Just started Novorapid - hypo after eating?

[JMoli]

Hi, I just started bolus yesterday, 2 units Novorapid before meals and my Tresiba basal has reduced to 3 units from 6.
Yesterday my numbers were fairly good but today had a hypo (3.2) one hour after eating lunch (chicken mayo brown bread sandwich)
Does anyone know why this happened? Thanks

 

[KK123]

Hi, I just started bolus yesterday, 2 units Novorapid before meals and my Tresiba basal has reduced to 3 units from 6.
Yesterday my numbers were fairly good but today had a hypo (3.2) one hour after eating lunch (chicken mayo brown bread sandwich)
Does anyone know why this happened? Thanks

Hi there, well hypos can occur for many reasons (timing of insulin, incorrect ratio, speed at which the food is digested, type of food, exercise just before...or after...or during...you get my drift) BUT in this case I am inclined to say it was because you had too much insulin for that meal. You say you have '2 units before meals', is that a fixed dose? What has your team told you to do?. If it is a fixed dose then you will need to adjust your meal to match the dose (not ideal and the wrong way round) but I know when you first start off they give you a fixed dose so you can determine your insulin to carb ratio. I wouldn't want to interfere with what your Dr has told you to do but I would try the same meal again and take 1 unit to see if that makes a difference. Just so you know though, you will find MANY variations on the food/insulin theme and how it affects you, it does take time though before you get to a point where you more or less know how it all fits in and even then it can be hit or miss. x

 

[JMoli]

Thanks, yes - moving to carb counting next week but my nurse wanted to see how the 2 units worked for me. I’m now high on jelly babies ugh

 

[KK123]

Thanks, yes - moving to carb counting next week but my nurse wanted to see how the 2 units worked for me. I’m now high on jelly babies ugh

Ah, I thought so, I was up and down (mainly down) when I started off, hypo's galore. I am sure you do this but I had to write everything that I ate down along with the doses etc so that they could then see what my ratio was. They tend to start you off on a dose based on your size/weight so of course it's very hit & miss that way. Keep testing and if you have lots of lows make sure you phone them as often as you need, they will then readjust what you're on until you get to the stage where you can do it yourself (which may be very soon if you are a quick learner). x

 

[JMoli]

Thanks, there’s so much learning with this isn’t there! I stood frozen to the spot with a piece of toast in my hand wondering if I was allowed it last night before bed! x

 

[Daibell]

Thanks, there’s so much learning with this isn’t there! I stood frozen to the spot with a piece of toast in my hand wondering if I was allowed it last night before bed! x

Having too many carbs occasionally e.g. a piece of toast isn't going to do you any harm. It's too much insulin that can cause problems.

 

[JMoli]

Having too many carbs occasionally e.g. a piece of toast isn't going to do you any harm. It's too much insulin that can cause problems.

Yes, I’m wondering if I’m a bit lower today as I lowered my Tresiba yesterday but it can take a few days to show the change with that can’t it? Before I started the bolus regime my nurse said to have a piece of toast before bed if I was less than 8, and last night I suddenly panicked - will the dinner bolus cover it etc

 

[DCUKMod]

@JMoli - I'm not challenging anything the others have said, but as someone newly diagnosed, your pancreas may throw out some insulin from time to time. In my head, I envisage it as spluttering.

It's something that happens, usually in the early days after diagnosis, and sometimes more often when the individual starts on insulin. It's like their pancreas gets a change to rally a little bit, when the injected insulin starts.

Sadly, over time, that stops happening, but I have observed some frustration over it, from time to time.

 

[Jaylee]

Hi, I just started bolus yesterday, 2 units Novorapid before meals and my Tresiba basal has reduced to 3 units from 6.
Yesterday my numbers were fairly good but today had a hypo (3.2) one hour after eating lunch (chicken mayo brown bread sandwich)
Does anyone know why this happened? Thanks

Hi @JMoli ,

If i remember correctly, you are recently diagnosed..?
One variable regarding this, possibly could be the "honeymoon" where your pancreas Is still trying to "help" a little before finaly stopping? When the pancreas eventually ceases production it should "relatively" be easier with bolus calculations & timings.
Insulin sensitivity can sometimes change during the day for some folk too.

I don't use Tresiba as a basal. But any basal is a foundation to build the rest of your personal insulin dietary regime on.
Here is a useful link on basal testing. https://www.mysugr.com/en/blog/basal-rate-testing/

You may need just a little nudge up with fast acting carbs like jelly babies followed up by something a little longer acting.
Personally, if my basal is out the hypos could recur with just fast acting carbs.? Especially during a hectic daily routine or some form of exercise.
Sounds like your nurse is trying to help you avoid night hypos with the toasty bed time snack.?

Hope this helps. Keep testing.

