Few questions on insulin pls.

EllieM

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Yes thats my next step but generally I seem to get better input from forum members than my medical team! If I may ask, what do you take to treat hypos and whats your general process in terms of how long before you recheck etc.
I take glucotabs (usually a couple is enough for me though others need more) but I have a history of losing hypo awareness if I have too many hypos so I have a cgm (dexcom in my case) which alerts me when I get to 4.4 so I am able to treat at 4,4 and rarely go lower than the high 3s. To be honest, if you have dodgy hypo awareness I'd strongly recommend a cgm. Depending on your location you should be able to get it funded by your clinic. (eg all T1s in UK qualify, I'm in NZ where no one does).
 
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Clueso

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It comes down to the right timing and dosing of the particular food you ate. Not always the easiest to figure out.

I am going to hazard a guess that something you ate with the pasta had some fat content. Given that you have said you dropped to a 3 after an hour then shot up to a 12 later. The jelly bean at 2 carbs each/4 carbs is usually a good amount to treat a hypo. But it can depend on how much insulin is hitting etc.

This is a guess, since I don't know what you ate and we can all be different in how we react. In this case I would guess your prebolus timing and then dosing were off.

Since you had eaten, the jelly beans negated some of the insulin you took. Let's go with the assumption your insulin hit faster than your food. You dropped, ate the jelly beans, and then proceeded to climb as your food digested. But at that point you didn't have enough insulin. Some went to the jelly beans originally, but it sort of sounds like you might not have had enough insulin for your meal too. 2 jelly beans commonly would not make you go from 3-12. Some of the food did that, meaning at that point you hadn't had enough insulin.

Fat content slows down the absorption of the carbs. So you prebolused for that particular meal too soon for the food you ate to hit. So you dropped. If something has a higher fat content, I don't necessarily prebolus. In this case I would say you needed the jelly beans because you dropped, but you needed more insulin for your food. With a higher fat meal, I commonly do my insulin in stages. I don't always prebolus for it either. There are variables of course for all of us in digestion time, insulin need and timing.

Example for me, a vegan taro donut. High carb with fat content because it is deep fried. I dose a third when I eat it, a third a half hour later and another third an hour after........ and adjust with some later if needed.

Higher protein can also hit later. But even if it wasn't high fat.......... your insulin dose hit too early for your food. In that case you could be really insulin sensitive. Your insulin hit before your food. But you went too high, doubtful the jelly beans caused that increase. So then it comes down to... not prebolusing so early for that meal, and potentially needing more later because it wasn't enough.

And always keep in mind things can vary, we have usuals. But usuals can be influenced by say heavy exercise earlier or even the day before.

It's very unfortunate you don't feel hypo's. Some people just don't. Most of us can reset at what level we feel them by making sure we don't have any so you become sensitive to them again. If people drop too much all the time, they stop feeling them or don't feel them until they are really low. When I first started using insulin I felt anything under 100. Now they don't bother me until I am somewhere between 3.3-3.9 (60-70). It is unlikely since you just started insulin that you have had a lot of lows? Although I do remember a few people said they experience hypo's when they first were having issues with BG levels.

Hope this helps, just keep in mind we really can all vary in our response and our needs.
I cant thank you enough for your thoughtful, analytical and detailed response. I think you have found where I went wrong and something I simply didnt consider in that the inulin worked before my food and makes sense as I waited an hour after insluin to consume my meal. I probably overdid this!

Your comment in relation to 2 Jelly Beans unlikely to be the culptrit makes perfect sense.

I think next time, I will just do it 15 mins prior and then see how I go as its always better to be able to adjust from high sugar to low than the reverse.

What threw me off was even after 12 hours I was over 9 and I was simply too scared to take more insulin. In terms of answering your query no it wasnt a meal with much fat, just carbs and a fair bit of it. But I also have the added challenge that since I am LADA, I am still creating a bit of insulin naturally which makes the balancing act even more challenging.

Can I ask, what is your hypo treatment and process?

Again, thank you for your detailted reponse. Its changed my outlook!
 

Marie 2

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I would get a CGM like @EllieM has said, you would find it so beneficial especially if you don't feel hypo's.

I aim for around 5.2 (95), but I pretty much accept between 4.4-6.1. (80-110)

When I'm at home, low trending or slow drop..... 1 or 2 chunks of fresh pineapple that are about 2 carbs each. Maybe grapes. Faster drop, a few sips of OJ or 2 vegan ***** bears, at 2 carbs each. Sometimes I will use a vegan candy bar I like. 1/4 is 6 carbs, a 1/3 is 8 carbs. It's nuts and caramel, the nuts help stabilize me longer and the caramel part is fast acting. Good for a more stubborn low or a repeat low. At home though I have several choices if I want.

If I am out and about, I always have the vegan ***** bears with me and a candy bar. I have found that sucking on the vegan ***** bears as they are coated with sugar help them work faster. They taste good and hold up really well.
 
