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Long working short-acting insulin

D

Dennis78

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Pump
Since the beginning of my diabetes career i'm having issues to which no one seems to have answers.
One of those things is that my lunch bolus is working too strong at a time where it should not noticeably have any affect anymore. I'm talking about 5 hours after lunch and sometimes even more.
Very much longer than short-acting inline should be active.
At around 4 pm i have to take carbohydrates to prevent a hypo. After that BS rises but starts dropping again within half an hour. And again i have to take extra CH to prevent a hypo. This could go on till 8 pm. 8 hours after last insuline. No excercise or activity is involved. I've been tested multiple times if my pancreas is still producing insuline which is not the case.

I've had multiple brands and types of insuline but they all act kind of the same way.

When i was on pen injections, 10 years ago and before, my doctor convinced me to go on pump to address this problem, among other things. He thought my afternoon-problem was caused by basal insuline. The theory was that by switching to pump and setting the basal level to zero between around noon and 6 pm the problem would be gone. But nothing noticeable happened here.
Basal on pump after 12 is at the lowest rate so practically zero so the drops in the afternoon could only be caused by the lunch bolus insuline.
Problem is only in the afternoon. Bolusses after breakfast and supper seems to act normal concerning effectiveness in time range.

Anyone recognizing this problem?
 
Hi, @Dennis78

Welcome to the forum.

Which insulin are you using?
 
Hi @Dennis78
Welcome.
Mine does the same but i do it deliberately.....
I overload my background insulin to keep myself in the 5s.
I have an active job where i'm on my feet so graze on 10g carbs to stay level during the day.
I have 50 years of MDI and a CGM and my last HBA1C was 39 or 5.7.
I only class a hypo at below 3 as i function normally above 3 and never passed out or been hospitalised.


I would never recommend this to anybody.

The big game changer came when i got my libre and bought a miaow miaow that had xdrip running.

I analysed the data to the nth degree and i live next to the pennines so went walking alot to see the effect it had on my levels.

So activity and too much insulin is the culprit for me but you are saying its different for you?
Novorapid lasts 5 hours and sometimes longer if i'm active and my levels drop quickly.
If i'm dropping just off my levemir my levels drop but nowhere near as quickly.

I have no idea if this helps but i wish you well.

Tony
 
Its a feature and depends how you monitor it (numbers can be made to read anything.... ;-) ).

So you can get residual fast acting over a period of hours way longer than we are told - and that can give lows as the insulin in system builds throughout the day.

e.g. I run a fully-closed-loop using Fiasp and have the Duration of Insulin Action set at 10 hours to prevent the low.

Have a read at: https://www.diabettech.com/why-we-a...n-action-dia-times-we-use-and-why-it-matters/
 
Wow...39
I cannot imagine staying at around 5 al day long. Even if i would succeed at all.
Yes, insuline sensitivity is a problem at activities. Trying this would cause hypos with the slightest activities
 
Dennis78 said:
I'm on Novorapid with Ypsopump/CamAps FX currently. I've also had Humalog and Fiasp when i had Omnipod
Click to expand...
I’m on MDI. Though I’ve not had some of the reported slow acting profile with Novorapid. (Or the non functional.)
I do find it can have a little “surprise” in the 5th or 6th hour? Regarding my experience with NR.

I play in 2 bands & always make sure I don’t have any bolus on board on gig night.
Sometimes find myself cruising between 4.6 & 5.2 in a 12h fasting window. (Breaking it after the show.. or during in liquid form if I go low..)
 
Dennis78 said:
Wow...39
I cannot imagine staying at around 5 al day long. Even if i would succeed at all.
Yes, insuline sensitivity is a problem at activities. Trying this would cause hypos with the slightest activities
Click to expand...
A hba1c of 39 mmol/mol correlates to an average bg of 6.5 mmol/l, with some individual variations.
I aim for the same range (and definitely don't succeed all the time), but I can only do it by eating lowish carb. This suits me because I like the food, and the action time of my insulin matches the food better.

I also see the tail action of my insulin some 5 hours or longer after my last injection, and late afternoon is indeed the time it can bite me.
My idea is that some of it has to do with my varying I:C ratios during the day. I need much more insulin for the same food earlier in the day than later. So if I inject with the correct ratio at noon, by the time the tail action of the insulin is active it's relatively a much larger dose based on ratio.
Just a bit of thinking based on my own experience, no idea if this is the same for you @Dennis78

 
Dennis78 said:
Wow...39
I cannot imagine staying at around 5 al day long. Even if i would succeed at all.
Yes, insuline sensitivity is a problem at activities. Trying this would cause hypos with the slightest activities
Click to expand...
It Is achievable and its where my libre comes into play.
During the day at work i have no fast acting insulin on board so when i start dropping it drops slowly which is where the 10g top up of carbs come in.This keeps me in the 5s and my CGM with a quick glance at my watch tells me if i'm going low, equally if i'm rising i get a wriggle on bring it down with activity.

