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A Little Experiment

P

Pneu

Well-Known Member
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So given that my insulin sensitivity has been increasing recently I have been experimenting with a slight increase in the amount of carbohydrates that I am eating... So far no noticeable effect on my levels but today I am having a baked potato for lunch which is something which I haven't had in a while due to the way that it used to spike my blood glucose at +1h and +2h...

Also with my switch to Apidra over Novorapid I have noticed that I can control my +1 spikes more easily than previously so worth re-trying old foods to see what happens with the newer insulin...

Right so that said down to some methodology!

I am doing two BG tests every 15 minutes and taking an average which I will record and plot. I will start testing from the moment I inject and start to eat through to three hours post meal. I find testing like this can show you some interesting results that you might not get from a straight one or two hour test.

Insulin wise I am eating the potato with cheese and some butter so will be spliting my Apidra into two injections 70% just before I start eating and a further 30% one-hour after I started eating... Given my experience of Apidra I know that for me it really starts to work between 45min - 1hour 15mins and will generally cease action after 2 hours...

Anyways... Graph of results below...

BGGraph.JPG

Link to Full Size: https://picasaweb.google.com/lh/photo/g3dmfsRb7MFKE8Q-YeZHsA?feat=directlink

I am pretty please with the results with 6.2 mmol/l at +1 hour didn't spike my sugars as much as I thought it would... also shows why +1 hour or +2 hour testing doesn't show the full story as my sugars actually spiked at 7.4 mmol/l before the Apidra began to do its work.

Anyway I hope my fellow spreadsheet and graph geek's find this interesting! perhaps we can inspire some fellow members to take up spreadsheeting! certainly has always helped me understand my condition.
 
That is interesting Pneu, thanks for posting that.

Can I ask how many units of Apidra you injected? Like you I have to split my Apidra dose if I have a higher carb meal. I inject half with my meal and half an hour later otherwise I get a big spike. I found that if I injected the needed dose to take care of the spike later on it could sometimes work too quickly and I would be Hypo during eating...I hate that :evil:

Sorry if you have already written about this but why did you change from Novorapid to Apidra? Is novorapid a longer acting fast acting, if that makes sense ?

I sometimes wonder if Apidra is just too quick to act for me but my team has said to leave it for now as I am hopefully going the pump route. I just can be very sensitive to it at times if I am really up on my training.

glad to see you are having such success with it :D
 
Fallenstar...

I changed to Apidra as I have read a number of things that say it has less 'tail'.. that means I can get back to fasting levels quicker without having to worry that 3/4 hours post meal I will drop low.. Personally I find that pretty much after two hours my Apidra is spent which is great because it means that I can get that tighter control... it also means that I do need to double wave if I expect the carbs to keep coming for more than 2 hours..

If I eat a really high-fat meal then I would actually inject Novo at the start then a 2nd wave of Apidra to cover the higher 2 - 3 hour spike.. the Novo for me works for around 4 hours so that would then mop up any carbs still messing around after that..

Reference the units... I value Jacket Potato's @ 25.2g of carb / 100 and mine was a largish one weighing in at just over 200g so total carbs for my meal were around 52g (I normally stick to 30 - 35g / meal)... I use a 1:4 ratio for lunch... so my total injection was 13 units.. split into 9 up front and 4 @ 1 hour... which is roughly 70/30
 
Thanks :D

So do you find that a meal high in fat will spike you later on? Interesting

I just know that if I had a large jacket potato with cheese and injected 9 units, I would be hypo while I was eating it, and to be honest with that amount also for a good while afterwards. That is the trouble I have most of the time I am soooo insulin sensitive. If I had run that morning I may have to have that with no insulin if I had had a low trend, if not stagger the dose and test a lot in the afternoon....no run and I would have about 4 units,entire. and still have to watch a few hours later.

I'm going on the DAFNE course but don't know how successful it will be for me ,but I go with an open mind and a lot of hope :)
Do you find that the Apidra is faster than the Novorapid...as strong say? Do you need the same amount of Apidra as you do Novorapid?
I'm sure I will know more when I have done the DAFNE course and can hopefully not be chasing my tail quiet so much. I hate having to chase up lows.
I do wonder whether Novo rapid might be a better one for me though , as my cells gobble up the insulin but later it wears off too quickly for my digestion and I get highs later ,unless I really cut back on food and to be honest I have trouble at the moment I don't want to lose anymore weight and I get hungry :cry:
Thanks for your take on things Pneu, it really does help to hear other peoples experiences even if things don't work for yourself quiet the same, it really sounds like you've got it down :wink:
Can I ask what Basal you are on and how many unit's you take? I read you also split the dose but how many units do you take of this one?
 
