Insulin Reaction Curves

[Tokolosh]

Hi All

I’ve had a look around this site about this subject and can’t find anything. Very possible my eyesight is the failure if I’ve missed it as I have severe sight impairment. So decided to try and ask here if anyone knows of where to find it on here or if there are any good documents.

For a while now I have been monitoring my BG more closely due to more available time and noticed there is about a 1.5-hour gap before my short acting Insulin starts to bring my sugar down. To try and keep my BG steady at ~8mmol I’m finding I need to wait 2 hours after taking my NovoRapid insulin before eating. I spoke to the DSN at the diabetic clinic who suggested trying different short acting insulin’s to speed up the reaction curve. The DSN suggested Fiasp insulin but after trying this for about 5 weeks, I’m finding the same reaction time to that of NovoRapid. The DSN has now suggested Lyumjev and gave me a link to the manufacturer about this insulin. I went to the site and although it states this insulin may react quicker than other insulin, there is no profile / reaction curve tables.

My Question:
Is there a document or site that one can look at all the various insulin profiles / reaction curves.

 

[EllieM]

Hi @Tokolosh I generally find that googling "insulin-name profile chart " gives me some useful info and pretty graphs.

eg

Onset of Appearance | Fiasp® (insulin aspart) injection 100 U/mL

View the Fiasp® (insulin aspart) pharmacokinetic profile and learn about its onset of appearance vs NovoLog®. Read Important Safety and Prescribing Info.

www.novomedlink.com

Having said that, what is your bg when you inject your insulin? I find that my insulin (humalog, which is supposedly similar to novolog) acts a lot faster when my bg starts at 5 or 6 compared to 8 or 9. And if I'm over 10 my insulin resistance seems to go up and it takes simply ages....

 

[Tokolosh]

Hi @Tokolosh I generally find that googling "insulin-name profile chart " gives me some useful info and pretty graphs.

eg

Onset of Appearance | Fiasp® (insulin aspart) injection 100 U/mL

View the Fiasp® (insulin aspart) pharmacokinetic profile and learn about its onset of appearance vs NovoLog®. Read Important Safety and Prescribing Info.

www.novomedlink.com

Having said that, what is your bg when you inject your insulin? I find that my insulin (humalog, which is supposedly similar to novolog) acts a lot faster when my bg starts at 5 or 6 compared to 8 or 9. And if I'm over 10 my insulin resistance seems to go up and it takes simply ages....

Hi
Thanks, I was only googling name reaction curve lol. Will do the profile next time.
My BG can vary a fair bit between 4 and 10 but sometimes goes plus or minus either end. I had thought about the different BG values and done a lot of testing around either end of the scale. I've always worked my insulin intake as anything up to 10, I will inject 8 units, anything above 10 I inject what ever the BG is. i.e. if BG is 12mmol I will inject 12 units. This is for a normal meal of anything between 35g and 45g of Carbs. 50g and above I adjust the amount of Insulin accordingly. I did find I needed to reduce this when trying Fiasp. I agree with the higher the BG, the longer it takes to come down below 8mmol. But the start of the Reaction Curve is always the same at 1.5 hours for either when the BG is below 4mmol or above 10mmol. I worked the 2 hour wait on me for BG of between 4 and 10mmol and is mostly always the same time.

 

[Tokolosh]

@EllieM
I've just taken a closer look at the Link you posted. That's exactly what I was looking for, so thankyou.
Looking at the chart, I'm starting to think I'm understanding the times incorrectly. When I look at the Chart and the peak is less than 1 hour, I was understanding it to mean that my BG should be right down at the peak time. But I think it is only the Peak time of Insulin being absorbed through the flesh and then as you would expect will take up to an hour to start bringing the BG down. So equates to what I'm experiencing of 2 hours lol. So will have to try and adjust my vision of what is meant to be happening.

