Advice needed: Evening lows and delayed reaction to Novorapid

[Catherine4188]

Hello,

I was just diagnosed as type 1 last week. I have been placed on Glargine and Novorapid. To begin 10 units of Glargine but reduced to 8 after a few days due to lots of hypos. I have now started carb counting and use the Accu Chek Expert meter. I'm finding that my Novorapid ratio is maybe too high at 10g / 1 unit as after 2 hours 30 mins to 3 hours, I'm having readings of low 4's and I'm having to treat them like a hypo as I have shakes etc. Does anyone else have this delayed reaction after they do their 2 hour test? It's not too much of a worry during the day as I can act upon it but at night I'm finding that I'm getting close or hypoing before bed. Even if I've had a snack and not given more insulin. My nurse has advised a level of 7 to allow me to go to sleep.

Does anyone else have this issue? What do you do to solve it? I don't want to eat loads of sugar and carbs before bed like I'm having to at the moment, I'll gain loads of weight.

Thanks for any advice you can offer.

 

[Seer]

Try reducing the Novorapid even further before bed. I always check my bloods before I get into bed and then decide what action to take. Hypos can be distressing at night and personally I'd rather risk a slightly higher reading. Like you I don't like to take sugar as it's hard to stop in the middle of a hypo and then it seems like a never-ending cycle of insulin-sugar-insulin. Getting the balance right is hard work and I've not managed to perfect it after 20 yrs but I do manage to keep my Hba1c at 7.5 not too bad for an elderly diabetic on insulin. Remember we are individuals and we need to work out our personal solutions. One-size does not fit all. Hope this helps and you get your right balance soon.

 

[catapillar]

I'm finding that my Novorapid ratio is maybe too high at 10g / 1 unit

If you think your ratio is too high use a lower ratio. Try 1:12 and if that's still too much insulin keep adjusting until you find the ratio that's right for you.

You might need to have a look at guidence on carb counting and adjusting insulin dosages, have a look at the Bertie online course - https://www.bertieonline.org.uk

And get in touch with your DSN to discuss the post meal hypos and seek advice on your dosage.

 

[Scott-C]

Catherine, although you describe it as a delayed reaction, it's worth remembering that although Novorapid is called a fast acting insulin, it reaches its peak about 2 hours after injection, and there'll still be active insulin for about 4 or 5 hours after injection. I don't know if it's been designed that way because food takes a while to fully digest or if it's just part of the chemistry. Google novorapid profile to see some graphs of it. I frequently get quite a surprising kick down in the last hour or two of action. It's this time element which we have to factor in which makes T1D so infuriating/interesting. If you get a Libre and then open the professional option (code is CAA1C) then each time you enter an insulin dosage you get a wee gingerbread man called the Active Insulin Symbol which gives a rough indication of how much insulin you've still got working. Pretty useful to avoid insulin stacking situations. I don't swear by it but it adds another useful clue to this puzzle. I think there might be similar things on some ordinary bg meters.

 

[Scott-C]

Hmm, just realised after posting that reply, how ironic is it they've chosen a gingerbread man as the AIS..maybe they're teasing us

 

[donnellysdogs]

If you go low or high anywhere 2-3
hours after a bolus injection then it is the bolus injection that will be incorrect.. either the ratio or over estimation of carbs etc.

This will apply too if you need to correct and you go low before 5 hours.. it will be the bolus ratio thats incorrect.

 

[azure]

I'd say that was a normal reaction not a delayed one. If you're going too low after your meal, then it's more than likely you're bolus (meal) insulin needs reducing a little.

I don't think I've mentioned it yet, but Think Like A Pancreas is an excellent book for Type 1 and very popular here for goood reason.

Bear in ind your blood sugar may be slightly erratic early on due to the 'honeymoon period' when your own pancreas recovers a little and can sometimes add some insulin of its own, making unexpected lows more possible. All you can do is test lots, and be prepared to adjust your insulin with your DSN's help.