High fat meals will certainly delay the carbohydrate being released, for instance if you eat something high in fat and carbs... say a pizza you will find your BG spike will be at 2 - 3 hours.

I use the same ratio for Apridra and Novo, but the Apidra is certainly faster and shorter acting.. for me

Apidra: Acts over 2 hours with the main action being at 45 mins - 1:15 mins
Novo: Acts over 4 hours with main action being at 1:15 mins to 2 hours, although this is not as an aggressive action as the Apidra's is..

Everyone is different but I do have a supportive consultant who has let me chop and change my insulins to achieve the best control I can..

Reference Basal... I take Insulatard twice a day @ 8pm and 8am.. my evening dose is 35 units and my morning dose is 20 units.. this is slowly being reduced as my insulin sensitivity after 5 stable years seems to be increasing?! I was previously on 200+ units a day of Levemir which totally didn't work for me..

Reference the amount I take I am quite a large guy 6'6'' and 90kg (14 stones) so the more of you there is in general the more insulin you need / kg to get the same effect
 
Fallenstar said:
I'm going on the DAFNE course but don't know how successful it will be for me ,but I go with an open mind and a lot of hope :)
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Fallenstar, I'd be really interested to know whether the dafne course helps you so please do come back and post when you've been on it.
I found it helped, not so much with info which I mostly knew, but with getting me to have a look at why I was doing things in a certain way. I found it really helped me understand the role of basal, and insulin action times, so hopefully it will be good for you too.
 
Thanks Snodger :D I really do hold out high hopes as I have found my Diabetes harder to control as the years have passed. I have found the last 3 years the hardest and sometimes it seems the more effort I put in the worse it can be sometimes, so something concrete for me to go on can only be a good thing I hope.
On the whole I don't do too badly but I did have better control when I was much more unhealthy, ie poor cholesterol , overweight, sat on my **** a lot :lol: Oh the irony :wink: . I had perfect hbA1c's at that time, 5.5, 6.7,6.1
Now I have got really fit and healthy my control is worse hbA 8.6 last one....not bad but could do better.
I have got a lot more insulin sensitive though over the years and what swings one way, well, tends to start the pendulum effect from time to time.
Also my Cortisol is low and Thyroid prob's so this is all interlinked with my control. I'm hoping the DAFNE will help in the long run and I will certainly let you know if I have positive results. I've been out of the Diabetic loop for too long really ,I like to try and keep it on the back burner in my life, I always could really, it's just of late it has come back around to bite me on the *** :lol:

Did you find your control improved Snodger after the DAFNE? What would you say was the best thing you got out of it?
 
Fallenstar said:
Did you find your control improved Snodger after the DAFNE? What would you say was the best thing you got out of it?
Click to expand...
no my HbA1c rose! but not by much - by 0.6. I had actually got it down to the best level I'd had for years, then I went on DAFNE, and messed around with my insulin, when perhaps I should have just trusted myself more on what I was already doing. I went to clinic quite soon after, so the DAFNE week and the week after it were biasing the HbA1c a little I think.
Having said that, I think messing around with it and making mistakes does actually help you understand the way it works. AND, I had been on a too-high basal rate and been regularly hypoing in the night; I'd just accepted that as 'the way it is' - which seems crazy when I look back on it. Sorting out my basal was probably the best practical thing that came out of it for me, and the fact that I have many fewer night hypos does mean my control is better, even if my HbA1c is a little higher.
But the best thing overall was the chance to discuss diabetes properly with HCPs who actually cared and knew their stuff. They are there with you the whole week and you work together with them on the problems you are having - so you don't feel left alone struggling with something that doesn't quite make sense.
In my experience, even the best doctors are often knowledgeable only about the textbook-and-research side of diabetes. So it was really refreshing to talk to the DAFNE tutors because they are literally having to deal with the same practical problems as we are, alongside us. And their attitude (on my course) was very much, yes you can do it, we are here to help you do it... they weren't judgemental at all and they were very positive.

sorry that was a bit of a waffle. Hope your course is as good.
 