It works and i am always aiming for lower but fear i may have reached my best.

I have the confidence and tools to tinker and tinker i do and find it fascinating and its how i conquered my own insulin resistance way back when and also worked out it only works for me.

Good luck

Tony
 
Ok, guys. I've been doing a lot of thinking these days about your reactions and new insights. For which i'm very thankful.

Years i spend finding answers about my afternoon dips. Spoken to a dozen doctors and even switched hospitals specifically for this thing just to get answers.
They all agreed with me that the activeness of insuline in the afternoon was abnormal and they all said they haven't seen this in any other patient before. This was feeding me with the idea that i was unique in this and that i might be suffering from an additional medical issue.
Now i'm thinking that the effectiveness of insuline after 5+ hours might not be that abnormal afterall. Allthough i still think the effect with me is very strong. Yesterday i had to take a total of a full lunch of CH just to compensate my afternoon dips.
I also think that increasing insuline sensitity during the afternoon is involved.

So new ideas and a different way of thinking about this. Whished i posted earlier on this forum.
 
Hi @Dennis78 - I used to get a dip at 4pm every day no matter what I did.

There is always an answer to these things its just not always obvious (someone will have something similar).

I switched from MDI (injections) to a pump, and get the same thing happening - even tried dropping my insulin off from 2:30 PM (helped a bit but didn't solve and repercussions from eating anything which were a very high BG).

In the end, I went with a HCL (Hybrid closed loop) - CGM (glucose monitor) and a pump working together to monitor BG dips and reduce insulin when that happened - solved it.

Also means I can eat when I want, and don't get dawn phenomenon etc - its a long path to solve it - but there are many many other benefits too.
 
I have these afternoon dips since the beginning of my diabetes. I was on MDI back then. Switched to pump (Omnipod) around 8 years ago. The theory was that by setting basal rate to zero at around noon, insuline on board would be 0 at 4 pm so afternoon dips would be gone. But no real change happened here.
Now i'm on a hybrid closed loop (Ypsopump+CamAPS FX) for a year. Doctor told me that there was a good chance the algoritm would pick things up and switching to a HCL would be a solution to this problem.
But again nothing is changed. I can see the learning algoritm is struggling with it preventing a afternoon hypo by shutting down insuline already at 10 am.
 
Totally understand that - had the same issues till I switched to Ultrafast (Fiasp) from Novorapid - thats another load of work to get it right, but does work much better in a loop (some find Lyumjev better - it didn't work for me as I got huge resistance)

CamAPS is "a bit behind the loop" ( see what I did there??) for some of the algorithms (I use a DIY Loop and while its very complicated to set up - the control and ability to tweak is much better) its learning process will be over a week or so, if no benefit yet - you have to look elsewhere, either settings in the loop or insulin make / type to change the DIA profile.

Only other thing I can suggest is snacking in the afternoon with some complex carbs (pain but as a temporary it might help)
 
Another that has large drops in the afternoon.

I presented evidence that it is the bolus that is the issue by showing no movement if I miss lunch (a lovely flat level reading) but large drops after 5 hours when i did have lunch.

Trainee consultant seemed interested but their suggestions either was something already tried or didn't make sense to what I had presented.

When letter came after appointment the main consultant intermated more likely basal rather then Bolus was the cause for the drop. I understand he didn't see the evidence I presented just the words the trainee discussed so this flat with no food (which i think was the most important bit of our meeting) probably wasn't discussed at the discussion. I now just try and live with it, but waiting for my annual appointment which is overdue (Nov-25 was the 1 year due date) to see if i can present more evidence to say nothing to do with basal all to do with bolus.

MDI is my insulin therapy (Fiasp & Tresiba) was on Humalog and Lantus - had the same drop but not as large.
 
Happens to me. Novorapid has a bit of a spike at about 5 hours i find. I also proved it by living on lettuce & Tresiba only for a day, but DN convinced it should be out of my system.

Its worse if I've been sat at a desk. Almost as if it sits in my fat and waits for me to start moving hours after lunch then wham, jelly baby time.
 
ROE100 said:
I presented evidence that it is the bolus that is the issue by showing no movement if I miss lunch (a lovely flat level reading) but large drops after 5 hours when i did have lunch.
Click to expand...
I did exactly the same thing several times.
I also presented proof that my lunch bolusses worked way longer than the theoratical 4 hours setting basal to 0 and skipping supper. It was clearly visible that i had dips 7+ hrs after last bolus.
 
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