Advice please

helensaramay said:

@Mad76 a healthy pancreas can time when to release incredibly fast acting insulin into the blood stream to match the peaks of carb release from food.
With injected insulin, we try to mimic this. Unfortunately, fast acting insulin is slow compared to the insulin from a healthy pancreas and different food releases carbs at different rates ... and this can vary more based on what is eaten with what.
If we inject too early, the insulin becomes active before the carbs are released and our BG goes low. If we inject too late, the carbs are released first and we see a peak.

The other thing about the insulin from a healthy pancreas is that it does not hang around in our bodies for long. Unfortunately, fast (ish) acting insulin hangs around, still active for 5 or 6 hours.
So, to mimic a healthy pancreas, not only do we have to time the insulin peak with the carb peak, we also need to bear in mind the length of time the insulin is active and hope this is not longer (or shorter) than the period over which the carbs are released.

The general advice is to bolus insulin 15 to 20 minutes before eating because NovoRapid graphs (see https://www.diabetes-support.org.uk/info/?page_id=408) say it starts acting after about this time. Unfortunately, many of us find it takes longer - I used to find it took 45 minutes.

By taking the insulin earlier, you are more likely to match the insulin peak with the carb release peak so the peak is lower. Sometimes, the insulin peak misses the carb release peak but, because more insulin is actrive at the carb peak time, your BG falls quicker.

Some foods (especially high carb and high fat foods, like pizza) take a long long time to release the carbs, this can lead to a late peak. Some people manage this with a double bolus - half before they eat and half a few hours later. Trial and error is the only way to tell what works for you for different foods. With pizza, I take 40% up front and the 60% over the next 4.5 hours (with a pump, this is easier).

If your BG returns to normal, you are taking the right about of bolus - it is just about timing. So I would not suggest increasing your dose.

Rises from food are normal. People without diabetes see some rises after eating. I like these graphs (https://imgur.com/a/wLiNa) from a student without diabetes using a Libre which shows these rises ... including some to around 9mmol/l.

My last comment would be about your starting point.
When calculating (guessing) insulin doses, there are two things to consider - how many carbs in your food and what is your starting BG. Ideally, the target is not where you started by somewhere between 5.0 and 6.0. So if your pre-meal BG is 4.1, you may want to reduce your insulin dose that you calculated from the carbs and if your BG is 9.0, you may want to add some more.
These two things use two different ratios (which you will learn on DAFNE) - insulin to carb ratio (how many units of insulin to take with 10g carbs) and insulin sensitivity factor (how many mmol/l does 1 unit of insulin reduce you by).

Sorry, if I have blathered on for too long and hope ths makes some sense.

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