Change of Bolus Insulin and Having Issues

[Michele01]

Hi there - I'm wondering if you can help me please?

History: I'm Type 1.5 (but my body acts like a Type 1) and have been on insulin for about 10 years now. My HBAIc has always been ok but at the expense of large peaks and troughs. So based on that, my endo suggested using a Libre2. I've had that for over a month and it was clear that my basal probably wasn't correct and my bolus wasn't controlling the spikes well enough. I've checked my levels against my bc monitor and although they are always 2 behind or in front (which is to be expected I think) they are reasonably correct. So I managed to get my basal right and then my Endo changed my bolus from Novorapid to Fiasp to try to reduce the time of the peak. She warned me that it works really quickly and I should see the peak in an hour and it will be out of my system in 4 hours.

This is where I need your help please. I haven't changed my basal amount at all BUT this new Fiasp seems to be creating huge peaks and troughs and there doesn't seem to be any control from the bolus. For example I ate a low carb meal last night of 40g. Normally I would take 8 units (I'm on a 2 x 10g). Over the past few days I've realised that my normal amount per 10g isn't working with the Fiasp so I took 11 units. My readings went from 6.4 to 18.4 in an hour, 3 hours later were 9.7 but then shot up to 13.1 (without eating anything) at 4 hours later. Overnight my levels plummeted to 3.7. This morning the levels have shot up again (without eating) but taking my readings to 17.9! It looks like the introduction of this new bolus is upsetting my basal now.

I am so confused and upset. I don't know how to control this and I'm about to throw the towel in with this new insulin. Is it the insulin just not suiting me or is it me? Should I expect such huge differences with a different insulin until I get used to it? Thank you for any help you can give.

 

[StewM]

Hi there - I'm wondering if you can help me please?

History: I'm Type 1.5 (but my body acts like a Type 1) and have been on insulin for about 10 years now. My HBAIc has always been ok but at the expense of large peaks and troughs. So based on that, my endo suggested using a Libre2. I've had that for over a month and it was clear that my basal probably wasn't correct and my bolus wasn't controlling the spikes well enough. I've checked my levels against my bc monitor and although they are always 2 behind or in front (which is to be expected I think) they are reasonably correct. So I managed to get my basal right and then my Endo changed my bolus from Novorapid to Fiasp to try to reduce the time of the peak. She warned me that it works really quickly and I should see the peak in an hour and it will be out of my system in 4 hours.

This is where I need your help please. I haven't changed my basal amount at all BUT this new Fiasp seems to be creating huge peaks and troughs and there doesn't seem to be any control from the bolus. For example I ate a low carb meal last night of 40g. Normally I would take 8 units (I'm on a 2 x 10g). Over the past few days I've realised that my normal amount per 10g isn't working with the Fiasp so I took 11 units. My readings went from 6.4 to 18.4 in an hour, 3 hours later were 9.7 but then shot up to 13.1 (without eating anything) at 4 hours later. Overnight my levels plummeted to 3.7. This morning the levels have shot up again (without eating) but taking my readings to 17.9! It looks like the introduction of this new bolus is upsetting my basal now.

I am so confused and upset. I don't know how to control this and I'm about to throw the towel in with this new insulin. Is it the insulin just not suiting me or is it me? Should I expect such huge differences with a different insulin until I get used to it? Thank you for any help you can give.

Can't say much to help, but I've been having similar issues with Fiasp. So I'm interested to see what answers you get.

The really delayed drop is proving a major issue for me.

 

[StewM]

The issue I'm experiencing is that the Fiasp seems to have two distinct peaks. When I pre-Bolus I see my Blood Sugar begin to drop quite quickly after but the minute the carbs hit (regardless of GI/amount of Carbs) the Carbs overwhelm the first peak, and then don't drop until the delayed second peak. The problem is it can sometimes 6-7 hours before the second peak hits.

 

[Hopeful34]

It would be helpful to know what you had for your meal last night. Was there fat involved that would delay the absorption of carbs etc? In the meantime if you've got a new box of cartridges, it would be worth trying one of those in case the box you're using isn't working correctly. If using a reusable pen, could it be faulty?