But this is still giving the issue of waiting for 2 hours before eating. I know from monitoring my BG and eating a meal i.e. breakfast being Weetabix, milk and sugar which is 38.2g of Carbs, my body is digesting and using those Carbs in 10 to 20mins. Different foods react at different times but essentially to keep my BG at around the 8mmol, I need to wait 2 hours before eating or my BG goes well over the 10mmol. So hence why I'm trying to find a much faster insulin to cut that 2 hours down.

 

[In Response]

I am not sure how you are measuring this but a few things to bear in mind
- food takes time to digest. So while you may find that your insulin takes an hour or so to start working, depending upon what you eat, the food may take a fair amount of that time to be digested and start affecting your BG. This does depend upon the food you eat - hypo treatment works very fast but pizza can take affect BG for 4 or 5 hours after eating. The challenging is to match the peak of the carb absorption with the peak of the insulin profile.
- fast acting insulin activation time is often dependent upon your starting BG. For example, I find my fast acting insulin can work immediately if my BG is in the 4s but take 90 minutes if it is in double figures.
- NovoRapid is often called "NovoNotSoRapid" or "NovoSluggish". There are now faster insulins available in the UK such as Fiasp and Lyujemv (that second one may be misspelt).
- I see you recently changed from NovoRapid to Trurapi. While this is supposed to be biosimilar, some people find it does not work in exactly the same way. Have you noticed this delay more since swapping to Trurapi? It is worth talking to your doctor about it.
- Do you rotate and check your injection sites? Is it possible that you have lumps at your sites? These can affect the insulin absorption. Have you tried injecting your insulin someone else?

 

[Tokolosh]

Hi @In Response

Yes, the NHS / Doctors Surgery sent a letter stating they were changing the NovoRapid to Trurapi and I switched to Trurapi soon after. After using the Trurapi for a few months, I found it was taking much longer for it to start working so spoke to the Doctor and was switched back to the NovoRapid. After being back on NovoRapid, on one of my visits to the Diabetic Clinic, I asked about trying a different Insulin to speed up the reaction time for the Insulin to start working due to my finding NovoRapid taking 2 hours for me to eat. They suggested I try the Fiasp Insulin and they gave me a prescription for 5 Viles of Fiasp to trial it out. I’m on the final Vile now and finding it has not changed the reaction time much so now they are suggesting the Lyumjev Insulin. I’m just trying to find information profile curves for this Insulin which EllieM found for me.

I understand the food absorption rates differ not just in type of foods but also for different people, no fixed times for anyone. The Breakfast, I’m talking about is Weetabix, Milk and a T-Spoon of Sugar which equates to 38.2g of Carbs. For me, measuring the times my body is absorbing and affecting my BG is based on after checking my BG level and eating this and then monitoring my BG regularly for about 2 hours after. This is when I haven’t eaten anything prior at least 3 or 4 hours. It generally, for me, becomes shown in my BG anything between 10 and 20mins. I’ve used it for minor Hypo’s which works great as no real High BG after eating a high Carb like sweets.

Talking about my breakfast meal of Weetabix. I wake up around 7am and check my BG level before eating or drinking anything. If it is between 4 and 10mmol, I will inject 8 units of Insulin (NovoRapid and presently using the Fiasp) and then monitor my BG continuously. When I notice the BG starting to move down (~1.5 hours) and peaking at around 2 hours, only then do I eat the Weetabix. This seems to be working well as my BG rarely if ever then Peaking over 10mmol. I would like to decrease this 2 hour interval between injecting and eating.

 

[EllieM]

This seems to be working well as my BG rarely if ever then Peaking over 10mmol. I would like to decrease this 2 hour interval between injecting and eating.

Bear in mind that the dawn phenomena means that the liver often pumps out sugar first thing to get you going, so that may be contributing to your breakfast issues.
https://www.diabetes.co.uk/blood-glucose/dawn-phenomenon.html

Is your issue with the slow action of insulin just in the morning?

 

[Tokolosh]

Bear in mind that the dawn phenomena means that the liver often pumps out sugar first thing to get you going, so that may be contributing to your breakfast issues.
https://www.diabetes.co.uk/blood-glucose/dawn-phenomenon.html

Is your issue with the slow action of insulin just in the morning?