Hi Snodger :D
Thanks ,not a waffle at all,it all helps.

So there are specialist DAFNE people??? I thought it would just be my Diabetic nurse?

Sorry P for hijacking your thread x
 
no worries... were here to help! if you find it in one of my threads (even by the backdoor!) then all the better
 
This is fascinating to me (and not just because of the graphs!). I’m finding the reverse problem. I find that my levels have started to shoot up and stay high for 2-3 hours at least after eating and taking Apidra, and only really come down at about 4-5 hours, when they take a bit of a plunge and I go hypo.

For example, the last three days after breakfast I’ve been around 8-9 three hours after apidra, at about mid six four hours after and 3.9-4.4 at lunchtime, about five hours plus after apidra. Ditto for lunch – 90g carb, 9u apidra. Still at 13 or so by two hours after lunch, around 8-10 later in the afternoon at 3-4 hours after lunch at least 5.5 when I drive home at 5pmish but have dropped to 3.6 for three days now at about 6-6.30pm, five and a bit hours after lunch.

I had assumed this was a basal problem, but I’ve dropped my basal quite a bit. I was taking 6u am and about 18u pm about two weeks ago. I’m now only taking 3u levemir in the morning, and 12u in the evening (dose taken after the hypos occur) and my morning fasting levels are stubborn at around 7 or so. I was wondering if for my apidra was lasting longer. Either that or my pm levemir is lasting all day long. My DSN has said to stop the morning levemir but I wasn't sure about that. I may try it though. If that's the case, I'm not sure what to do with my apidra doses. Should I be considering novorapid?
 
Russ...

are you 100% certain that your basal is correct? you have reduced your basal by nearly 40% that's a massive change so I am wondering if the new level is correct or if the old levels were correct or if both are wrong? I would stop changing the levels and try some fasting tests just to see what happens.. get the basal right and then look at the bolus..

Reference the Apidra... certainly I have found that two insulins that should have similar profiles.. i.e. the Apidra and Novo actually work quite differently for me in practice... so I would never rule out trying a different type of insulin to get a better result..

What I have also found though is that as my sugars increase I need more insulin to get the same result... if you are spiking really quickly then it could be that the Apidra is working but in that first couple of hours as its working against carbs and high sugars its keeping you level... once the carbs are dealt with it then is reducing your sugars over the rest of its activity..

Do you inject the Apidra before you eat? or once you have finished? (my money is on when you have finished)
 
Hi Pneu,

Thanks for your comments and letting me hijack the thread somewhat. I've recently moved to trying to inject before eating recently and I've definitely found that splitting my dose of apidra works well with bigger meals out. I have had some success with injecting about 60% when I order and the rest when I've finished the main course.

I'm not sure my basal is still right at all, but I've come down a bit from 24u levemir at max to now 15u levemir (and was on 22u lantus, which many people say you need less of than levemir).

I've just talked things through with my DSN. She's still of the view that my basal may not be right as well, so I'm going to drop my morning levemir and up my evening slightly to try and address my fasting levels, which are stuck in the high sixes to mid sevens. Once that's settled, I'm going to try to increase my apidra ratios to put a cap on the post meal highs and perhaps consider an apidra top up dose during the morning, and if that doesn't work I will try novorapid.

I think there is definitely not a straight line relationship between carb amount and apidra dose. For me, I think I need a higher ratio of apidra to carb for bigger meals than smaller ones, and you're suggesting that you need more than you would expect if you are at a higher starting point.

Still, I'll keep experimenting and see what happens.
 
Russ,

I often split my novorapid dose when eating a big meal which contains fat, for example on a Saturday night my wife makes us all home made chips (far better than a chippy :wink: ) with sausages from our local butchers with a salad, I inject two thirds of my insulin before eating then inject the remainder approximately 90 mins later. Seems to work a treat as the fat slow down the absorption of the food so the split dose avoids a spike later in the evening, yes it's another injection but as I don't find injecting a problem I find it a better alternative than running low after eating or running high before bed.

Nigel
 
"For me, I think I need a higher ratio of apidra to carb for bigger meals than smaller ones"

My son finds this too. He can eat up to 60g carbs and cover it OK using his usual ratio, but if he eats more than that he needs to add a third as much insulin again.
 
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