Injecting Insulin before or after meals

[a2412]

My other half has been injecting his rapid-acting insulin either mid-way but more so directly after meals. I know it increases post-prandial glucose levels and the spikes in glucose levels aren't good for long-term, even though he takes a long acting insulin at night.

I was telling him that he should be injecting before meals but he's not comfortable with that because he bases his units on how much he eats, he seems to think that injecting pre-meal increases the chances of a hypo because what if he doesn't eat enough.

I just wanted to know, does it really make that much of a difference if he injects directly after a meal or mid-way through or should i be trying to help him to inject pre-meal?

 

[Brendon.Dean]

My other half has been injecting his rapid-acting insulin either mid-way but more so directly after meals. I know it increases post-prandial glucose levels and the spikes in glucose levels aren't good for long-term, even though he takes a long acting insulin at night.

I was telling him that he should be injecting before meals but he's not comfortable with that because he bases his units on how much he eats, he seems to think that injecting pre-meal increases the chances of a hypo because what if he doesn't eat enough.

I just wanted to know, does it really make that much of a difference if he injects directly after a meal or mid-way through or should i be trying to help him to inject pre-meal?

Yes, it makes a significantly noticeable difference on insulin - meal timing.

 

[dancer]

If he is insulin sensitive it could make sense to inject once he has finished eating. If he's not insulin sensitive then injecting before meals is more likely to give better control.

 

[a2412]

If he is insulin sensitive it could make sense to inject once he has finished eating. If he's not insulin sensitive then injecting before meals is more likely to give better control.

what do you mean by insulin sensitive? How do you know how much to inject when you dont know how much you're going to eat? surely it increases hypo chances ?

 

[dancer]

I am insulin sensitive. Little changes in insulin can cause big changes in blood sugar. If I bolus before eating but don't eat what I expected to, I would then go hypo. This can happen to anyone but for those who are insulin sensitive, it causes more problems.

 

[jlarsson]

It depends on current blood sugar and what you're eating as well. Some meals will take a while to have any noticeable effect on your blood sugar so it might be a bad idea to inject before and get an unintentional hypo, and vice versa.

 

[SimonCrox]

I think that there is some work in children showing rapid acting analogue OK after meals:-
http://care.diabetesjournals.org/content/26/8/2359

I have seen something on the new Fast Insulin Aspart working OK after meals, and OK 20 mins after started food:-
https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1595
In ONSET 1, Fast Insulin Aspart had slightly less HbA1c reduction after meals than before, but slightly fewer hypos.

Health care professionals on rapid analogues often take it post prandially cos they never know if they will have to dash off before end of meal; in folk with dementia, one never knows if they are going to eat the whole meal, so post-prandial novorapid if they eat the whole meal, nil if they don't, is a valuable trick, and I believe the same applies to some children.

So, there is evidence to show post meal or during meal rapid anaolgue works OK and has fewer hypos; I think any of the anaolgues eg Novorapid, Humalog and Apidra would be similar (pick the one whose pen you prefer) but Fast Aspart might be a bit better than the origianl analogues.

Best wishes

 

[kitedoc]

It is all about timing, insulin absorption and type of food in a meal and time of day.
I used to give my Novorapid one hour before having, say. breakfast because the Novorapid was taking 2 1/2 to 3 hours to reach its peak effect. Otherwise, taken say, 1/2 hour or at breakfast time the blood sugar rise from the meal got ahead and sometimes I would hypo later because I had mistakenly thought a bigger dose would thump down the blood sugar and all would be well.
Taking the insulin after the meal because he does not know how much he is going to eat is not seem sound. The idea of the diabetic diet as I understand it is to stick to same carbo intake, even if the actual food is varied. His way of doing times is like chasing his own tail. Apologies for being blunt but that is the reality.
I have not used Fiasp but from its profile and the response from those that have used it suggests that it could be used at or just after meal time - but I bow to those who have experience of it.
The only other way maybe, and it is a big maybe, is to have something like beans only for breakfast ( and not broad beans). The lower GI etc might, just might, give the after meal insulin a chance to catch the relatively delayed sugar peak.
At other times of day my insulin resistance/insulin effect may vary from that of breakfast. Anyone on an insulin pump knows that the basal insulin rate varies across the 24 hours. And the settings for insulin to carbs ratio etc vary also.
I wonder if this explains the sensitivity in insulin some have in regards to its effect and risk of hypos, or whether this is more related to an unusually rapid absorption of insulin after injection.
I have not tried the low carb diets specifically and so am inexperienced in stating how they might work in his situation but others may have some helpful info on this.
I hope answers to your question may help him to see his way towards more sensible habits.

 

[Deleted Account]

Without evidence such as Libre history, it is difficult to know how far in advance of a meal you need to inject.
It may also be difficult to know how much of a meal you are going to eat (especially when eating out).
Therefore, I do not think it is a terrible thing to inject during or after a meal.
As others have said, it depends what he is eating ... and how fast he eats.
But it is much better to inject during or after eating than not at all.

 

[becca59]

[ The idea of the diabetic diet as I understand it is to stick to same carbo intake, even if the actual food is varied.

Since when? I always thought the whole point of basal bolus was to be able to eat what we want when we want. My breakfast carbs will be nothing like my lunch, and my lunch today will be nothing like yesterday’s.

@a2412 injecting before/during/after will depend on levels before eating, what he is eating, and from experience knowing how that insulin reacts at different times of the day. It is a steep learning curve.