Thanks. Yes I know the Liver pumping out sugars and alas also know from experience lol that drinking alcohol stops that from happening due over working it trying to remove the alcohol.

No this slow reaction, if it can be called an issue, happens morning and evening and sometimes during mid day but that meal is usually taken care of with the long acting insulin.

 

[In Response]

@Tokolosh what about your injection sites?
Is it possible that, after years of use, you need to trial a different part of your body for injections?

 

[becca59]

@Tokolosh I gave up many years ago having a high carb breakfast. My morning rises were just too hard to manage. I now eat a few berries and Greek full fat yoghurt, no more than 10 carbs total. It’s not perfect, but easier. I can eat those sort of items from about 4 o’clock onwards with very little insulin. So it is definitely my morning rises and resistance. Am also a Fiasp user.

 

[Tokolosh]

@Tokolosh what about your injection sites?
Is it possible that, after years of use, you need to trial a different part of your body for injections?

Oh yes. I started doing that many years ago. Presently I'm using 8 different sections of my stomach and 5 different sections of my upper thigh on both legs. The DSN suggested my bum and upper arm. Tried my bum which is very difficult to do as I'm a chicken, so have to use my finger to locate where I'm going to inject and push the needle in from there. Then its a strain to work my hand/fingers along the pen to the top of it to push the plunger down. I'm causing more damage to the flesh in that movement and definitely not flexible enough to use both hands. But I do resort to using those areas every so often. The upper arm is a similar problem but also, even with the smallest needle (4mm) every time I inject there, it goes into the muscle so the reaction curve is pretty fast i.e. 20mins but not good for the muscle. I cannot pinch any flesh on my arms so no fat. Have tried the Calf but that is even worse for pinching fat and definitely goes straight into the muscle. Haven't tried any area on my upper chest but I would think that might hurt terribly.

If you have any other suggestions of places to use please let me know.

 

[Tokolosh]

@Tokolosh I gave up many years ago having a high carb breakfast. My morning rises were just too hard to manage. I now eat a few berries and Greek full fat yoghurt, no more than 10 carbs total. It’s not perfect, but easier. I can eat those sort of items from about 4 o’clock onwards with very little insulin. So it is definitely my morning rises and resistance. Am also a Fiasp user.

I thought my Carb intake was low, that's impressive. Would be interested to know if you survive your day with such low Carbs. I walk almost every day at least 2km to help my elderly mother. If I don't get my normal 38 Carbs for Breakfast I find it almost exhausting. I agree with the low Carb diet and keep mine pretty low through each day. Normally about 130 Carbs a day. But do eat protein rich food, meat, throughout most of the day.

You pose an interesting subject about how much or what is the minimum Carbs per day we should be eating.

 

[EllieM]

You pose an interesting subject about how much or what is the minimum Carbs per day we should be eating.

To be honest, I think it's a how long is a piece of string question, and varies massively from person to person.

 

[becca59]

@Tokolosh I manage absolutely fine. On swim mornings I get up, inject a small amount of insulin if over 6mmol and rising, go off and do my 70 lengths swim and return for my breakfast about 8am. Mornings are my busy time-grandchildren, gardening in the village, my own garden, housework, food shopping etc. We eat between 1 and 2 and I keep the carbs low in the week, but have pizza type treats at the weekend. As a rule I don’t eat again until the following day, unless particularly hungry, or on the low side. And never after 6pm. In truth I have found that I need a lot less food than I thought I did. My husband will tell you, I am someone who finds sitting and relaxing difficult. Though at 65 I am improving on that score, particularly after two days grandchild care lol!

 

[CheeseSeaker]

Hi @Tokolosh,

Couple of bits that might help in understanding insulin reaction curves.

Trurapi is a generic (biosimilar) Novorapid - 'should' be the same but there is lots of evidence that generics can react differently, so good you were put back on Novorapid.

Novorapid (for me at least) didn't kick in until 1 hour after injection, peaked at 2 hours and had a active live (Duration of Insulin Action or DIA) of 4 hours.

