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Type 1 Insulin stacking

MJDS

Member
Messages
13
Hey everyone

Just came across a new term ive never heard before and was wondering if anyone could explain what it means.

Grateful for any help.
 
Hey everyone

Just came across a new term ive never heard before and was wondering if anyone could explain what it means.

Grateful for any help.

Insulin has an activity profile. For example, rapid acting insulin increases fairly sharply and peaks at around the 2hr mark. It then tapers off over the next 2 (possibly 3) hrs.

Insulin stacking, simply refers to injecting more insulin before the activity of the previous insulin has completely finished working.

Generally it should be avoided but with a bit of practice it's possible to achieve some beneficial results in specific circumstances.
 
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Thanks Urban Racer.

I just can't think of what circumstance that would be useful. If someone was planning on eating something for a period of time every hour or two ? (Like a party)
 
Thanks Urban Racer.

I just can't think of what circumstance that would be useful. If someone was planning on eating something for a period of time every hour or two ? (Like a party)

Or if you want a snack in between meals (sometimes I just need that chocolate bar to get me through that boring meeting at work :)), or someone brings in stuff for the whole department at work (and has specially brought in something gluten free (normally very carby) just for me).

I know also often at the weekend there is not 5 hours between breakfast and lunch for myself - yes sometimes my insulin does take that long!
 
Or if you want a snack in between meals (sometimes I just need that chocolate bar to get me through that boring meeting at work :)), or someone brings in stuff for the whole department at work (and has specially brought in something gluten free (normally very carby) just for me).

I know also often at the weekend there is not 5 hours between breakfast and lunch for myself - yes sometimes my insulin does take that long!


Thanks Rokaab,that makes sense. Would this mean then that you would have two insulin intakes (one for the meal, the other for the snack) What would be the difference if you took into account the snack when you had insulin the first time, so like extra dose of insulin for the meal and snack. (I'm assuming the snack is planned in which of course is not always the case :)
 
Thanks Rokaab,that makes sense. Would this mean then that you would have two insulin intakes (one for the meal, the other for the snack) What would be the difference if you took into account the snack when you had insulin the first time, so like extra dose of insulin for the meal and snack. (I'm assuming the snack is planned in which of course is not always the case :)

Yes it means one injection for breakfast, one for each relevant snack, adding more insulin to my breakfast could go horribly wrong and cause hypos if said insulin kicks in faster or if the snack doesn't happen, and also my snack times can vary somewhat, not guaranteed I'll need/want one either - more injections gives a lot more flexibility (and that's what MDI is supposed to do), and yeah I don't know if someone will be bringing in stuff on a particular day, or we'll suddenly end up in an incredibly boring meeting that was only decided upon 15 mins before it started, or whether I'll just feel hungry :)
 
Thanks Urban Racer.

I just can't think of what circumstance that would be useful. If someone was planning on eating something for a period of time every hour or two ? (Like a party)

This may help you to visualise :-
upload_2020-4-28_12-56-26.png

The flatish green line would be your basal insulin (in a perfect world).

The black curve broadly represents fast acting insulin. So if you were to inject a short time after the 2hr peak, you would create a new peak that is on top of the existing curve and potentially higher. It would also extend the activity time.

Many T1's have a problem with Pizza. The (fatty) cheese slows down digestion of the carby bread base and may need a percentage your dose before the meal, and remainder a bit later. You need to find out over time, how your body reacts to foods - a great reason to be using glucose monitoring!
 
This may help you to visualise :-
View attachment 40848

The flatish green line would be your basal insulin (in a perfect world).

The black curve broadly represents fast acting insulin. So if you were to inject a short time after the 2hr peak, you would create a new peak that is on top of the existing curve and potentially higher. It would also extend the activity time.

Many T1's have a problem with Pizza. The (fatty) cheese slows down digestion of the carby bread base and may need a percentage your dose before the meal, and remainder a bit later. You need to find out over time, how your body reacts to foods - a great reason to be using glucose monitoring!

Oh wow yes that does help, Thanks Urban Racer. I find this really fascinating. I’ve had type 1 now for 27 years but never had this explained to me.

I imagine porridge oats (made with full fat milk) can have the same effect as pizza ? It’s my favourite breakfast item which I have had to give up.

A cgm would change many diabetics lives I think, I am really fortunate to have had one agreed for me just this week (live in England) after several severe hypos.

Yes it means one injection for breakfast, one for each relevant snack, adding more insulin to my breakfast could go horribly wrong and cause hypos if said insulin kicks in faster or if the snack doesn't happen, and also my snack times can vary somewhat, not guaranteed I'll need/want one either - more injections gives a lot more flexibility (and that's what MDI is supposed to do), and yeah I don't know if someone will be bringing in stuff on a particular day, or we'll suddenly end up in an incredibly boring meeting that was only decided upon 15 mins before it started, or whether I'll just feel hungry :)



I’m with you there Rokaab, thanks for letting me know, it’s very hard to plan how the day goes exactly (depending on where you work) so I can definitely relate.