 

[Michele01]

The issue I'm experiencing is that the Fiasp seems to have two distinct peaks. When I pre-Bolus I see my Blood Sugar begin to drop quite quickly after but the minute the carbs hit (regardless of GI/amount of Carbs) the Carbs overwhelm the first peak, and then don't drop until the delayed second peak. The problem is it can sometimes 6-7 hours before the second peak hits.

@StewM thank you so much for your reply. Yes that's exactly what's happening to me also. I hadn't identified that there was a 2nd peak but I think that's what may be happening. I just can't work it out at all. Here's today's graph and bear in mind I haven't eaten a thing yet (never eat breakfast). At 10am this morning I took 19u of basal (normal amount) and because my readings were at 17.2 I took 12u of Fiasp (with Novorapid this would have brought me down to 5). What it did was only bring me down to 11.7 in an hour and then started rising again. 2 hours later I was at 16.2 and rising so I took another 10u of Fiasp. One hour later I'm at 8.2 and falling. This really makes no sense at all.

 

[Michele01]

It would be helpful to know what you had for your meal last night. Was there fat involved that would delay the absorption of carbs etc? In the meantime if you've got a new box of cartridges, it would be worth trying one of those in case the box you're using isn't working correctly. If using a reusable pen, could it be faulty?

Thank you for your reply @Hopeful34. I had two grilled sausages, 2 rashers of bacon (also grilled), 1 fried egg and a small portion of baked beans. It wasn't particularly oily. This is my first box of cartridges and my first cartridge as I was only switched to this insulin 5 days ago. From Stew's reply above I do wonder if this is a quirk with Fiasp and if so, I have NO idea what to do about it. I've gone from being fairly confident about control to a jibbering worrying wreck now!

Would you mind having a look at the graph I've just posted please? This is with NO food whatsoever and only 3 cups of coffee between 10am today and now. I just can't work out why my levels are rising so much.

 

[StewM]

@StewM thank you so much for your reply. Yes that's exactly what's happening to me also. I hadn't identified that there was a 2nd peak but I think that's what may be happening. I just can't work it out at all. Here's today's graph and bear in mind I haven't eaten a thing yet (never eat breakfast). At 10am this morning I took 19u of basal (normal amount) and because my readings were at 17.2 I took 12u of Fiasp (with Novorapid this would have brought me down to 5). What it did was only bring me down to 11.7 in an hour and then started rising again. 2 hours later I was at 16.2 and rising so I took another 10u of Fiasp. One hour later I'm at 8.2 and falling. This really makes no sense at all.

Yeah, this looks familiar, putting it mildly.

For me, if my theory's correct, the issue is whilst I can get the dosage right for one Peak. It's very difficult to get the dosage right for both peaks. My current strategy is going with a lower Bolus to Carb ratio, and a long pre-Bolus. This does result in me entering the 3-4 range (not ideal) but then my Blood Sugar catapults up when the carbs kick in. Basically the closer I can get that second peak to the carbs the better.

 

[Hopeful34]

Sorry you're having so many problems with Fiasp. I'd start by ruling out a faulty box of cartridges, faulty pen, faulty box of basal cartridges etc. Once you've done that, if the overnight readings don't settle down, you could try going back to novorapid for a few days and seeing what happens with your overnight readings, and then make a decision. There are so many things that can affect our blood sugar, and unfortunately worry is one of them.

 

[Michele01]

Yeah, this looks familiar, putting it mildly.

For me, if my theory's correct, the issue is whilst I can get the dosage right for one Peak. It's very difficult to get the dosage right for both peaks. My current strategy is going with a lower Bolus to Carb ratio, and a long pre-Bolus. This does result in me entering the 3-4 range (not ideal) but then my Blood Sugar catapults up when the carbs kick in. Basically the closer I can get that second peak to the carbs the better.

@StewM are your levels rising without food though? I'm sorry for being thick but could you explain exactly how you counteract the second peak - are you saying that for example if your food is 60g you would take whatever ratio you're on to counteract that (for me that would be 12u of Novarapid but no idea what it would be with Fiasp) and then you inject again with another amount once your levels start rising for the second peak? If yes, how do you calculate how much for the 2nd peak? I'm so sorry to be dense.

