Bernstein. Fast-acting insulin.

[ert]

I'm on long-active Levemir since yesterday. It's taken until this moment to get my prescription for fast-acting Fiasp. My blood sugars usually go down at dinner time and spike up 3 mmol/l 6 hours later with 12 grams of carbohydrate and nightly running, weights and the gym. Considering my fasting acting pen only has 1 unit doses (my nurse worked out I need 0.5 units for 10 grams of carbohydrates as my insulin sensitivity is sky high) I don't think I can use it tonight. Are there any LCHF diet type 1's on insulin who could advise?
Also Bernstein said to take high powered short-acting insulins 20 minutes before eating or time it until blood sugars rise 5 mg/dl. I think Fiasp may fall into this category. Any advice on this?

 

[Deleted Account]

We cannot advice on insulin doses.
However, half unit pens are available for Fiasp (e.g. the NovoPen Echo) and would recommend that you request one of these.

 

[Notorious]

A pump can help with tiny doses for the very insulin-sensitive, if this is an option going forward.

 

[tim2000s]

I'm on long-active Levemir since yesterday. It's taken until this moment to get my prescription for fast-acting Fiasp. My blood sugars usually go down at dinner time and spike up 3 mmol/l 6 hours later with 12 grams of carbohydrate and nightly running, weights and the gym. Considering my fasting acting pen only has 1 unit doses (my nurse worked out I need 0.5 units for 10 grams of carbohydrates as my insulin sensitivity is sky high) I don't think I can use it tonight. Are there any LCHF diet type 1's on insulin who could advise?
Also Bernstein said to take high powered short-acting insulins 20 minutes before eating or time it until blood sugars rise 5 mg/dl. I think Fiasp may fall into this category. Any advice on this?

If you're using MDI, Fiasp isn't really ideal for LCHF. It acts more quickly than traditional fast-onset insulins, and you'd probably find that you'd need to dose multiple times with it to handle the delayed blood glucose levels that tends to happen with LCHF. It works very well in an artificial pancreas for this reason.

You should certainly ask for a half unit pen, given your insulin sensitivity, or even a pump, which delivers in 0.1 or 0.05u doses, as your insulin sensitivity is far too high for a 1u pen.

 

[Deleted Account]

I understand the suggestions from @tim2000s and @Notorious for a pump but the OP has just started insulin (less than 2 days). Therefore, I would suggest a note of caution before considering pumping
- the OP is still in the honeymoon period and so her insulin needs may rise
- I have found pumping fantastic but required more effort in accurate carb counting, adjusting basal rates, changing pump sets, etc. Therefore, I would strongly recommend learning to walk with injections before running (and dancing) with a pump

 

[ert]

helensaramay thanks. I know everyone is different and I have a seek advice from my diabetes nurse, but I didn't even know of the existence of a 0.5 unit pen to ask for one. My GP thought I was asking for the finest size needle when she filled out the prescription. So thank you. Also, point taken I'll stay with the insulin pens for now.
I'm amazed that I can take long-acting insulin 3 units morning and night and my blood sugars sit at 6 mmol/l. This is something I hadn't considered. I thought all injected insulin caused insulin to progress downwards towards a hypo. Long-acting insulin is the best thing ever. Why on earth did I don't take it 18 months ago? Plain ignorance on my part. I didn't take the advice 'you must start insulin' very well when I had some sort of impaired control through extreme diet and exercise. I just got caught up in the madness of my new situation.
Day two on insulin and I haven't been confident enough to try my rapid-acting insulin after finding myself a similar situation I've been living in with just some long-acting insulin. I need to brace myself, to jump in. My own experience living on low c-peptide without insulin for the last year and a half is that breakfast spikes my sugars sky high, even just protein, even with exercise; however, with dinner, I could get away with exercise and a glass of wine to stop any increase. I only had dinner last night, enough calories for the day. I'm going to do the same today and start short-acting on the weekend. They won't have my half-unit pens until next Tuesday so I will have to eat at least 20 grams of carbohydrate to cover 1 unit with my nurse's calculation. I have Dex4 tables in case things go wrong and will start above 6 mmol/l.
tim2000s what fast-acting insulin do you use? I know I have to seek medical advice but it would be helpful to get an inside idea. I will be prepared to split the dose of the Fiasp which I think was what you may have been indicating.

 

[Diakat]

@ert because most diabetics are T2 it is very easy to pick up the message that “exogenous insulin is bad” this is not the case for T1s or those whose pancreas has given up.

 

[LooperCat]

helensaramay thanks. I know everyone is different and I have a seek advice from my diabetes nurse, but I didn't even know of the existence of a 0.5 unit pen to ask for one. My GP thought I was asking for the finest size needle when she filled out the prescription. So thank you. Also, point taken I'll stay with the insulin pens for now.
I'm amazed that I can take long-acting insulin 3 units morning and night and my blood sugars sit at 6 mmol/l. This is something I hadn't considered. I thought all injected insulin caused insulin to progress downwards towards a hypo. Long-acting insulin is the best thing ever. Why on earth did I don't take it 18 months ago? Plain ignorance on my part. I didn't take the advice 'you must start insulin' very well when I had some sort of impaired control through extreme diet and exercise. I just got caught up in the madness of my new situation.
Day two on insulin and I haven't been confident enough to try my rapid-acting insulin after finding myself a similar situation I've been living in with just some long-acting insulin. I need to brace myself, to jump in. My own experience living on low c-peptide without insulin for the last year and a half is that breakfast spikes my sugars sky high, even just protein, even with exercise; however, with dinner, I could get away with exercise and a glass of wine to stop any increase. I only had dinner last night, enough calories for the day. I'm going to do the same today and start short-acting on the weekend. They won't have my half-unit pens until next Tuesday so I will have to eat at least 20 grams of carbohydrate to cover 1 unit with my nurse's calculation. I have Dex4 tables in case things go wrong and will start above 6 mmol/l.
tim2000s what fast-acting insulin do you use? I know I have to seek medical advice but it would be helpful to get an inside idea. I will be prepared to split the dose of the Fiasp which I think was what you may have been indicating.

The idea of the long acting is to just keep you level - neither rising or falling, in the absence of food. The fast one is to counter carbs, or to correct if needed. It’s a shame they didn’t explain that all that time ago and saved you so much grief.