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Fast acting insulin

purrpleness

Active Member
Messages
33
Type of diabetes
LADA
Treatment type
Insulin
Hi guys, i have a question regarding Trurapi. I thought fast acting insulin was supposed to work, well fast?
My control has been shocking, i am like 6% in range. I take my Lantus every morning and i was given 1unit for every 30g, that didn't work at all, so we now changed it to 1:20. Also, going by my CGM data, no matter what i eat rises me but apparently i peak at lunch time, so i was told to take insulin with my lunch. I haven't been doing so, I'm a pretty big snacker also, so even if i did take the insulin with my lunch, an hour or so later i'd say have some crisps. - Anyway i was doing the bolus for a few weeks and gave up as it wasn't really doing anything, But today i decided i will be good, i had 2 sausage rolls, each at 24gs, My diabetic-M app told me to bolus 5 units of trurapi, all good. Took it. I still hit 22mmol, Literally it has taken 4 hours for me to finally get to 12mmol where i am sitting now.
I thought fast acting was suppose to be fast? Surely i shouldn't be still hitting 20+mmol after taking 5 units of fast acting insulin and not dropping till 4 hours later? I believe thats why i just hadn't bothered doing it (i know the risks) - i hit 27mmol yesterday because i had beans on toast for lunch, i felt sick the other night at work for no reason also, tested ketones when i got home and they were 0.7, that did scare me, that is why i am going to do better.
What i'm asking is, how long should it take for your bolus to work?
Thanks guys.
 
Hi @purrpleness , it looks like you're still working on finding the correct doses for you.
This takes time, trial and error.

Some people need 1 unit for 30 grams of carbs, others need 1 unit for 3 grams of carbs.
So usually, people are started on a relatively low dose and slowly titrate their way up until it more or less works.

It's a massive help if you log your carbs and blood glucose before and after food. With this information, you and your diabetes nurse can work out how to adjust your doses.

On how long it takes to work, standard advice is to inject some 15 minutes before eating, are you doing this already?
For some, this works well, others find they need to give it a bit more time.

Good luck!
 
I take Trurapi and find it takes 4 to 5 hours before my blood sugar returns to where it was before the meal. Depending on what I will eat, I often inject 1 hour or 1.5 hours before the meal in order to avoid a high spike, but at the same time I'm careful and ready to eat in case it starts working earlier. I find it inconsistent, but it does eventually work.
 
Hi Antje,
Thanks for your reply. I always log my before and after my blood glucose, not always the carbs though as i do remember what i had eaten, yet i haven't been bolusing for it. It's been a while actually that i might drop my diabetic team an email, they're very good at replying or even jump straight to my dietician as they all work together. I have just had my evening meal and i am actually in range for the first time!! i don't take fast acting for my evening meal, especially if it takes all the way from lunch to my evening meal to go into range, i don't want to take any more.
I'll get onto my DT and see what they think Thank you.
 
Hi Jat1,
Thanks for your reply, so Trurapi isn't really fast acting after all then? lol I had those sausage rolls today at 12.30pm took 5 units, i was already sitting at 15.5mmol (thats just from a coffee) and it is now 7pm and im finally in range. I'm not used to being in range anymore, so used to feeling anxious from the high feeling, i'm looking forward to working this out and feeling what i would call 'normal' for a change
How do you know if youre going to eat within that time frame unless you are cooking? i eat when i am hungry, if i waited say for a sandwich i would probably not be hungry anymore.
Why are people given different types of insulin? I understand the difference between long acting and short acting, how come there's not one fast acting that fits all if that makes sense? Sorry for all the questions, still learning lol
Thanks again
 
purrpleness said:
so Trurapi isn't really fast acting after all then
Click to expand...
It’s relative.
Injected insulin is not as fast as the insulin a healthy pancreas can produce.
But bear in mind that although it can still be working 5 hours after injecting, this is the “tail” as you can see if you Google ”Trurapi profile”. It starts working about 20 minutes after injecting and has a peak.
And carbs are not absorbed as soon as you put food in your mouth. It depends upon the food. As you probably know from hypo treatments, some carbs are absorbed within about 15 minutes but, if you have tried pizza, you will know that this can affect your BG 4 hours after eating it.
The trick is to time your bolus so that the peak of activity coincides with the peak of carb absorption. Twenty years after diagnosis, I am still amazed when I manage it. That is only possible because I have worked out what my insulin to carb ratio and knowing that it can differ at different times of the day.