 

[Michele01]

Sorry you're having so many problems with Fiasp. I'd start by ruling out a faulty box of cartridges, faulty pen, faulty box of basal cartridges etc. Once you've done that, if the overnight readings don't settle down, you could try going back to novorapid for a few days and seeing what happens with your overnight readings, and then make a decision. There are so many things that can affect our blood sugar, and unfortunately worry is one of them.

@Hopeful34 I'm pretty sure this isn't a faulty batch because @StewM seems to be having exactly the same issues. I agree about the worry not being good but my levels went so high last night I felt so poorly and I just hate not being in control. Perhaps Fiasp just doesn't suit me.

 

[StewM]

@StewM are your levels rising without food though? I'm sorry for being thick but could you explain exactly how you counteract the second peak - are you saying that for example if your food is 60g you would take whatever ratio you're on to counteract that (for me that would be 12u of Novarapid but no idea what it would be with Fiasp) and then you inject again with another amount once your levels start rising for the second peak? If yes, how do you calculate how much for the 2nd peak? I'm so sorry to be dense.

No, my levels are staying consistent without food.

Well, therein lies the problem. I would simply wait for the 2nd peak to kick in as a correction would send me low (even just a single unit). The problem is, there's definitely a "point of no return" on the high, whereby if I reach Xmmol/l that goes beyond the second peak's ability to bring it down. But I haven't precisely figured out where the Point of No Return is.

 

[Michele01]

No, my levels are staying consistent without food.

Well, therein lies the problem. I would simply wait for the 2nd peak to kick in as a correction would send me low (even just a single unit). The problem is, there's definitely a "point of no return" on the high, whereby if I reach Xmmol/l that goes beyond the second peak's ability to bring it down. But I haven't precisely figured out where the Point of No Return is.

Mmmmm the graph I showed was without food so there's something definitely not right for me.

So you don't inject just before food but wait until the second peak and then adjust for that (although you haven't worked out what to inject at that point). Is that correct?

My levels are now heading to the hypo range and I still haven't eaten etc., so I think I'm going to have a salad with low cals and not inject at all and then go back to Novorapid for my evening meal because I can't bear feeling so awful. I feel a bit of a failure but think I need to show my Endo what's happening and get her input because something is definitely not right. Thank you so much for all your input.

 

[StewM]

Mmmmm the graph I showed was without food so there's something definitely not right for me.

So you don't inject just before food but wait until the second peak and then adjust for that (although you haven't worked out what to inject at that point). Is that correct?

My levels are now heading to the hypo range and I still haven't eaten etc., so I think I'm going to have a salad with low cals and not inject at all and then go back to Novorapid for my evening meal because I can't bear feeling so awful. I feel a bit of a failure but think I need to show my Endo what's happening and get her input because something is definitely not right. Thank you so much for all your input.

I take Bolus then wait ten to twenty minutes depending on where my Blood Sugar levels were at (wait longer for higher Blood Sugar Levels).

This usually means the insulin is already dropping my levels before the food kicks in. The food kicks in as it’s starting to peak. My sugar then elevate and I wait for the second peak to bring it down even if I end up out of range. Generally.

 

[tim2000s]

Mmmmm the graph I showed was without food so there's something definitely not right for me.

So you don't inject just before food but wait until the second peak and then adjust for that (although you haven't worked out what to inject at that point). Is that correct?

My levels are now heading to the hypo range and I still haven't eaten etc., so I think I'm going to have a salad with low cals and not inject at all and then go back to Novorapid for my evening meal because I can't bear feeling so awful. I feel a bit of a failure but think I need to show my Endo what's happening and get her input because something is definitely not right. Thank you so much for all your input.

Hi Michele, if you're seeing craziness without food, it suggests that there's something else going on as well, possibly related to you basal.

When was the last time you undertook a basal test? Getting basal right is likely to help calm things down a bit and will allow you to check insulin/carb ratio and insulin sensitivity factor, both of which tend to be affected by an incorrect basal.

 

[boggle]

Faulty Libre 2?