probably would take about 5 or 6 units of Novorapid in that situation. But if I were to eat porridge I'd have to take a very large dose; say 15 - 20 units to cover it and then have all the problems of possible hypos in the tail end of the insulin action.

The 'gentler' action insulin that Phoenix mentions; the 'regular' insulin, is in the UK Humulin S which has a slower start and longer tail, but I think it's too slow for me.

All a bit weird really. Possibly I just won't be able to reduce my insulin by much more.

Sometimes I wonder why I bother being a diabetic; it seems such a lot of effort sometimes... :crazy:

Dillinger

 

[noblehead]

Sometimes I wonder why I bother being a diabetic; it seems such a lot of effort sometimes... :crazy:

if only we had a choice! :lol:

 

[nigelho]

Hello,

I'm on a basal/bolus regime and I've been using Novorapid as my short acting insulin for more than a decade.

I have a slightly weird relationship with it; in that I need to take about 1 unit per gram of carbs. Which is a lot. I'm on a pretty minimal carb diet but still take the levels of Novorapid that someone on a fully carbed up diet would take.

The strange thing is that my basal insulin, Levemir, isn't also high (currently split dose of 19 units; 10 am / 9 pm). So it doesn't look like generic insulin resistance. I started taking Metformin to see if that would have any effect and it has slightly reduced the general dose but not much; I'm happy to take it though.

Does anyone else have experience of this? Or have experience of insulin becoming less effective with you over time?

My consultant thinks that the high Novorapid levels are because the fat in my diet is increasing my insulin resistance and I know that has been discussed here before (with Phoenix for instance) but that strikes me as being pretty unlikely; as each meal I eat is not stuffed with fat and the same heightened levels are needed for protein based meals.

Thanks Hive-Mind

Dillinger

I'm having a similar problem with my novorapid which sounds like your problem..I'm taking the following novorapid
Breakfast 1:1.5 grams carbs
Lunch and tea 1:2 grams carbs
Humulin I at breakfast 26 units and 18 units around 20.30pm.

At the moment these are working even the morning readings are mostly good. I had to stop taking 5 X 500mg Glucophage as it wasn't reducing my insulin intake ratios and was having hypo in the evenings/early morning and waking up high. I have always carb counted and even on diagnosis 5 years ago I was using a lot of novorapid..My body don't like levemir or lantus...have huge problems with those insulins. Seeing my consultant on Monday and will ask to try Aprida and even consider if a pump might work better?????

Might be something to do with fatty liver causing insulin resistance but I feel that its the novorapid not now working for you or me.

 

[Dillinger]

Hi,

I changed to Apidra (as it doesn't have zinc suspension and some people have a problem with that in novorapid) but it didn't really change the amounts I needed so I have gone to Humalog which I find more appropriate for low-carbing.

It's still a bit weird though; I hope they can shed some light on it for you. I didn't get any answers really!

Best

Dillinger