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In Response

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@Clueso I think you are expecting carbs from all food to be absorbed at the same rate.
Earlier, I mentioned that carb dosing is about quantity and timing.
AS we are all aware, there are fast acting carbs which we use to treat hypos.
There are also slow acting carbs, typically food with fat which slows down carb absorption.
High fat, high carb meals such as pizza or, as you recently tried, pasta with a creamy sauce are harder to work out timing.
These meals can affect my blood sugars for 4 or 5 hours after eating and require split bolus (a small amount before eating and the rest an hour or so later).
We are all different so you need patience to work out what works for you. This will result in some mistakes but that is something to learn from.
 

Finnlee

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2. I am also trying to figure out how long before my meal should I take insulin? I have tried 15 mins before and yesterday one hour before food and I still went down to 3. Logically I know I should probably take 2 or 1 units and see how I go, but I still need to know how I manage hypos without overshooting on the high end.
A 15 minute pre-bolus one day and a 1 hour pre-bolus the next is a big difference. I'd say start with a small pre-bolus time (10-15 minutes) for a few meals and see how it goes, keeping in mind that the pre-bolus time that works for you will probably vary between breakfast, lunch and dinner.

I found I need to be very careful with my pre-bolus timing.

Usually, I aim for a 30 minute pre-bolus for breakfast, but it can be anything up to 1.5 hours if I get up late and have to deal with dawn phenomenon. I try to wait until my CGM reads 100mg/dL (5.5mmol/L) to eat.

Lunch and dinner, I generally bolus right before I eat. For a while, I found I needed to bolus for dinner 20 minutes after starting to eat otherwise I'd go low mid-meal.

Generally, if I go into a meal on the low end, I'll eat a bit of my meal before bolusing. If I'm high, I'll bolus a bit earlier and keep an eye on my CGM.

My current pre-bolus times are with Humalog and NovoRapid. Other insulins like Lyumjev and Fiasp will need a shorter pre-bolus time, if any pre-bolus at all. I've got some Lyumjev to try out, so soon I'll be playing the pre-bolus game all over again, but cautiously to avoid wicked lows.
 

Circuspony

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@Clueso I was diagnosed in my 40s and I'm on Tresiba and Novorapid. I do a fair amount of exercise which also makes dosing more complicated.

The first thing I learnt was there is no point in getting too stressed about numbers going up after eating. Our bodies don't process insulin at the same rate as they process food - & it's different for all of us. My friend's teenage son can bolus at the same time as me, eat the same meal and we'll both have dramatically different BG levels an hour later. His are always better than mine which is annoying!

So please try not to stress as you work out how dosing works for you. It's more of an art than a science .......
 

Clueso

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Thank you everyone for your words of wisdom. All of you have given me a lot to work with. As we all know, this is a disease that is much as its the old pancreas failing, its a mental rollercoaster.

I think now its clear I pre bolused too long and should make it 15 mins prior to meal and see how I go. But then I need to work out when does my body digest a meal at its peak a basic bowl of pasta or rice.

Last question to everyone if I may, when you do have a large carb meal (without much fat) even after injecting necessary insulin, what do you expect your peak blood sugar to get to and then how long will it remain there before it comes down to your target?

Reason I ask that is, maybe I am expecting too much. I seem to go to around 10 after 2 hours and remain there for another 2 or 3 hours.
 

Marie 2

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@Clueso I don't think you can judge by what I do though. It took me years, an insulin pump, a CGM and retirement. Plus I happen to be considered one of the most controlled people. Each person can also be very different in how they respond and each person can have things that affect their control. Everyone because of illness, job or circumstances can make control easier or harder. I would not be able to do this well when I was still working, I maintained a 44 (6.2) level when I was working.

I don't expect to go above 8.3 (150) and I usually don't. It doesn't mean I'm always successful though. But I have my alert set at 7.2 (130) so I watch and see if I continue to go up. I usually eat at home so if I go above 7.8 (140) I get on my exercise bike to stall it or stop it until my insulin can kick in. As soon as you throw fat into the mix with high carb though, I will then need some insulin later.
 
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becca59

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@Clueso you ask about peaks after eating. We are all different and manage these in different ways, particularly now we all wear cgms and see these peaks in real time. However the rule of thumb is you need to be back in range 4-5 hours after eating the meal as that is when the insulin generally finishes working. If you are not then there are things to work on. There is so much written on this forum about peaks and testing before and 2 hours afterwards. This is for type 2s who are producing their own insulin. When you throw insulin injections into the mix it is a whole new ball game. Those peaks hanging around are about insulin timing, how old the insulin is, how much exercise you have taken part in that day, how carb heavy a meal is and what other things you ate at the same time and what level you were when you ate more food. Stress is also a big factor. If you are constantly worrying about what level you are this can have an impact-infuriating-but true.
Keep experimenting, but don’t beat yourself up if each day is not the same.