I suggest he starts with breakfast, as that tends to be at the same time and we tend to eat the same things. Check levels 2 hours later, if excessively high inject earlier and vice versa. If more or less right then leave things as they are. Then choose another meal. Be disciplined, decide carbs to be eaten and stick to it. Though if at the end something hasn’t been eaten, substitute a jelly baby to make the carbs up. Don’t as yet eat more than injected for. It’s a good way of not overeating.
Unfortunately this disease is all about discipline, the handling of it gets easier and he will find his own way.

 

[becca59]

I’m afraid this hasn’t posted as I intended, everything after the first paragraph is mine. Apologies to Kitedoc

 

[kitedoc]

I’m afraid this hasn’t posted as I intended, everything after the first paragraph is mine. Apologies to Kitedoc

No problems. Gremlins are found everywhere when it comes to the internet.

 

[Rokaab]

I’m afraid this hasn’t posted as I intended, everything after the first paragraph is mine. Apologies to Kitedoc

No problems. Gremlins are found everywhere when it comes to the internet.

It's actually more-than-likely because the quote tag (the [ / QUOTE] without the spaces) is more than likely at the end of the whole post (or it may have been inadvertently deleted) rather than at the end the quote text is

 

[Draco16]

I know we're all different, so advice I was originally given (inject at the same time as your first mouthful) might not be so bad for everyone... but for me by far the biggest improvement in my control has been pre bolusing, which CGM revealed.

Broadly I used to test at 2 hours after eating and maybe be ok... but CGM revealed the spikes that were happening in the intervening time.

I'm now horrified by the general inject when you eat guidance. Though worse I remember a girl on my DAFNE course who would only inject after she'd eaten... she never had a bs reading below 17 all week.

This is why I find eating out so hard... what time will the food arrive, and how many carbs will it contain... when and how much to pre bolus.

Maybe the OP's OH could try injecting half before and the other half after (if needed).

 

[a2412]

I'm still really confused. Whats the main issue behind injecting after meals?

Isn't injecting before meals increasing chances of a hypo?

 

[SimonCrox]

If using a rapid acting analogue eg Apidra, Humalog, Novorapid, FIAsp, injecting after meals allows you to set dose according to how much you have eaten, and is slightly less likely to cause hypos, than injecting before meals.
The confusion arises cos the original insulins took a while to have a peak effect so that it was recommended to take them a while before food (which was difficult to do - see comment above about eating out), and then the rapid analogues came out that could be given immediately before meals (a great step forward) with less hypos than old insulins. Then folk hit on the idea of giving at end of meal, and was found to be Ok in kids so was done in adults.
best wishes

 

[Draco16]

I'm still really confused. Whats the main issue behind injecting after meals?

That you spike bs to high levels as even fast insulins are not fast enough to catch up once food has got the headstart.

Obviously depends on what and how much food, how much insulin, metabolism, time of day / month etc, etc, etc.

Why not get a Libre as a one-off so you can both see what is going on? Or as an alternate do some intensive testing on a few different meals.

Take readings before eating, when finished and then every 20 minutes to the 3 hour mark.

Then use that information to determine the value or otherwise of pre-bolusing for your OH.

 

[LooperCat]

It’s a flippin’ nightmare, isn’t it? Since I did DAFNE in 2011, I’ve injected my Novorapid as I sit down to eat, as taught. Tested two hours later, and things were pretty much back to pre-meal levels. So I always did that - until I got my Libre on prescription in January. Oh boy. Massive peaks an hour to 90 minutes after eating that I’d never seen before. So I tried pre-bolusing, but had very little success with it - for a couple of reasons: the main one for me is social - if I’m “waiting for the bend” (a Sugar Surfing technique where you inject and wait for the insulin to just start bringing your BG down before eating), it doesn’t always coincide with when we’re eating as a family as the time it takes to kick in can vary, and half the time I end up eating alone while the family eat their meal when it’s ready. I got fed up of having to have a sandwich before dinner time because it had started working sooner than expected, or a cold/microwaved meal if it was later. And as for eating out... So much for “normal eating”! The other big reason is that I’d often have a hypo soon after a meal, as the insulin would start working before the food was absorbed. I’m good at maths, and have no problem with the calculations, but my stupid body doesn’t always pay attention

My solution doesn’t suit everyone, but works for me and my life. I just drastically reduced my carb intake so I don’t need to take any bolus at all, unless it’s a meal containing a large amount of fish protein, in which case I inject for the protein at half the amount I would for carbs. I’ve found that the BG rise from protein in the absence of carbohydrate pretty much matches the action of my Novorapid.

If your OH feels uncomfortable injecting before a meal, perhaps he could switch to FIASP? Much faster acting than Novorapid for most people, and better suited to injecting at or after eating. It’s not available everywhere, I don’t think, but might be an option for him if he can get it.

 

[Circuspony]

I haven't got a CGM but I inject around 15 mins before a meal because that's how long it takes novorapid to be absorbed. I always test my BG first so if I'm very low then I might delay a bit.

I hold back when eating out due to portion sizes and kitchen delays, but at home I like to give it a head start.

 

[novorapidboi26]

Most folk will chose their meal and eat it......

if your partner consistently cant finish his meals then its fine to inject just after a meal I would say.....

novorapid is marketed to start working ten to fifteen minutes [or there about] after being injected, so for most that means injecting before, so that the insulin begins the same time as the digesting does, which is quite quickly...

ultimately its all about the spike when considering timing......if the 1.5 hour test shows a number that's above your desired target, then the timing needs to be tweaked.....

if the anxiety of possible hypos is too much then that's another issue completely...