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Is it normal to need pretty high doses of Novorapid?

C

Catsymoo

Well-Known Member
I'm 26 years old and had type 1 since I was 22. I got changed over from 30/70 insulin to basal bolus last October. It's helped my control and given me more freedom with food, however, I find that some weeks I need (in my opinion) stupid high doses of Novorapid for not much carbohydrate. In general for meals, I eat a lot of salads, vegetables, cauliflower rice, chicken. And I snack on frozen banana slices, cinnamon coated apple slices and frozen grapes. Sometimes I have those Yushoi rice snacks since they're made from green peas or something and low fat/calorie. That is 90% of my food apart from Wednesdays is my day off so I eat more like a normal person. I do eat the basic vanilla carbs like bread, rice, etc but not nearly as much as most people. For instance once a week or fortnight we have takeout food, but even then I give myself small portions of carbs and try to pick the chicken out so I don't eat all the fattening sauce in a curry. My nurse told me I need 20 units of basal (taking 26 now), and 1-2 units of Novorapid per 10g of carbohydrate. I'm finding I need about 5 per 10g. I've just had a small bag of those sunbites low fat crackers and had to take 7 units for 14g of carbs, and I guarantee you my blood sugar will still be about 10 later. Last night, I had a medium sized burrito for dinner since it was cheat day. I took about 23 units of Novorapid, and my blood sugar was still 10.9 this morning. I took 8 units, had a 7g of carb cereal bar for breakfast... 2 hours later blood sugar is still 10.7.

This isn't a constant thing, and I find it weird that I still have to take like 7 units even if I'm having an avocado and chicken salad, or cauliflower rice. I know protein and fat slow down carbs and stuff, I'm just getting fed up of requiring insulin for basically nothing and the scale is going up and up despite me eating pretty healthily. It's gotten to a point where I barely need to count my carbs, because I know 7 - 11 units covers most meals I eat, and I eat the same foods all the time.

I am on birth control pill and Metformin, and I also take vitamin D tablets to help with weight loss. (I work half nights and don't see much sun since it makes me feel a bit nauseous). I've lost about 4lbs since taking the vitamin D. I drink Pepsi Max, Nutribullet smoothies and water, to help with sweet cravings. I know P. Max isn't great for me, but it stops me reaching for sweets if I'm having cravings. I'm really struggling with weight loss. I don't look 14.5 stone, but I am, and I really hate myself. I got down to 13 stone 12, but that was after barely eating for a week out of depression. It seems I still need lots of insulin even if I low carb, and I get really upset because I know it's stopping me from losing weight at a normal pace a person would if eating well and exercising. :(
 
Hi @Catsymoo , does your insulin resistance go with your menstrual cycle? I know for many women that this can be the case.

On your basal and bolus levels and the amounts you need for meals, have you ever basal tested? That would tell you whether your background levels are correct and may provide some indication of why you need the Novorapid you do. Basal testing instructions can be found here: https://mysugr.com/basal-rate-testing/

With regard to weight loss, if you are Lpw Carbing for weight loss, I would expect you to see a difference, but you'd need to include exercise to some extent. Having a cheat day every week doesn't really work with proper low car as it kicks your body out of the state it needs to be in to work effectively. Likewise, the foods you snack on won't be helping you in a low carb context. Bread, rice, etc, even in small amounts don't really work, especially if losing weight is what your goal is. Sadly you have to be really regimented and disciplined with it for it to really work. It's not really the insulin stopping you losing weight. It's more likely to be the additional carbs you eat.
 
Have you done a basal test to check this is correctly set? If it is not, it could be that some of the bolus you are taking is being used in place of basal dose. Additional, helpful information would be what is your Total Daily Dose each day over say 7 days, and how many carbs did you eat in total on each of these days? Are you confident that you are including all carbs, inc those in veg? Another thing to consider is the amount of protein, and if that is affecting you BG at all? Stress and other factors can significantly affect BGs, so it could be a number of factors. Generally speaking, as body weight goes up, so does the TDD.
 
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Just gonna throw it out there that I'm not "low carbing", I just eat less of them so I don't have to take as much insulin. The bigger my doses the more weight I gain regardless of what I eat. When I have a cold I gain 2-4lbs from having to triple my doses to counteract antibodies and resistance. Even if I eat nothing but salad. Vegetables I eat aren't carby ones. I eat a lot of water based ones and stuff like cauliflower, spinach and beets that doesn't have much calories in.

I do not have periods because birth control stops it. I haven't had one in 2 years. Although it might be the pill itself causing random hormonal fluctuations.
 
Insulin is a growth hormone as well as a fat storing hormone. The more insulin I take the more weight I gain and vice versa.
Lowering carbs will allow you to lower insulin and perhaps lose some weight
It does take some time to go from carb burning to fat burning as well as to regain insulin sensitivity. And as was said even a cheat day will stop fat burning in its tracks for a few days.
I don't get periods either because I am post menopausal but I still certainly get hormone fluctuations. Ask my husband lol. I tend to run a little higher a few days a month as well as run on the low side a few days.
Also protein in excess can raise your BS. It certain,t does mine. I do best low carb, under 20 , about 5 oz protein a day and fat to satisfy. But that is just me and the only way I maintain my weight without gaining. One cheat meal of extra carbs and up the scale goes for about 3 days.

