Novorapid not so rapid?

[GrumpyMule]

Hello all,

I am totally new to any sort of Diabetes Forum so forgive me if this question has already been asked..
I have been a type 1 diabetic for 21 years and only within the last year have been moved over to 4 injections a day, previously I was on two injections and mixed insulin.
I now use Novorapid and Lantus and have also recently purchased the Freestyle Libre and I really love the machine.
However it has given me a clearer picture of what my levels are doing during the day and after I have taken bolus insulin and eaten.
For some reason the novorapid does not seem to be 'rapid', I can eat something (tends to be plain food - potato/meat/veg) and my levels shoot up and do not come down and I end up having to inject more insulin. However sometimes I will shoot down and not be able to get back up, once I was stuck at 1.8mmol for about 15 minutes!
I am unsure if this has been happening since starting with novorapid as only now do I have a clear picture of how my levels are reacting to it, I do not seem to have this problem with Lantus (quite the opposite, I struggle with lows overnight).
I have been moved on to 6mm needles as opposed to 5mm to see if that would help, which it did not.. And I am strict with moving my injections sites so as not to create fat build ups and delayed insulin release.
Trying to get an appointment with my consultant means having to wait until April to resolve this issue, my diabetic nurse says that I need to just give myself more insulin but then I have dramatic lows and my GP says that same thing.. It has been drilled into me that being high sugared has really bad consequences later in life and I am spending a lot of my time over 15mmol, the other day I hit 25.7 and had to inject 4 units but it only brought me down to 17.6 after 1 1/2 hours. I have to be honest I am extremely fearful of what this will mean for me in terms of future health problems and I do not feel as though I am getting the care and information I need..
Has anyone else experienced problems like this with novorapid? If so, what action has been taken?

Any comments appreciated!

 

[tim2000s]

Welcome to the forum @GrumpyMule , and your experience with Slow-voRapid. It (and all the other rapid insulins) are not really that fast. With the Libre, many of us have discovered just how slow. Many have to inject up to 45 mins before eating in order to avoid spikes.

But that's getting ahead of myself. Have you had any education on carb counting, basal use and Insulin Carb ratios? These are critical factors with using Basal/Bolus approaches. If you have been told to use fixed insulin doses then you will need some help.

Firstly basal testing will make sure your Lantus is at the right levels: http://mysugr.com/basal-rate-testing/

Secondly, BDEC will take you through getting your Insulin:Carb ratio and various other important points for use of Rapid acting insulin: http://www.bdec-e-learning.com

Obviously, feel free to ask questions here - we're all happy to help!

 

[noblehead]

It's all about the injection timing @GrumpyMule

When the analogue insulins like Novo first came out we were promised that we could inject just before or after eating, most on the forum find this not to be the case unless the meal is high in fat or contains low-gi carbs. I have to bolus 20mins ahead for most meals which prevents a big spike and keeps my bg within my target range.

The author of the book Think Like a Pancreas wrote the following article called Strike the Spike, it discusses injection timings:

http://www.diabetesselfmanagement.c...blood-glucose-management/strike-the-spike-ii/

 

[Dillinger]

Hi,

Sorry to hear you are having problems. I think that you need to retest your basal amounts and your bolus/carb ratio.

You are saying that you are having overnight lows with your basal. The implication of that is that you need to reduce that or change the time you are taking it. When do you take your Lantus?

These are estimates of action for insulins;

https://www.diabetes.org.uk/Documents/Magazines/Insulinwallchart.pdf

It's not ideal as the timings are a bit vague for my liking but better than nothing!

The basic rule for correcting these problems is start with basal then fix bolus.

Here is the go-to link for fixing basal amounts http://mysugr.com/basal-rate-testing/

Then look at your bolus; the anticipated ratio is 1 unit of insulin for each 10 grams of carbs. Mine is nowhere near that and also changes from the morning (much less sensitive to insulin i.e. need more) to the evening (much more sensitive i.e. need less).

The other core blood glucose managing thing that you can do which you probably haven't been told by your GP or nurse is to cut out carbs as much as possible. Carbohydrates are not our friends.

