Insulin dosing advice gratefully recieved

[Chris Bowsher]

Currently using

Levemir @ 23:00 18 u daily

Novorapid for meals, on average around 6 - 9 units each meal depending on what i'm eating.

I am carbohydrate counting and using ratios to calculate Novorapid doses - frequently 1u:10g

Injecting around 30 mins before meals (most of the time)

I am finding that 2 hours after eating i am often reading between 10mmol - 14mmol

then around 4 - 5 hours after eating, i am having to take extra carbohydrate to counteract hypos

Would this suggest that my basal insuln does is too high? and bolus too low?

Would it benefit me to try and reduce Basal dose and then increase bolus ratios also?


any advice appreciated.

 

[Deleted Account]

Might be worthwhile doing a basal test where you fast for 8 hours and work out what affect your basal is having over that time.
It is difficult to tell when you have food and bolus to interact with the basal.
Once you know the affect of your basal, you can start adding food and bolus.

But don't worry, you don't have to do the whole day in one 24 hour fast!

 

[Fairygodmother]

What carbs are you eating? The rate at which different carbs are absorbed affects blood sugars: your results suggest that you may have highs followed by lows because of this.
We’re all different. Do you get high readings after every meal or only after eating certain kinds of carbohydrate?

 

[Chris Bowsher]

@helensaramay thank you

 

[Chris Bowsher]

@Fairygodmother -

In my work week i tend to eat bran flakes and milk for breakfast

Generally a sandwich for lunch

not much else during the day apart from fruit or orange juice to counteract any hypos

EDITED TO ADD.

generally i would say that my blood sugar is high like this 2 hours after most meals, but comes back down within four hours ish

 

[NicoleC1971]

Peak action of your bolus is at 4 hours by which time you should be back to normal not hypo.
So I would do that basal testing although I suspect the basal action should be lessening over time.
As others have indicated high fat/hiigh carb meals will get absorbed more slowly and the contrary.
And finally when eating carbs/dosing insulin it is always tricky to get it right! (there are too many variables in an individual to fit into fixed rules).

 

[Chris Bowsher]

@NicoleC1971 thanks

when you say 'peak' do you mean it's action is almost over, or do you mean it's action is at it's strongest?

 

[Draco16]

generally i would say that my blood sugar is high like this 2 hours after most meals, but comes back down within four hours ish

Given this i'd suggest experimenting with pre bolusing earlier. I found with Novarapid I had to pre bolus 45-50 mins before breakfast and 30 mins for other meals. We're all different, but maybe experiment there.

While you're trying to get on top of this the other variable you could control is the amount of carbs in each meal - up to 90 grams of carbs in one meal is a lot. Fewer carbs make control easier. I'm not talking no carb or low carb necessarily, I limit each meal to c50g max and that makes control much easier.

 

[Fairygodmother]

@Fairygodmother -

In my work week i tend to eat bran flakes and milk for breakfast

Generally a sandwich for lunch

not much else during the day apart from fruit or orange juice to counteract any hypos

EDITED TO ADD.

generally i would say that my blood sugar is high like this 2 hours after most meals, but comes back down within four hours ish

That doesn’t sound like much carb, Chris, but of course it depends on the amounts.
Basal testing would give you a clearer view of what’s happening, I agree. I’m trying to remember, as I write this, what you said your bs were at the time you pre-bolus for meals. Do you check bs before you take the first bite too? Starting to eat when above 6 takes my bs higher before they begin, much later, to fall again.

 

[Fairygodmother]

Using a Libre helps to fine tune bs. Try it?

 

[Draco16]

That doesn’t sound like much carb, Chris, but of course it depends on the amounts.

I took the OP (with a ratio of 1:10) then 6-9 units would imply carbs per meal of 60-90g... 90g carb per meal is a lot.

Excellent point on where your BS start from before eating. If i'm in the 4s I can reduce pre bolus time and the amount I inject compared to if i'm in the 6s (and I mean I can reduce by more than the 2pt (6-4) difference suggests... eg 0.5 unit as a correction would bring me down 2, but for the same given meal starting in the 4s i'd inject a whole 1 unit less then if I started in the 6s). Just one of the hundreds of variables we need to consider!