What is a basic days meals and snacks for you? How many carbs do you estimate you are eating in a day?
 
Kristin251 said:
Insulin is a growth hormone as well as a fat storing hormone. The more insulin I take the more weight I gain and vice versa.
Lowering carbs will allow you to lower insulin and perhaps lose some weight
It does take some time to go from carb burning to fat burning as well as to regain insulin sensitivity. And as was said even a cheat day will stop fat burning in its tracks for a few days.
I don't get periods either because I am post menopausal but I still certainly get hormone fluctuations. Ask my husband lol. I tend to run a little higher a few days a month as well as run on the low side a few days.
Also protein in excess can raise your BS. It certain,t does mine. I do best low carb, under 20 , about 5 oz protein a day and fat to satisfy. But that is just me and the only way I maintain my weight without gaining. One cheat meal of extra carbs and up the scale goes for about 3 days.

What is a basic days meals and snacks for you? How many carbs do you estimate you are eating in a day?
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I work Friday-Tuesday and do 3am starts. On my work days my usual food is coffee in the morning and a mouthful of smoothie to line my stomach. When I get home from work I almost always have a salad with some chopped chicken and avocado. I sometimes skip the avocado. I'll have a small glass of green smoothie, and if I'm still hungry or craving sweets I'll have some frozen grapes or banana. I often have a nap during the day and then dinner tends to be cauliflower rice and chicken with spinach/a sauce that isn't fattening. Snacks are cinnamon apple slices, and maybe a few crackers/snack a jack or whole grain snacks or something. Wednesday we will have a fatty dinner, but I try to save myself for it all day by not eating much, and I limit the carb portions and try to fill up on the friendly foods or water. Thursday I'm more likely to have a sandwich since I'm at my boyfriends house and their kitchen is unusable. But it will be brown bread and under 450 cals.


Obviously there are days where I might eat a bit different like a day out where I'll have a bagel in Weatherspoons or something, but you get the idea. I'm starting to think my sleeping pattern is the issue, to be honest.
 
your still eating hidden carbs in things like smoothies though.

My first step would be get a blood test and make sure everything is working about right
 
Catsymoo said:
I work Friday-Tuesday and do 3am starts. On my work days my usual food is coffee in the morning and a mouthful of smoothie to line my stomach. When I get home from work I almost always have a salad with some chopped chicken and avocado. I sometimes skip the avocado. I'll have a small glass of green smoothie, and if I'm still hungry or craving sweets I'll have some frozen grapes or banana. I often have a nap during the day and then dinner tends to be cauliflower rice and chicken with spinach/a sauce that isn't fattening. Snacks are cinnamon apple slices, and maybe a few crackers/snack a jack or whole grain snacks or something. Wednesday we will have a fatty dinner, but I try to save myself for it all day by not eating much, and I limit the carb portions and try to fill up on the friendly foods or water. Thursday I'm more likely to have a sandwich since I'm at my boyfriends house and their kitchen is unusable. But it will be brown bread and under 450 cals.


Obviously there are days where I might eat a bit different like a day out where I'll have a bagel in Weatherspoons or something, but you get the idea. I'm starting to think my sleeping pattern is the issue, to be honest.
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What's in the smoothy?
As mentioned before it could be the carbs. Doesn't seem like a lot but they add up. Are your meals sizes large? I would be hungry without any fat. I tend to gravitate toward leaner proteins but use avocado nuts and mayo for fats. Maybe yiu should try upping fats a bit and lowering carbs ? Worth a shot ? Sometimes just switching up the diet and throwing the body off is enough to kick start weight loss. Your diet seems very low fat. Maybe instead of your fruit / grain snacks smash an avocado with sea salt and eat with celery through the day as snacks. Or a small handful of nuts. I eat one avocado a day. Helps keep me full and weight down. Do you find yourself hungry a lot?
How long have you been at this job and those hours? Do you get a good sleep when you sleep?

Just thoughts and ideas. It's frustrating when you don't know what's wrong. Been there done that
 
Kristin251 said:
What's in the smoothy?
As mentioned before it could be the carbs. Doesn't seem like a lot but they add up. Are your meals sizes large? I would be hungry without any fat. I tend to gravitate toward leaner proteins but use avocado nuts and mayo for fats. Maybe yiu should try upping fats a bit and lowering carbs ? Worth a shot ? Sometimes just switching up the diet and throwing the body off is enough to kick start weight loss. Your diet seems very low fat. Maybe instead of your fruit / grain snacks smash an avocado with sea salt and eat with celery through the day as snacks. Or a small handful of nuts. I eat one avocado a day. Helps keep me full and weight down. Do you find yourself hungry a lot?
How long have you been at this job and those hours? Do you get a good sleep when you sleep?

