Novorapid... not so rapid ?

[Mad76]

Hi all,

Interested to hear others experiences of novorapid. I am increasingly frustrated about how slow it is for me. I use the libre, so can see from there once the arrow starts to go down I take that as the novorapid having effect.

It's really really bad in the morning takes an hour and a half to 2 hours to work. So unless I want a massive spike after breakfast that's how long I have to wait.

During the rest of the day it takes about 45 mins to an hour at least typically.


So is this a typical experience???
I'm abroad atm so wont be able to request a change yet. I've heard on here flasp is faster ?? I have been on novorapid since diagnosis just over a year ago.

Thanks

 

[Rokaab]

I know I found Novorapid to be very sluggish at times, sometimes I could see it kicking in some 4-5 hours after taking it (dead rapid --- not!), I ended up changing to Fiasp

 

[MarkMunday]

Novorapid usually takes an hour to peak, but blood glucose may start dropping before then. It depends partly on how well your basal needs are being covered by basal insulin action at that time of day. So have you tested your basal in the morning?

 

[Antje77]

I switched to Fiasp because of the sluggishness of Novorapid. Works much better for me.
I used to pre-bolus by about 45 minutes on Novorapid. Mornings are a different story, I have a srong foot on the floor effect, maybe that's part of what you see happening in the morning. I don't do breakfast, but on Novorapid it still took a couple of hours to get my bg down after it shooting up when getting out of bed, despite injecting for it before leaving my bed.
On Fiasp I usually manage a straight-ish line when getting up in the morning if I inject before getting out of bed.

This was the main reason I switched to Fiasp: For meals I can pre-bolus, but it's impossible to pre-bolus for getting out of bed. Turned out it made injecting before eating a lot easier too, and I see much quicker if I need a correction.

 

[UK T1]

Wow I'd heard it called novo-sluggish but hadn't realised that some have to pre-bolus so far in advance!

I've been using novorapid for 14yrs, since getting my libre last year I noticed I had to bolus 10-20 mins before I start eating, depending on the meal I'm having. Since lockdown my otherwise mainly standing, on my feet all day, job has been turned into sitting at a computer all day, so I've noticed I have to increase lunch time bolus timings to 15-30 mins before my meal. The consultant said this is to be expected if your circulation is not as stimulated if you're less active. I do some exercise after work and am back to bolus ing 10-20 mins before my evening meal.
I don't know if a similar situation might be the case for you? Though if it takes hours then it seems not!

Have injection site health and needle sizes been considered?

 

[Mad76]

Thank u all very much for your replies

I think my basal is fine.

Sounds like fiasp might suit me better. Once back I'll ask my gp about it. Was it easy to swap ?

 

[MarkMunday]

Before making any decisions about changing bolus insulin, check that you are getting the basal coverage you need. If there is a basal insulin action gap, it can look like bolus insulin is taking longer or not working.

 

[Rylando88]

I love novorapid I’ve tried some others over the years to compare but I always end up going back to it! My long acting has changed 4 times which can have an effect and also I noticed that the novorapid acts differently depending on what time I do my basal, I currently take tresiba first thing but have taken it before bed and around 8pm in the past too as well as previously using lantus, Levemir and fiasp. I’d deffo mention it to your team and see if they have any ideas before you give up on it completely but if you can’t find a way to make it work for you then maybe a different insulin would be the way to go!! Good luck!!

 

[Mad76]

I didn't realise that basal could affect speed of action of bolus.

I have not attended daphne yet. Was booked on for june, but it was cancelled because of covid.

So basal testing , is it basically when u have no bolus in system, and have not eaten, then the bg levels should remain pretty steady ?? Basically using the libre can I just not eat or take novorapid for a few hours and monitor bg levels ? Or is it much more complicated than this ??

Thanks in advance

 

[MarkMunday]

I didn't realise that basal could affect speed of action of bolus. ...

It goes almost without saying that how well a bolus covers a glucose load depends partly on how well basal insulin requirements are covered. The bigger the basal action shortfall, the more bolus dosing needs to be loaded to achieve desired blood glucose levels. Yet diabetes educators often don't get this.

... So basal testing , is it basically when u have no bolus in system, and have not eaten, then the bg levels should remain pretty steady ?? Basically using the libre can I just not eat or take novorapid for a few hours and monitor bg levels ? Or is it much more complicated than this ? ...

Yes, you have got the idea. You a;so need to be in the target blood glucose range at the beginning of the test. You also need to avoid eating, unusual exercise and stress during the test. You can start with an overnight test. If you are in the target range in the morning, you can skip breakfast and test until lunchtime. On separate days, test after lunchtime and suppertime. Fasting for a whole day causes the liver to make glucose, which confuses test results. Have fun ... .

 

[Mad76]

It goes almost without saying that how well a bolus covers a glucose load depends partly on how well basal insulin requirements are covered. The bigger the basal action shortfall, the more bolus dosing needs to be loaded to achieve desired blood glucose levels. Yet diabetes educators often don't get this.

Yes, you have got the idea. You a;so need to be in the target blood glucose range at the beginning of the test. You also need to avoid eating, unusual exercise and stress during the test. You can start with an overnight test. If you are in the target range in the morning, you can skip breakfast and test until lunchtime. On separate days, test after lunchtime and suppertime. Fasting for a whole day causes the liver to make glucose, which confuses test results. Have fun ... .

Thanks so much for your help.

 

[Antje77]

Was it easy to swap ?

For me it was. I simply told my DN I wanted Fiasp, she prescribed the penfills, and I put a new penfill in my pen.

I started with a slightly lower dose than I used with Novorapid to see what would happen and tested a bit more often too. Went back to my old doses quickly.

 

[porl69]

NovoRapdi has a good nickname on here..... NovoSLUGGISH