 

[MarkHaZ123]

Sounds like you just didn't need your insulin.

If you are having a snack which is very low in carbs you can just skip insulin. Such as a couple of biscuits I'd not have a shot for.
When you carb count you will learn to not have insulin at certain times with certain things.

I tend not to have any at dinner time now as I go into hypo midafternoon if I have insulin. I have a heavy job so constantly grafting so I burn the carbs away

Also nothing wrong with jelly babies I always have a bag in the van, the car and plenty in the cupboard

 

[miahara]

Getting a perfect result and balance is like shooting arrows at a moving target on a windy day, there are so many variables involved. I started with just a basal (lantus) dose and then later had to add Novorapid as a bolus. My ideal insulin:carb ratio varies considerably and I need much less insulin for some meals than others. Recently I've been lowering my basal dose bit by bit to stave off early morning lows and it seems to be working. Exercise has a really big impact on me and if I'm anticipating any significant exercise after lunch I skip my insulin and load extra carbs.
There's a very good book - Think Like a Pancreas by Gary Scheiner, and I found it very helpful in deciphering the insulin conundrum. It does lean towards the use of CGM such as the Libre but is still a good general reference book. One thing I did pick up from it is that the use of a logbook to record insulin and carbs can be of great value, I've been doing that and found it a great help as it's so easy to look back and see what you did and how well it worked.

 

[JMoli]

Thanks everyone, ended up with high reading last night 3.5 hours after dinner and bit higher reading than I’d like when I woke up. Now low again before lunch.
The blood sugar has been dropping so had some peanuts and cheese, down again so had a Rich tea biscuit. Down again (not hypo levels, now sitting at 4.7) with Libre arrows pointing down. Getting close to lunch, not sure what to do? Don’t want to hit the jelly babies just yet - but would one be ok? I’m feeling so lost with this!

 

[JMoli]

Sounds like you just didn't need your insulin.

If you are having a snack which is very low in carbs you can just skip insulin. Such as a couple of biscuits I'd not have a shot for.
When you carb count you will learn to not have insulin at certain times with certain things.

I tend not to have any at dinner time now as I go into hypo midafternoon if I have insulin. I have a heavy job so constantly grafting so I burn the carbs away

Also nothing wrong with jelly babies I always have a bag in the van, the car and plenty in the cupboard

Haha, I’ve not really got much of a sweet tooth and never particularly liked Jelly Babies. My kids are always trying to steal them though. Is it possible I need less bolus at lunch than other times? I seem to be pretty high 3-4 hours after dinner but that tends to be the most carby meal of the day. Breakfast and lunch are around 35 g, I’m now going low before lunchtime

 

[JMoli]

Getting a perfect result and balance is like shooting arrows at a moving target on a windy day, there are so many variables involved. I started with just a basal (lantus) dose and then later had to add Novorapid as a bolus. My ideal insulin:carb ratio varies considerably and I need much less insulin for some meals than others. Recently I've been lowering my basal dose bit by bit to stave off early morning lows and it seems to be working. Exercise has a really big impact on me and if I'm anticipating any significant exercise after lunch I skip my insulin and load extra carbs.
There's a very good book - Think Like a Pancreas by Gary Scheiner, and I found it very helpful in deciphering the insulin conundrum. It does lean towards the use of CGM such as the Libre but is still a good general reference book. One thing I did pick up from it is that the use of a logbook to record insulin and carbs can be of great value, I've been doing that and found it a great help as it's so easy to look back and see what you did and how well it worked.

Thanks, I had forgotten about that book - will read up on bolus and carb counting. There’s so much to learn and I’m trying not to be a perfectionist as it just doesn’t seem to be going to plan! Dinner last night didn’t go well, spaghetti, and ended up pretty high. Seems like I have a lot of learning and testing ahead of me. I’m lower through the day and too high at night, hopefully the nurse can guide me through what to try next. Is it ok to have the odd jelly baby to get the blood glucose up a little bit? I had a head before lunch, closely followed by its torso when it didn’t rise after 15 mins! I don’t have a clue what I’m doing

 

[KK123]

Haha, I’ve not really got much of a sweet tooth and never particularly liked Jelly Babies. My kids are always trying to steal them though. Is it possible I need less bolus at lunch than other times? I seem to be pretty high 3-4 hours after dinner but that tends to be the most carby meal of the day. Breakfast and lunch are around 35 g, I’m now going low before lunchtime

Hi there. It may not be a question of needing 'less bolus at lunchtime', it could be more about WHAT you are eating for lunch (I'm keeping it simple here because you are new to it as many other factors such as insulin resistance changing throughout the day could also come into it as with many other things), same with your evening meal which for me would be the highest carb meal of the day so I would need more bolus for it. I am assuming you are not eating the same meal in the same quantity for breakfast, lunch and dinner so the amount of insulin for each would be different too. It's very hard to 'advise' because it is complicated and really a question of trial and error. If you are low before lunchtime (ie several hours after your last meal), it usually means your basal isn't quite right as that is a fasting result.