Just thoughts and ideas. It's frustrating when you don't know what's wrong. Been there done that
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It's a green smoothie so 50-70% spinach, coconut water, kiwi and lime. Just so we are clear, I'm not looking to go low carb. I've done it before and I felt awful. My skin looked terrible and I had no energy. I had to get back on my fruit. Right now I just avoid white, refined carbs. I tried the high fat thing and I gained weight. I have lost weight since Christmas, but only like 5lbs. It's just so slow and I gain it back so easily, even if I eat what my family eat for one day, and they're all skinny, it's so unfair. My step dad can eat an entire pack of digestives and he's really healthy according to his recent checkup.

Back to my original question though, my doses. I have to ask. Is 26 units of Lantus at 5pm once a day, and my bolus needs high? As in anything to worry about? I'm sorry I didn't mean for this post to become about weight loss. I think I just need to worry about my sugar levels themselves and stop obsessing over my weight. Because health is more important. You'd never guess my weight by how I look. I look like a size 12-14 in my middle, my arms are a bit flabby up the top from weight loss (I was a size 24 at one point) and the rest of me is normal.
 
For me that is very high. But if you need it to bring bs down and aren't willing to change your diet then you need it. We all require different insulins and do better on different diets. If I ate carbs I may need it too. I personally like to keep my insulin doses as low as possible and will alter my diet accordingly. Insulin and I don't get along too well. It makes me feel awful so I like as little as possible to keep BS where I like it
It does sound as you are a bit insulin resistant.
 
@Catsymoo, losing weight and being more active can help with insulin resistance, if possible try having a walk after some of your meals as may find you can reduce the bolus dose by as much as 50%.

Regards to your lantus dose, 26u doesn't seem excessively high.
 
Hi, when we have blood tests, thyroid is tested as well. We are all so different with our diabetes management and no way is right or wrong, we have such different needs, My Insulin quota for the day x 3 Novorapid and x 1 night time Levemir, is about 28 to 30 units. What about your injection sites, I can see you are 4 years in with type 1, but have you had your injection sites looked at by a DSN ?
Maybe there are hidden carbs or you may think the carb content is less than you think with your food intake. I agree with @noblehead, about trying to exercise after meals if possible. Also Insulin resistance.
Try tweaking your diet by reducing some foods or omitting them, you should then get a good picture of what is going on. Another good thing is to write a food diary, also some foods spike the BS. Do you really need to eat snacks, because by cutting these out, it could make a difference ?
Good luck @Catsymoo
 
Just as a speculation, I'm also on birth control (combined oral contraceptive) and find that when I have my week off I often need a lot less insulin. I once read somewhere that oestrogen can increase insulin resistance, so if your birth control contains oestrogen then perhaps that's part of it?
 
becky.ford93 said:
Just as a speculation, I'm also on birth control (combined oral contraceptive) and find that when I have my week off I often need a lot less insulin. I once read somewhere that oestrogen can increase insulin resistance, so if your birth control contains oestrogen then perhaps that's part of it?
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I'm on mini pill, so I don't have a break. :(
 
Hi Catsymoo, I'm a long-time lurker first-time poster! Your post really struck a chord with me and compelled me to register and post.

Are you by any chance on Cerazette? I was put on Cerazette for 6 months and it played absolute HAVOC with my control, My basal went from 22 IU to 56, HbA1C from 6.3% to 7.8% and I felt dreadful.

Within 8 weeks of coming off the Cerazette my sugars returned to normal (cue a fortnight of hypos!) and I actually yellow-carded the Cerazette as it had had such an extreme effect on my sugars.

I'd suggest possibly trying another form of birth control. Loestrin 20 is a diabetic-friendly alternative.
 
Hi.
I'm no expert but a couple of points I would note:
A) check your Ketones, make sure these constantly high readings aren't causing underlying problems. The amount of insulin you're taking should prevent ketones but you never know.
B) could you have become insulin resistant?
C) maybe they could try you on a different insulin?
D) maybe your basal needs changing? You could do a test to check it yourself first?
E) maybe your thyroid function is low, this would explain poor weight loss too
F) apples and bananas have carbs in them, if you're snacking on them you need insulin for them, they aren't free of carbs = higher BM readings AND Smoothies would also not be free = require insulin so maybe it's this that's causing the problems?
The final point is, maybe you're not eating enough and this could also be a problem for a diabetic?
Good Luck lovely, hope you get to the bottom of it. Sounds frustrating and I bet the lack of weight loss could get you down, don't let it, you can do this - go to your GP / DSN, get some help xxxxxx


Greg&Rachel (parents to Carter T1 aged 8)
 
So while I'm not taking any basal insulin right now, my bolus ratio is about 1 unit for every 5 gr. Of carbs. I was 1 unit for every 10g, but the last two weeks that's changed for some reason.

It's even a higher dose depending on the food. This week I had a veggie burger with a 1/2 portion of fries - a 60g meal according to the restaurants nutritional info- I took 10 units and was at 11mmol 2 hours post meal. I wasn't coming down after that, so I had to do corrective doses. So I probably took 16 units for 60g carb meal. That would have put me at 1 unit for 3.75g.
 
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