When to inject insulin with slow release carb?

[Liftupjoe]

Hi I am trying to sort out my bloods as keep going hypo now I’m exercising and eating less carbs . I am so confused about fast and slow release carbs ??? So do I inject after eating with slow release carbs or before ? And also if I’m swimming at 1 o’clock do I (at my break at 11) have less insulin or do I have less insulin at my evening meal ? I have taken down my long acting insulin and lowered my insulin unit to carb ratio and now going high all the time.
Thank you please help love Kate x

 

[Juicyj]

Hi @Liftupjoe I don’t differentiate between fast or slow carbs, carbs are carbs and so I inject before eating any carbs, personally I start my bolus if I can 20 mins beforehand so I can time the action of the insulin to meet the release of the carbs and avoid a spike,

In regards to swimming I try and start with bg levels of 6+mmol/l and either have a small 10g snack before I swim or reduce the bolus injection prior to swimming, there are no hard fast rules as we are all different so what works for me may not for you and I have worked out our local pool is quite cool so my body is working harder to maintain core temp, I always keep glucose and meter pool side though so I can access quickly if I need to. If you have doubts then just do a test after 30 mins to see how your bg is responding.

 

[Postleneo]

Hi I am trying to sort out my bloods as keep going hypo now I’m exercising and eating less carbs . I am so confused about fast and slow release carbs ??? So do I inject after eating with slow release carbs or before ? And also if I’m swimming at 1 o’clock do I (at my break at 11) have less insulin or do I have less insulin at my evening meal ? I have taken down my long acting insulin and lowered my insulin unit to carb ratio and now going high all the time.
Thank you please help love Kate x

Hi there I can not comment on exercise as I have not thrown that into the mix yet. Regards to carbs I tend to always inject before my meal unless my bs is on the low side is less than 4.5 then may inject after my meal. If I was to have a high fat meal which would have an effect on insulin absorption I have in the past split my bolus... I.E having a chicken curry with rice I found that what worked for me was I needed to split my injections and give 3 injections one before the meal one 2 hrs later and another 2hrs after that. Now I'm on a pump I just give a combo bolus 30/70 split over 6 hrs. This seemed to work for me but was a lot of trial and error

 

[AJB_81]

I'm currently in a strong honeymoon phase and have ~ 1 unit:25g carbs, so not sure how helpful this will be:
If I have a high carb & high fat meal as a treat on a Saturday (Chinese takeaway, fish and chips etc...) I do 4 units at time of eating and 2 units 2 hours after (generally)... basically have a mutliwave bolus with injections, this puts me up to 6 injections a day be prevents the inevitable BG kick up later on as the slow release carbs get through, and also the slow to digest fatty food gets through (not sure which of these is more prominent?). Don't see why only pumpers should get multiwave boluses

 

[Liftupjoe]

Great thank you all x

 

[kev-w]

Hi @Liftupjoe I always keep glucose and meter pool side though so I can access quickly if I need to. If you have doubts then just do a test after 30 mins to see how your bg is responding.

Off topic (sorry) Do you put these in a waterproof bag? Are the life guards ok about it and do you not worry it'll get kicked in the pool? I so want to do this, but test in front of my locker, if looking like my bloods dropping, eat glucose pre swim and hope for the best relying on a feeling of weakness in my wrists near the end of the swim to warn me to sort myself out and go from there.

I've always tried to swim on an afternoon, so the active insulin is just from my night time basal, but if swimming on a morning I'd drop a unit off, or a half unit, depending on my bloods, my blood sugar reading can drop 5 mmols over a 45 minute swim with me needing glucose, it can also rise and me need a unit or two, and I think I eat mainly 'slow' carbs anyway.

 

[Juicyj]

Hi @kev-w We have a pool side spectator area so I leave my bag with towel at the side or if we’re at a different pool then I speak to the guard telling them why I need it pool side - I had a bad hypo once at 1.8 and was in a bad way trying to get my stuff out of the locker, it was this experience that taught me to ensure it should always be within easy reach.

 

[kev-w]

1,8 ouch, you've done well keeping going at it as that'd be scary!

I've told the story of me waking up in the back of the ambulance outside the old pool having dropped unconscious in the dressing room minus my 2 kids, it was a good few years before I swam again (and different insulin). 2.4 is my lowest poolside in the last 4-5 years and if I hadn't cramped and flipped onto my back id not have noticed which I promptly dealt with....

