Finally started Novorapid and struggling

[enzina]

Hi All,

Hope you're doing well this weekend. I got so much information from this forum although i don't post that often.
I have started injecting Novorapid on Friday and the only information i have is from the internet, specially this forum. The nurse in the hospital just said, she wants to see me in two month time again and i should just try. The sugar levels are still erratic and i'm so scared. Yesterday after lunch i had a hypo of 2.8 according to my Bayer Contour meter and had only taken 4 units of Novorapid. Lunch was two slices of rye bread, tomatoes, peppers, avocado and butter. I'm taking 15 units of Lantus.

HbA1c is 8.5, GAD always positive, C-Peptides very low.

The spike in the afternoon was a slice of cake i bought in a cafe. Usually i never, ever eat a cake..

The nurse also didn't mention the 6 tablets of Metformin, i assume i still have to take them? I'm feeling so lost, am too scared to go out for a longer time. I have bought the Freestyle Libre but find it very inaccurate and had to send back the first one. In the hospital they said from May on they prescribe it but i don't think i will qualify.

 

[Diakat]

How did you calculate the 4 units? Has the nurse given you a ratio of insulin to carbs? Can you call her to ask about the metformin? Spikes will happen, you can reduce them by prebolusing.

 

[enzina]

Thanks Diakat,

No, the nurse didn't give me anything but i thought 40 carbs means i have to use 4 units? I could call the nurse although i only have a number to call at the hospital nurses office, i always see a different nurse.

The same happened today, i just had a reading of 3.3 and that happened even before lunch.

 

[Japes]

I would call in for more information both about the Novorapid and the Metformin.

When I started on Novorapid, I was given a set dose (of 4 units per meal) for a month, then the ratios were calculated after that month by the nurse and dietician. I queried did that mean 40 grammes of carbs with every meal but told vaguely "Just eat, and call us back if you have hypos." (!!!!!)

I was also taken off Metformin as soon as I was put on insulin.

 

[Diakat]

Try to call her as this seems wrong for your 40g lunch.
We can't really advise on dosage, but if that was me I'd probably try 3.5 units or 3 for lunch and see what happened.

 

[enzina]

Thank you, i will try to call them tomorrow. I have taken only 2 units today.

 

[Scott-C]

Hi, @enzina , as a very general rule, a common starting point is to assume 10 g of carbs will raise bg by 2 to 3 on your meter, and 1 u will lower by 2 to 3. So, it works out at about 1u for each 10g.

But it's just a starting point. That ratio works well for a lot of people, but, as we always say, we're all different - I tend to need about 1.5 for each 10g, others will be less than 1u.

The trick is to experiment with the same meal a few times with the same carb count, changing the dose slightly until you get a clearer idea of what's right for you.

If you figure out that, say, for example, 0.7 of a unit seems to do the trick for you for each 10g, it's then just arithmetic to adjust the amount for any quantity of carbs.

It's sometimes useful to wait till you're relatively stable and then eat 10g of dextrotabs and wait a few hours to see how much it rises by until it evens out again, and conversely, take 1u and see how much it drops by before levelling out. Experiments like that will give you a clearer idea of your personal customised ratios, which makes it an easier game than just assuming 1 to 10 is true.

Unfortunately, a surprising number of health care professionals have heard about 1 to 10 and for some bizarre reason think it is set in stone and applicable to everyone.

 

[ickihun]

Thanks Diakat,

No, the nurse didn't give me anything but i thought 40 carbs means i have to use 4 units? I could call the nurse although i only have a number to call at the hospital nurses office, i always see a different nurse.

The same happened today, i just had a reading of 3.3 and that happened even before lunch.

I guess if your taking metformin too, you may need less than that ratio.

 

[enzina]

Hi, @enzina , as a very general rule, a common starting point is to assume 10 g of carbs will raise bg by 2 to 3 on your meter, and 1 u will lower by 2 to 3. So, it works out at about 1u for each 10g.

But it's just a starting point. That ratio works well for a lot of people, but, as we always say, we're all different - I tend to need about 1.5 for each 10g, others will be less than 1u.

The trick is to experiment with the same meal a few times with the same carb count, changing the dose slightly until you get a clearer idea of what's right for you.

If you figure out that, say, for example, 0.7 of a unit seems to do the trick for you for each 10g, it's then just arithmetic to adjust the amount for any quantity of carbs.