Fiasp is Novorapid with 'stuff in' to make it absorb quicker. Works for some and not others (worked well for me for 2-4 weeks and then stopped working).

When working well it kicked in at about 5-10 minutes and had a similar DIA to Novorapid (if looping you set it to 9 hours action, but thats more complications when running a HCL or FCL loop).

Lyumjev is Humalog with different 'stuff in' to make it absorb quicker - works better for me, but took a long journey to get there. it kicks in 5-10 minutes and peaks at about 45 mins, DIA is 9 hours looping (should be 4 for MDI).

If you're struggling with Fiasp, its worth a go, I'd recommend you try using a different injection site with Fiasp or Lyumjev - its much more sensitive to any resistance built up over years of injecting the same sites - took me a while to work this out with Lyumjev (same applies to Fiasp though)

Hope that helps a bit

 

[Tokolosh]

@Tokolosh I manage absolutely fine. On swim mornings I get up, inject a small amount of insulin if over 6mmol and rising, go off and do my 70 lengths swim and return for my breakfast about 8am. Mornings are my busy time-grandchildren, gardening in the village, my own garden, housework, food shopping etc. We eat between 1 and 2 and I keep the carbs low in the week, but have pizza type treats at the weekend. As a rule I don’t eat again until the following day, unless particularly hungry, or on the low side. And never after 6pm. In truth I have found that I need a lot less food than I thought I did. My husband will tell you, I am someone who finds sitting and relaxing difficult. Though at 65 I am improving on that score, particularly after two days grandchild care lol!

Sounds fantastic. I can only wish I had your energy lol. Before I turned 30, I was always very active playing Rugby, Squash, Swimming, Scuba Diving, MotoX, etc. but then my energy levels dropped excessively after I started working in design, sitting behind a computer 12 hours a day often 7 days a week. My energy levels went through the floor boards and became very lethargic but I also put that down to an extremely poor diet. I would think my Carb intake was well over 300g per day. Since my eye sight became severely impaired, 3 to 4 years ago, I stopped working and now spend a lot of time, through boredom lol, trying to focus on my BG, Insulin intake and Carb intake. I think my over fixation of this has reduced my overall dietary to very low Carbs for me at around 100 to 130g per day. I've become even more lethargic probably due to my diet but I think boredom has a huge affect on it to. I keep an Excel workbook for all my readings and my 3 monthly average BG is showing exactly 8mmol.

 

[Tokolosh]

Hi @Tokolosh,

Couple of bits that might help in understanding insulin reaction curves.

Trurapi is a generic (biosimilar) Novorapid - 'should' be the same but there is lots of evidence that generics can react differently, so good you were put back on Novorapid.

Novorapid (for me at least) didn't kick in until 1 hour after injection, peaked at 2 hours and had a active live (Duration of Insulin Action or DIA) of 4 hours.

Fiasp is Novorapid with 'stuff in' to make it absorb quicker. Works for some and not others (worked well for me for 2-4 weeks and then stopped working).

When working well it kicked in at about 5-10 minutes and had a similar DIA to Novorapid (if looping you set it to 9 hours action, but thats more complications when running a HCL or FCL loop).

Lyumjev is Humalog with different 'stuff in' to make it absorb quicker - works better for me, but took a long journey to get there. it kicks in 5-10 minutes and peaks at about 45 mins, DIA is 9 hours looping (should be 4 for MDI).

If you're struggling with Fiasp, its worth a go, I'd recommend you try using a different injection site with Fiasp or Lyumjev - its much more sensitive to any resistance built up over years of injecting the same sites - took me a while to work this out with Lyumjev (same applies to Fiasp though)

Hope that helps a bit

@CheeseSeaker Wow Thanks
Fantastic, I am still looking at the various curves to work out whether to try the Lyumjev. But from what you have experienced has made me more interested in it.

The Fiasp works very similar to the NovoRapid unless, by accident, I inject it into a muscle which then it reacts within 10 minutes. I did find the Fiasp worked less and less in my normal sites on my stomach so switched to my inner thigh. So I think I will try the Lyumjev