 

[Juicyj]

Hi @kev-w to be honest it did put me off for a bit as I was there with my daughter and arguing with her teacher who wanted to stay with me so I was mortified afterwards - you live and learn

 

[NoKindOfSusie]

I went swimming while travelling a few weeks ago, I just crammed down a granola bar and went for it, wish I hadn't now!

 

[kev-w]

Hi @kev-w to be honest it did put me off for a bit as I was there with my daughter and arguing with her teacher who wanted to stay with me so I was mortified afterwards - you live and learn

You do indeed, and go back and do it again

I went swimming while travelling a few weeks ago, I just crammed down a granola bar and went for it, wish I hadn't now!

So, you had a hypo or a hyper (which is pretty cr*p and maybe leaves you wondering why you bothered in the first place), I don't know what a Granola bar is btw, or what your blood was entering & leaving the pool, or when you swam in relation to your last fast acting and slow insulin and food, or whether you 'pootle' up and down breast stroking with your head out of the water, or swim crawl with tumble turns in interval sets, as they all can have an effect on what's happening with your blood sugar. I believe you're in the 'honeymoon period' so even if it's boring, go easy, build up fitness and your confidence will grow with it.

 

[NoKindOfSusie]

I felt fine. I felt better than I had in ages. But it was stupidly risky and probably involved some huge spike.

 

[Rokaab]

I felt fine. I felt better than I had in ages. But it was stupidly risky and probably involved some huge spike.

Personally I'd consider that spike far better than the possibility of going hypo whilst swimming, as long as you got it back down to normal after it'd be fine.

 

[kev-w]

I felt fine. I felt better than I had in ages. But it was stupidly risky and probably involved some huge spike.

Probably? You can finger prick in private in your cubicle, and feel fine, and better than you've felt in ages.

Go do it again, but test before and after, see what your body is doing, and you'll still feel fine.

 

[paulus1]

if you know tour bg reacts slowly to carbs experiment with timing. try afterwards. after all our bodies would not start producing insulin until it detects an increase in bg levels. if your getting hypos and hypers get back to the clinic.

 

[Shiba Park]

I felt fine. I felt better than I had in ages. But it was stupidly risky and probably involved some huge spike.

But if your levels were OK afterwards, that's a result, right? You might just have cracked it first time!

 

[becca59]

I bolus 20 -30 minutes before an average meal but 20 after for slow release. I make my own wholemeal bread and I can never bolus before as I always hypo. Trial and error.
Early morning swimming produces Adrenalin for me and I often have an injection after. My lows then occur middle of night, next morning, so eat before bed and reduce insulin following morning. Took the wearing of a Libre to work that one out! Up til then spent a lot of time stumbling in the dark. Just shows how individual we all are.

 

[Jaylee]

if you know tour bg reacts slowly to carbs experiment with timing. try afterwards. after all our bodies would not start producing insulin until it detects an increase in bg levels. if your getting hypos and hypers get back to the clinic.

Hi,

Unfortunately, exogenous insulin (as advanced as they are these days.) still doesn't have the same "working profile" as insulin secreted normally along with other pancreatic hormones..
Hence the rule of thumb with the timing of bolus injections by the manufactures? (20 minutes prior to eating.)
The trick is to time the Novorapid dose (& it's working profile.) in harmony with the digestion & breakdown of the carbohydrate & protien.. Fat can slow digestion. ("The pizza effect.") in which case, splitting the bolus dose can be more benificial avoiding a rapid drop then subsiquent spike later on..

That's how it works for some...

 

[AJB_81]

Hi,

Unfortunately, exogenous insulin (as advanced as they are these days.) still doesn't have the same "working profile" as insulin secreted normally along with other pancreatic hormones..
Hence the rule of thumb with the timing of bolus injections by the manufactures? (20 minutes prior to eating.)
The trick is to time the Novorapid dose (& it's working profile.) in harmony with the digestion & breakdown of the carbohydrate & protien.. Fat can slow digestion. ("The pizza effect.") in which case, splitting the bolus dose can be more benificial avoiding a rapid drop then subsiquent spike later on..

That's how it works for some...

That's good advice!
I've found when I over indulge and have something like Fish & Chips or a takeaway, I inject my insulin in 2 stages in about a 60:40 split. Staggered bolus I call it.

So for example:
100g Carbs = 10 units NovoRapid, I'd take 6 units at time of eating and 4 units 2 hrs later. Don't see why only pumpers get multi-wave bolus'... not very scientific but I find it works for me. Avoids the hypo cause by the insulin working faster than the food is processed...