Spike round 2 !

[AndyOD]

As a guideline what would you suggest on the split timings ? I.e. How long after / before eating ?

I would say an hour so inject just before eating 5 mins or so then after 1 hour again.

 

[AndyOD]

TDD - total daily dose still varies with different people, frame sizes, eating carbs etc. My dosage works out at 40% bolus 60% basal. Others work at 50/50 and others at 60/40 or 30/70.

So you should not go changing your basal to match your bolus amount. You need to increase or decrease your basal with basal testing...and then work out what your basal/bolus ratio is... This helps at times of eating more.. Say christmas... If you bolus more during xmas day, you may find that your basal needs to go up too...

My pump is switched to 250% temporary basal rate running for christmas.. As my bolus is increased so much.....

My ratios for every mealtime is different....

Interesting I very rarely change my basal nearly always 21 sometimes goes up if I'm ill(+1/2 or +1) The I vary my bolus by -2 to +4 depending on my meals. I thought perhaps wrongly ( I hasten to add) that the two were completely independant as when I'm sick I rarely feel like eating then I can tell when I'm getting better as my appetite comes back.

 

[donnellysdogs]

Aaah, but then when sick, us diabetics have to play by the sickday rules!!!!

I seriously eat at christmas.. Literally everything.... So wheras my carbs are normally 30-60g per day they caan go up to 150g with xmas pud, cake, drambuie etc.. So I definitely have to run my basal at 250% as my bolus's are sooooooo much higher that my balance would totally be out of kilter and my bgs would raise horrendously....it works for me, but we're all different...

 

[smidge]

Blood sugars don't increase before o eat. I always test the moment before I eat. I had found when I injected early that they hadn't moved either way in a half hour period... Absorption issue ?

Hi PG. I'm going to be of no help here except to say that I am experiencing a very similar thing as you describe. I am also on Apidra. It has worked very well for me for 5 years, but this year I'm struggling to keep my BG from spiking into the teens after food - even though I've not changed what I eat or anything. I bought one of the new Libre monitors and it is very clear from that that Apidra is taking nearly an hour to start working for me. I'm absolutely certain this didn't used to be the case. In fact I used to hypo occasionally pretty soon after eating because the Apidra was so aggressive. Carb is only taking 10minutes at most to start hitting my BG and has raised them loads within 45 minutes, so it doesn't take a genius to see the mismatch! The Apidra always seems to be playing catch-up. I don't believe it's down to injection site issues with me as the nurse checked me a few months ago. From having very tight control, this last year my levels have been all over the place. I have been concentrating on Levemir basal as being my problem, but at the moment, the evidence from the Libre is pointing to at least some of my issues being with Apidra.

Thank you for this thread as it has given me a lot to think about. I think I'll give Sanoffi Aventis a call tomorrow and see if they have made any changes to Apidra recently or have had any production issues that might have affected it. I guess th answer will be 'no', but worth asking. It's action for me has definitely changed.

Smidge

 

[noblehead]

Thanks for the link. When you say it should make up half do you mean add all you bolus together (average) per day and then give half that in basal ?

TDD is your bolus doses and basal insulin added together, they say your basal insulin should account for half of the TDD, although this is only a rough guide.

@smidge, have you thought about changing from Apidra to Novorapid, it might just sort your postprandial spikes out.

 

[smidge]

@noblehead - I am seriously considering a switch of bolus. It's just weird though because I've never had any issues with Apidra before, but it now seems to be like injecting water. It used to be so aggressive that I sometimes had to wait until after the meal to inject to slow it down. The action of it has definitely changed for me this year. I've always suspected it goes off pretty quickly i.e. if it's in the pen for 4 weeks, it is nowhere near as potent as when it's a fresh cartridge, but things have got so bad that this summer I started using a Frio bag permanently for keeping it cool. Strangely, I've looked long and hard at my basal, but the Libre is definitely highlighting the slow and weak action of Apidra as one of my issues.

Smidge

 

[noblehead]

Given what you've said I would consider changing insulin to see if it improves matters.

As you probably seen before Smidge, we have had members having similar difficulties to you and a change of insulin has resolved matters, I wonder if sometimes our bodies just get immune (if that's the right word) to insulin once we have injected it for a long period of time and it becomes less and less effective, I don't know but it's worth giving it a go to get your bg levels back down.

Good luck anyway.

 

[AndyOD]

Aaah, but then when sick, us diabetics have to play by the sickday rules!!!!

I seriously eat at christmas.. Literally everything.... So wheras my carbs are normally 30-60g per day they caan go up to 150g with xmas pud, cake, drambuie etc.. So I definitely have to run my basal at 250% as my bolus's are sooooooo much higher that my balance would totally be out of kilter and my bgs would raise horrendously....it works for me, but we're all different...

I'm self employed don't go in don't get paid :-(

Also I only try to be sick at weekends and bank holidays LOL

 

[donnellysdogs]

I'm self employed too!! No sick pay!!

 

[AndyOD]

I'm self employed too!! No sick pay!!

I'm not sure but I'm not supposed to like, but
Howrah for the self employed yeah.

 

[Lottie89]

Maybe try reducing your carbs? I worked out that your lunch maybe about 75g of carbs? 2x20g per slice of bread 20g- crisps 13g- yoghurt and then whatever filling you have on the sandwich.... I find that if I have more than 60g of carbs that my body struggles to digest it and my sugars will struggle to come down even if I've given the right amount of insulin. X

 

[PG1759]

Maybe try reducing your carbs? I worked out that your lunch maybe about 75g of carbs? 2x20g per slice of bread 20g- crisps 13g- yoghurt and then whatever filling you have on the sandwich.... I find that if I have more than 60g of carbs that my body struggles to digest it and my sugars will struggle to come down even if I've given the right amount of insulin. X

Thanks lottie. That might be part of the problem. You worked out my dinner pretty well