A insulin pump which can give short burst of insulin sounds like what would be a big help. I struggle to take my injections at work needing to walk 5 minutes away from my desk to find a good spot (which can be taken)
 
Hi, can I ask why you've had to give up porridge oats? I often have them with nuts and fruit and just find I need to inject my bolus (novorapid) a little earlier to kick in when breakfasts being digested but can still eat them. It's timings like that that is one of the reasons I love the libre - showed me huge spikes I was having around meals that I knew nothing of before! Exciting to hear you've had a CGM agreed.

Also, if you don't mind me suggesting as I have no clue about your workplace, but I often inject in my stomach area just under my desk/restaurant table if I don't want others to see. Obviously might not be possible depending on what you're wearing and the cleanliness of the environment but thought I'd mention to save you valuable minutes at lunch!
 
Hi UKT1

I gave it up because it would send my BS levels really high late morning, early afternoon. This is me despite carb counting.
By lunch time my bs levels would still be really high and I wouldnt know what to do (to correct or not)

The fact that it can take 2 hours for peak effect of the insulin to kick in sure sounds like it makes sense (my consultant told me to take it immediatley before meals 15 years ago when prescribed) Your way of doing it sounds good and I might give it a try thanks for that :)

Regarding my CGM yes it is exciting, I am hoping to learn a lot about how my body digests carbs. I'm really encouraged and glad to hear the Libre helped you with the timing, I'm hoping to master timings as well!

In terms of the injection site, I am avoiding injecting in my lower stomach area. Just because years of injecting there has left me with an unsightly fat deposit which I would like to reverse if possible. Sometimes however I do not have a choice and have to inject there.

Can I ask, did your Hba1c results get better after getting the Libre. Did you notice an improvement in managing diabetes and quality of life?
 
Hi UKT1

I gave it up because it would send my BS levels really high late morning, early afternoon. This is me despite carb counting.
By lunch time my bs levels would still be really high and I wouldnt know what to do (to correct or not)

The fact that it can take 2 hours for peak effect of the insulin to kick in sure sounds like it makes sense (my consultant told me to take it immediatley before meals 15 years ago when prescribed) Your way of doing it sounds good and I might give it a try thanks for that :)

Regarding my CGM yes it is exciting, I am hoping to learn a lot about how my body digests carbs. I'm really encouraged and glad to hear the Libre helped you with the timing, I'm hoping to master timings as well!

In terms of the injection site, I am avoiding injecting in my lower stomach area. Just because years of injecting there has left me with an unsightly fat deposit which I would like to reverse if possible. Sometimes however I do not have a choice and have to inject there.

Can I ask, did your Hba1c results get better after getting the Libre. Did you notice an improvement in managing diabetes and quality of life?

No problem, hope it didn't feel like I was prying! Yes I've always been told to inject novorapid 10-15 mins before eating, but adjust that depending on starting glucose levels (eg if close to being low) and what I'm eating, and try to time when I think the food will have started being digested compared to when the insulin kicks in. Other bolus insulins start acting much faster I'm told so id check with your diabetes team for yours. The libre has given me confidence to push this as far as 30 mins ahead for some meals, but it's taken time getting used to different meals. Hard as I rarely eat the same meal twice in any two week period!

I was due to have another blood test late March which obviously hasn't happened so I'm not sure! The app itself predicts your HbA1c and predicts mine will be the lowest I've ever had it measured as. I'm really intrigued to know how accurate that really is though as I know the Libre can be off, but it has definitely helped me even out spikes which is always a good thing. It has definitely enhanced my quality of life I'd say. I qualified for it due to my frequency of testing and my fingers are very very pleased!! Obviously you wear a sensor, but I find taking the measurement so much more discrete, and far easier if you're on the move or with dirty hands etc where finger prick testing would take much longer and often have been impractical. It took quite a bit of getting used to at first of course but if I hold my phone still it will scan through a thick winter coat which is ideal. The reader scans much more easily than my phone but I prefer the info you get via the phone app than the reader. Sorry if that veered off topic.
 
Thank UKT1 and no not at all, I registered for the forum to be able to communicate with people about particular matters regarding diabetes what I face.

I find it really encouraging and helpful when you reply and ask questions as I generally don’t talk to anyone about diabetes (people just don’t seem to understand) and so thank you to both for taking the time to answer and so I really don’t mind.

I really hope your blood test come back as expected and I think that should be more than enough evidence for the clinical commissioners to prescribe out CGMs to all diabetics. Many people report almost direct improvement following using a CGM.

My CGM arrived today and I’ve been using it for the past 6 hours.

I’ve been trying out stacking insulin (possible as I’m working from home at present) and taking small doses of insulin after each other rather than 1 big dose. I’ve been in target the whole time!

I am cautious however as I find it much easier to correct a slight overdose on insulin (have extra juice) than correcting a high BS.

I’m really curious to find out how diffident foods affect the BS and how I can match the insulin curve to the curve of different foods.
 
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