So, being low before meals tends to mean your basal is 'wrong' and being low after meals tends to mean the amount of bolus was 'wrong'. It's not that simple I know because it could be down to exercising or stress or a million other reasons. Or not. I'm so sorry that it all sounds ridiculous but honestly, it does take time to settle down so please keep on asking questions. You will find though that in the early days your numbers ARE up and down and not stable, you will find every day is different because your body is not robotic. Keep testing, keep in touch with your diabetes team and before long you WILL be able to make those adjustments yourself. Just to add about your jelly babies, if you are low then a 'head' won't do anything and neither will just one. A true hypo requires at least 15/20 (pure sugar) carbs which I think is around 4/5 jelly babies. If you are in the low 4s and want to up it a little bit then my experience is you need around 10 carbs (ie, a biscuit). x

 

[JMoli]

Hi @JMoli ,

If i remember correctly, you are recently diagnosed..?
One variable regarding this, possibly could be the "honeymoon" where your pancreas Is still trying to "help" a little before finaly stopping? When the pancreas eventually ceases production it should "relatively" be easier with bolus calculations & timings.
Insulin sensitivity can sometimes change during the day for some folk too.

I don't use Tresiba as a basal. But any basal is a foundation to build the rest of your personal insulin dietary regime on.
Here is a useful link on basal testing. https://www.mysugr.com/en/blog/basal-rate-testing/

You may need just a little nudge up with fast acting carbs like jelly babies followed up by something a little longer acting.
Personally, if my basal is out the hypos could recur with just fast acting carbs.? Especially during a hectic daily routine or some form of exercise.
Sounds like your nurse is trying to help you avoid night hypos with the toasty bed time snack.?

Hope this helps. Keep testing.

Thanks, I’m wondering whether my basal is correct. I’m waking slightly higher the last few days (around 8) but I’ve also been higher at bedtime and not sure if that’s related/connected? Hopefully the nurse will point me in the right direction, she’s used to me leaving garbled panicky messages on the answerphone! Yes, I think this is still the honeymoon period, certainly keeps things interesting. Thanks again, hopefully this gets easier!

 

[JMoli]

@JMoli - I'm not challenging anything the others have said, but as someone newly diagnosed, your pancreas may throw out some insulin from time to time. In my head, I envisage it as spluttering.

It's something that happens, usually in the early days after diagnosis, and sometimes more often when the individual starts on insulin. It's like their pancreas gets a change to rally a little bit, when the injected insulin starts.

Sadly, over time, that stops happening, but I have observed some frustration over it, from time to time.

Thanks for replying, it’s very kind. Yes, I’m hoping it gets easier once the honeymoon period finishes but also a bit torn as it feels comforting, sadly not hopeful, that my pancreas is still having the odd splutter. I guess I’ll have to keep testing and learning and hopefully have the odd day it makes sense

 

[Bishop]

Hello
If you are newly diagnosed you have to learn what works for you and how your body responds to insulin and foods.
Very important to know how to treat your lows to avoid later spikes.
I have made a video on how I treat my lows.
You can also find various other videos on different topics that you may find useful. Be careful since you are new, make sure you don't make any major changes in your treatment without talking to your specialist.

Good luck!

 

[Japes]

In the very early insulin days, when I was on very low levels of NovoRapid/Levemir with a pancreas occasionally bursting into life after a few days then going back to sleep again, I remember standing in the park, swearing at myself for the 3.2 which had just appeared less than 20 minutes into the walk home from work with a perfectly reasonable 7.5 before setting off, and startling a passer-by as I said "For goodness sake, pancreas, will you make up your mind if you want to live or die???!!!" It's still thinking about it but mostly has given up on me now.

In the early days, it was that and exercise which gave me the rapid hypos.

 

[JMoli]

In the very early insulin days, when I was on very low levels of NovoRapid/Levemir with a pancreas occasionally bursting into life after a few days then going back to sleep again, I remember standing in the park, swearing at myself for the 3.2 which had just appeared less than 20 minutes into the walk home from work with a perfectly reasonable 7.5 before setting off, and startling a passer-by as I said "For goodness sake, pancreas, will you make up your mind if you want to live or die???!!!" It's still thinking about it but mostly has given up on me now.

In the early days, it was that and exercise which gave me the rapid hypos.

Haha yes, trying to keep stable blood sugar just now is like nailing jelly to a wall. Off for a walk as for no good reason I’ve shot up to 10 over five hours after a lunch which I was low before. Never happened before. Not eaten since so who knows what’s gone wrong this time. I talk to it all the time, mostly yelling ‘why??!’