Best

Dillinger

 

[Dillinger]

Firstly basal testing will make sure your Lantus is at the right levels: http://mysugr.com/basal-rate-testing/

Secondly, BDEC will take you through getting your Insulin:Carb ratio and various other important points for use of Rapid acting insulin: http://www.bdec-e-learning.com

Great minds eh!? I just posted almost exactly the same...

 

[BooJewels]

I'm a T2 on NovoRapid and Lantus (in a regime known as Basal-Plus), so my considerations are obviously slightly different from your own. But even though I've not been on it long, I too have noticed a greater than expected spike at 2 hours post-food, then a noticeable drop in the next hour.

So after reading here, I saw that a lot of T1s we're taking NovoRapid further in advance of food than the instructions would indicate you should. So I've been increasing the time before food by 5 minutes each day to see if it makes a difference and last night and into today I had significantly better numbers than of late, without changing my insulin dose at all.

So I would suggest that timing is maybe more pertinent than changing doses, especially if you're also getting later lows. I can see that there have been other posts since I started typing, but I can't see them, so apologies if this overlaps with other comments.

 

[GrumpyMule]

Thank you all so much for your advice!!
@noblehead I have taken my bolus insulin 20 mins before eating this evening and although I have still spiked to 14.4mmol the spike itself has been less dramatic than before.I will continue to experiment with leaving more time and hopefully this will allow me to get some more control.
@tim2000s I have not been on any courses to learn to balance the bolus:carb ratio, there is a DAFNE course in my area but I have been told by my nurse that the waiting list is 3 years. I have enrolled but the other links you have sent me are brilliant and at least I can get some idea of what I am meant to be doing.
@Dillinger I tend to take my basal at 10pm and at the moment I am on 20u, It has been recommended by my nurse to take 10u at night and another 10u in the morning. I do not know what your experience with this is? Personally I am less keen to move to this as I already inject so many times a day that any way that I can keep this down saves some of the swellings in my legs which I sometimes get due to hitting veins..
I definitely find that I am more sensitive to insulin the morning and sometimes through until lunch, in the evenings is where I experience my most dramatic spikes. Is there any reason for this or is it just something which happens?
@BooJewels It is really nice to hear that people are experiencing the same thing as me. I do not know anyone who is diabetic so it is refreshing that people can identify with this problem and that I am not the only one! I am planning to implement your idea of moving back insulin times by 5 minutes as I think this will enable me to notice any trends.

 

[donnellysdogs]

Hi
Welcome to forum...

Are all of your erratic readings between 2-3 hours after a meal??

 

[donnellysdogs]

I wonder whether this is actually your basal also being wrong and would just like to ask if you have heard of or tried basal testing?

 

[noblehead]

@GrumpyMule, if you do extend the bolus timing just be mindful of the meal you are eating otherwise you may get caught out. Good luck.

 

[TorqPenderloin]

It's all about the injection timing

This.

I treat my blood sugar kind of like a pendulum. If the pendulum is standing still, it's very easy to control. IF the pendulum is swinging rapidly, it takes a lot more effort to get it to stop.

The same is true (in my experience) of my insulin timing. If I take insulin 15-30 minutes before I start to eat, my levels usually stay very steady. If I take insulin 15-30 minutes AFTER I eat, my levels swing back and forth and the chances of hypos/hypers are much more likely. When I realized that's how my body seems to work, it made my insulin management much easier.

 

[GrumpyMule]

Hi
Welcome to forum...

Are all of your erratic readings between 2-3 hours after a meal??

Hi
Welcome to forum...

Are all of your erratic readings between 2-3 hours after a meal??

Hi @donnellysdogs sometimes yes the readings do mostly spike around these times. However sometime 4-6 hours after eating lunch my levels will start to go higher out of no where.. I have been told that this is the liver releasing sugars as it thinks the body needs them but I am not sure how to combat this..?

 

[GrumpyMule]

Hi @donnellysdogs sometimes yes the readings do mostly spike around these times. However sometime 4-6 hours after eating lunch my levels will start to go higher out of no where.. I have been told that this is the liver releasing sugars as it thinks the body needs them but I am not sure how to combat this..?

I have also not heard of basal testing.. Is this something that my consultant should be discussing with me?