It's sometimes useful to wait till you're relatively stable and then eat 10g of dextrotabs and wait a few hours to see how much it rises by until it evens out again, and conversely, take 1u and see how much it drops by before levelling out. Experiments like that will give you a clearer idea of your personal customised ratios, which makes it an easier game than just assuming 1 to 10 is true.

Unfortunately, a surprising number of health care professionals have heard about 1 to 10 and for some bizarre reason think it is set in stone and applicable to everyone.

That makes perfect sense. Thanks so much Scott-C. I will experiment a lot from now on. I admire all of you who are managing this illness so well. For some reason i still believed my LADA wouldn't progress..
Best wishes.

 

[enzina]

Yesterday i have called the nurses office at the Royal Free. After half an hour a nurse called back, told me to get off the Novorapid and gave me an appointment in two weeks time. I told her i will be in very high numbers until then. She just said that is still safer as having hypos after Novorapid?

I have followed your advise above and from other posts in the forum and decided to keep on taking it. Slowly i'm getting a bit better and correct with the right amount of insulin.

The nurse also said even if i'm back on Novorapid i must take the 6 Metformin. That seems a bit strange to me.

I have also looked around to buy a bigger carry case and couldn't find anything. Can i ask where you all bought it please? Maybe they are selling it at the chemist? I only have the Bayer Contour case and the GluccoMen ketones tester case.

 

[Diakat]

How are your numbers looking now?

No idea about carry cases, sorry!

 

[enzina]

Hi Diakat,

Yesterday was the highest 13 and now, three hours after breakfast they are at 7. That's super, i have just used 3 units of Novorapid, what a difference to the weeks before.

 

[Diakat]

Good to

Hi Diakat,

Yesterday was the highest 13 and now, three hours after breakfast they are at 7. That's super, i have just used 3 units of Novorapid, what a difference to the weeks before.

Great news. ☺

 

[scotteric]

Yesterday i have called the nurses office at the Royal Free. After half an hour a nurse called back, told me to get off the Novorapid and gave me an appointment in two weeks time. I told her i will be in very high numbers until then. She just said that is still safer as having hypos after Novorapid?

I have followed your advise above and from other posts in the forum and decided to keep on taking it. Slowly i'm getting a bit better and correct with the right amount of insulin.

The nurse also said even if i'm back on Novorapid i must take the 6 Metformin. That seems a bit strange to me.

I have also looked around to buy a bigger carry case and couldn't find anything. Can i ask where you all bought it please? Maybe they are selling it at the chemist? I only have the Bayer Contour case and the GluccoMen ketones tester case.

There are no correct answers, you just have to do what works for you because it's different for everyone. The medical profession is terrified of hypos because they could get sued if something happens to you. The truth is hypos are just part of managing diabetes with insulin. They will happen and it's more important to be able to recognize them, treat them promptly and properly and to make changes if something is constantly causing predictable hypos. Avoiding them is as difficult as avoiding ever having a blood sugar over 8, both will happen! Remember your carb ratio isn't a consistent thing - it can change depending on the hour of the day, what you are eating, how well your basal absorbed, your activity or stress level, and so many other factors. Also, the type of food you eat will really impact your dosing. If you eat something high in protein or fat for example (which is more food than you might imagine), you will often require additional doses of insulin hours later due to delayed digestion and protein converting to glucose.

 

[enzina]

There are no correct answers, you just have to do what works for you because it's different for everyone. The medical profession is terrified of hypos because they could get sued if something happens to you. The truth is hypos are just part of managing diabetes with insulin. They will happen and it's more important to be able to recognize them, treat them promptly and properly and to make changes if something is constantly causing predictable hypos. Avoiding them is as difficult as avoiding ever having a blood sugar over 8, both will happen! Remember your carb ratio isn't a consistent thing - it can change depending on the hour of the day, what you are eating, how well your basal absorbed, your activity or stress level, and so many other factors. Also, the type of food you eat will really impact your dosing. If you eat something high in protein or fat for example (which is more food than you might imagine), you will often require additional doses of insulin hours later due to delayed digestion and protein converting to glucose.

Thanks so much Scotteric!
That's how i see it as well and i will get there. At the moment i'm taking rather less Novorapid just in case.