And yes libre / dexcom can change your life!

 

[kev-w]

I am finding that 2 hours after eating i am often reading between 10mmol - 14mmol

then around 4 - 5 hours after eating, i am having to take extra carbohydrate to counteract hypos

To me the drop sounds like the 'tail' of the bolus, a quick Google says for Kellogs bran flakes -
Total Carbohydrate 79 g 26%
Dietary fiber 18 g 72%
Sugar 17 g
so I'd guess there's too much quick carbs for your bolus giving you the spike up and it's not unusual to have to snack to see off the bolus tail, for what it's worth, Weetabix are 69g/100g carbs with 4.4g sugars, porridge oats at 56g/100 and 1g sugars, sugars of course are simple carbs that digest faster than the insulin is taken up and can spike you. (think glucose for a hypo)

Just my opinion mind.

 

[donnellysdogs]

I would have said that your basal is too high to be honest.

Bolus is at its peaking for working at 2-3 hours and can remain in tailing off up to 6 hours...

So if you were to increase your bolus to cover food and tail off you wwould need to reduce your basal.

My best consultant ever told me that if high or low 2-3 hours after eating its your bolus.. all other times its your basal.. so if you are having a peak first that needs more and if you are then tailing oftf and hypo at 4-5 hours then your basal need s to be lower, not hiigher.

The best way is to basal test.

 

[Chris Bowsher]

@donnellysdogs @kev-w @Draco16 @Fairygodmother

thanks for your input guys. I've taken it all on board.

 

[Chris Bowsher]

@kev-w good point on the type of cereal i am eating.

I think i will try the porridge daily instead of the bran flakes.


also i am finding a low carb evening meal really helps with overnight blood sugars.

 

[Engineer88]

@kev-w good point on the type of cereal i am eating.

I think i will try the porridge daily instead of the bran flakes.


also i am finding a low carb evening meal really helps with overnight blood sugars.

I find the worst carbs for me are breakfast, have you considered lowering those?

Secondly have you ever tried anything other than Novo? I was using it for years even though I repeatedly told consultants it wasn't working properly.

 

[Chris Bowsher]

@Engineer88 thanks for advice.

not tried anything else, Novo rapid seems to work for me, been using it for a long time.

Out of interest what were your issues with Novorapid?

 

[Engineer88]

@Engineer88 thanks for advice.

not tried anything else, Novo rapid seems to work for me, been using it for a long time.

Out of interest what were your issues with Novorapid?

It had no action for up to 2 hours post injection and sometimes longer. its fund the longer im on an insulin the more resistant I become to it.

 

[static192]

wow i thought i was the only one that finds novorapid doesnt work very well and when i use to go to the doctors they use to think im not taking care of my diabetes by purpose

 

[SallyEzra]

Hi Chris,

I found reading your posts, really interesting & highlights to me again how each of us can respond so differently to our meds. To me it definitely sounds like your Novorapid takes a while longer to get absorbed & start working, as you are already taking bolus 30mins pre meal with blood sugars rising to 10-14 in the 2hr window post eating. For me, I can only take my Novorapid (on pump) at the point of sitting with my meal in front of me or else I risk being hypo within the hour. For your blood sugar to have dropped so rapidly into hypo a further 2-3hrs down the line, may suggest that you are getting a delayed hit of absorption from that pre-meal bolus. Such a rapid decline from a blood sugar of 10-14 to hypo would indicate bolus rather than basal because if your basal injection was elevated that significantly above your needs, you would expect it to affect you with hypos more frequently throughout the day.

However, like others have suggested, a basal test may be the first most helpful thing to do. Personally, I find everything much easier to manage once I am happy that my basal is correct for my current way of life & then I find it far more straightforward to isolate & examine individual bolus periods throughout the day. At least then you can be confident that the basal is OK, rather than trying to juggle too many possibilities.