 

[steve_p6]

Hello all,

I am totally new to any sort of Diabetes Forum so forgive me if this question has already been asked..
I have been a type 1 diabetic for 21 years and only within the last year have been moved over to 4 injections a day, previously I was on two injections and mixed insulin.
I now use Novorapid and Lantus and have also recently purchased the Freestyle Libre and I really love the machine.
However it has given me a clearer picture of what my levels are doing during the day and after I have taken bolus insulin and eaten.
For some reason the novorapid does not seem to be 'rapid', I can eat something (tends to be plain food - potato/meat/veg) and my levels shoot up and do not come down and I end up having to inject more insulin. However sometimes I will shoot down and not be able to get back up, once I was stuck at 1.8mmol for about 15 minutes!
I am unsure if this has been happening since starting with novorapid as only now do I have a clear picture of how my levels are reacting to it, I do not seem to have this problem with Lantus (quite the opposite, I struggle with lows overnight).
I have been moved on to 6mm needles as opposed to 5mm to see if that would help, which it did not.. And I am strict with moving my injections sites so as not to create fat build ups and delayed insulin release.
Trying to get an appointment with my consultant means having to wait until April to resolve this issue, my diabetic nurse says that I need to just give myself more insulin but then I have dramatic lows and my GP says that same thing.. It has been drilled into me that being high sugared has really bad consequences later in life and I am spending a lot of my time over 15mmol, the other day I hit 25.7 and had to inject 4 units but it only brought me down to 17.6 after 1 1/2 hours. I have to be honest I am extremely fearful of what this will mean for me in terms of future health problems and I do not feel as though I am getting the care and information I need..
Has anyone else experienced problems like this with novorapid? If so, what action has been taken?

Any comments appreciated!

Just curious as to why you were moved to longer needles as opposed to going to 4mm.

 

[GrumpyMule]

Just curious as to why you were moved to longer needles as opposed to going to 4mm.

I suffered with lumps in my legs/stomach and found that all of a sudden I would get very low sugar levels very quickly.. My GP believed this to be down to the needles being too short and therefore not getting through enough of the muscle. The lumps have now stopped after using the longer needles however the erratic levels still persist..

 

[noblehead]

I have also not heard of basal testing.. Is this something that my consultant should be discussing with me?

Absolutely, or your DSN.

Getting the basal dose right is the foundation on which to bulid on, again by the author of Think Like a Pancreas the following explains why getting the basal dose right is so important:

http://integrateddiabetes.com/basal-testing/

 

[GrumpyMule]

Absolutely, or your DSN.

Getting the basal dose right is the foundation on which to bulid on, again by the author of Think Like a Pancreas the following explains why getting the basal dose right is so important:

http://integrateddiabetes.com/basal-testing/

Thank you, I will get reading and arrange another appointment with my DSN to get some further guidance!

 

[steve_p6]

I suffered with lumps in my legs/stomach and found that all of a sudden I would get very low sugar levels very quickly.. My GP believed this to be down to the needles being too short and therefore not getting through enough of the muscle. The lumps have now stopped after using the longer needles however the erratic levels still persist..

I'll let some of the others comment to back me up(or not?), but my understanding is that injecting into muscles will lead to faster absorption hence shorter needles to try and stay in the fat layer.

 

[BooJewels]

I was just starting to type as @steve_p6 posted - I'm nowhere near as experienced and knowledgeable as T1s, but I thought the idea was to get the insulin in under the skin - subcutaneously - not into muscle at all.

I use 6mm needles, as I'm well upholstered, but anyone lean, as T1s tend to be, would be more likely to use a 4mm needle.

Edited to add: http://www.diabetes.co.uk/insulin/how-to-inject-insulin.html

 

[donnellysdogs]

Absolutely, or your DSN.

Getting the basal dose right is the foundation on which to bulid on, again by the author of Think Like a Pancreas the following explains why getting the basal dose right is so important:

http://integrateddiabetes.com/basal-testing/

Noblehead is spot on...

Do have a look at basal testing as I actually believe this is best
done before trying anything else.....

Are you just eating 3 meals a day? I see you were on mixed before when it was important to probably eat snacks.

On bolus basal regime it is good to have 5 hours between wating to get a clear picture of how long your bolus lasts and that insulin isn't stacking up.