Hi Anna!
anna29 said:
I am looking for information on the fast acting insulins and the easiest way/methods
to work out the amount of carbs .
Which bolus insulins are the slowest or the fastest etc ?.
There are two main types of bolus - short-acting and rapid-acting. Short-acting needs to be jabbed about 45 minutes before you eat and last a lot longer in the body. I don't think these are used much these days. The boluses that most of us now use are the rapid-acting - Apidra, Novorapid or Humalog. They are all pretty similar as I understand it. You jab them just before or just after a meal. They work within about 10 to 15 minutes and are out of the system in 3 to 4 hours. However, they work differently for different people and different types of food. I use Apidra - I find it quite aggressive in its action. I jab just before eating and its used within 3 hours, so if I have a high fat meal, I sometimes have to split the dose and take a little with the meal and another unit or so 2 to 3 hours later. Many people report that Novorapid is slower to get started and has a bit of a tail at around 4 hours. My consultant denies this is the case and I haven't used it, so can't say for sure, but so many people claim this that I'm inclined to believe it.
Humalog and Novorapid can have 0.5 unit increment pens, whereas Apidra only has a 1 unit increment pen. To get around this, I use the Eli-Lilly Humapen Luxura HD (which is meant for Humalog) with the Apidra cartridges - it works very well although I doubt you'd get a nurse to recommend it.
anna29 said:
How do you work out your carbs eaten and calculate for the bolus needed ?
I have the Carb, calorie and fat bible (or something like that) and it has all the major foods in it with their carb content per 100g. For most of my favourite foods, I now know the carb content of 100g, so I don't usually need the book anymore.
At first I used to weigh everything precisely - after a while you can judge how much a portion of something weighs. My mobile phone has a calculator, so I use that to work out the carb content of each item in my meal and then add it all up. As my insulin:carb ratio is 1:8 (sort of) I then divide the total by 8 to arrive at the insulin dose I need. The best advice is to start out assuming an insulin:carb ratio of 1:10 and adjust from there. You should also assume a unit of insulin will drop you 3mmol and, again, adjust from there. Actually, a unit drops me by a little over 4mmol. Now I know that a roast dinner of my normal portion size needs 2.5 - 3 units Apidra, so when I eat out I know what to jab for that meal and don't need to work it out.
anna29 said:
Do you bolus with every meal ?
Yes. Even no and low-carb meals. At first I didn't need to jab for a chicken salad lunch, for example, but after a while my BG was rising into the 7s and taking several hours to come back down, so now I jab 1.5 units for my lunch. I would even jab 1 unit for bacon and eggs. It's a bit trial and error, but you work out what your body needs in the end. I have to jab for the protein elements of the meal because I low-carb (50g a day) and my body turns part of the protein to glucose. I think if you high or normal carb, you'd be taking much more insulin and the protein bit would be lost in the noise and not worth jabbing for.
I find it best to eat 3 meals and jab for each. Snacks are problematic as I would need extra jabs for those and you can start stacking the insulin if you're not careful, so I don't snack usually. If I do snack it would be a few almonds or a small piece of cheese for example to avoid another jab.
Take care
Smidge