As you are newly diagnosed, be nice to yourself and do not expect to get the timing and ratios right all the time.
 
Hi @purrpleness

Most long term T1s need to inject fast acting insulin before each meal (or snack). They sometimes prebolus (inject early) so as to have the insulin acting when the food starts hitting their system. If you have something which has slowly digesting carbs (hello pizza) you sometimes need to split your bolus (inject before and after). If you don't produce any insulin of your own, the long acting insulin covers your needs when you aren't eating (eg overnight) while the short acting is meant to cover your food intake.

If you don't need to inject before your evening meal that suggests that you are still producing some of your own insulin (honeymoon period?) but in the long term your insulin production should reduce and I'd expect that you'll need to inject more.

Have you been on a DAFNE course yet? That could help you learn to adjust your ratios. (They can vary by time of day, weather and also time.) I would expect that yours will change quite a bit as you move out of the hoenymoon period. You can also give correction doses if you find your bg is high before a meal....

Learning how to adjust your doses takes time, but makes a massive difference to managing levels. (Well, it does for me.)

I second the suggestion to keep records and contact your diabetic team.
 
Sometimes I find bolus increase is better especially with infection it's seems more stable(tresiba). Saves chasing with your rapid, though I try to stick to fixed doses of rapid but sometimes need to adjust depending on mmol.
 
A few suggestions:
Firstly, are you keeping a dialy diary of eating, glucose levels, insulin used etc. Having a record can help you track your diabetes and identify patterns and triggers for high or low glucose levels.
Next, has your specialist team considered splitting your basal insulin - Lantus can stop working after around 18 hours. Moving to another long acting insulin will allow a split dose, increasing the level of cover.
Are you injecting your fast acting insulin immediately before eating - research has proven it works best being injected around 10 minutes beforehand. However, using a diary will also help identify whether you might benefit from altering the time up to 30 minutes before eating.
Are you on any other medications. Many medications can impact on glucose levels - over the last year I have been prescribed medicine that massively reduced glucose levels to hypo levels. Now I research every medication before taking it because the Patient Information Leaflet is useless in this area.
Finally, knowledge in power. Ask about getting onto the DAFNE course which will provide a brilliant understanding of diabetes, how it affects you, and how to live a normal life with diabetes. Full details can be found on Diabetes UK or through your Nurse Specialist.
The important thing to remember is that your diabetes is your condition - get your knowledge up to date and don't let doctors and nurses assault you with a 'one size fits all' approach because it never will!
 
Thank you for your reply,
I have been in contact with my diabetic team since i wrote this post and this lovely nurse was very helpful and possibly the first person who actually made sense to me. I am understanding it a lot better now, i log everything in my Libre app, doses, carbs and put what I'm eating in the notes so that they can see it on their end. I do need to talk to the dietician again though as my Diabetes:M App settings need adjusting again, as it told me to take 7 units of insulin the other day and thought nothing of it and did as i was told then realized i usually take 4units for what i had just ate and did actually drop fairly quickly, so had a few sweets. I was advised to take 1 unit when i have a coffee as i rise pretty high, but i drink so much coffee through the day, i don't want to stack. I am currently waiting on a call back from the nurse when she's next free to see how i am getting on

She asked me where i wanted to be as far as levels go, obviously i said "in range" (which surely that's what they want too?) So she explained to me 1unit should drop me 4mmol or 3mmol, we will work that one out, so if i bolused for the food, it obviously only covers the carbs and if i was already high then i would only return back to that level, so an extra unit would bring me lower - That's the part that made perfect sense and has helped me a lot. I'm still never in range though.

My sister has been Type 1 since childhood, so i go to her a lot for any advice, i got diagnosed last year age 36. I was offered the DAFNE course, i declined due to really bad anxiety, I take Propranolol for it, been on it for a few years now and it doesn't touch my levels thankfully.
 
purrpleness said:
I was offered the DAFNE course, i declined
Click to expand...
Sounds as if you are picking things up which is great.
If you feel the DAFNE is not for you, there is an online version called BERTIE which you can go through at your speed. This should help with things like carb counting in more detail (Especially for foods that are digested at different rates) as well as basal testing and variation such as when you exercise, when unwell, etc.
 
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