Must I take insulin with every meal?

K_at_Home said:

Hallo!
I was diagnosed as diabetic last week and have been prescribed insulin. The insulin routine I am currently on is 3 shots of novorapid fast-acting insulin before my 3 main meals and 1 shot of levemir long-acting insulin at night. My problem though is that I eat 4 meals a day; I usually have a small bowl of cereal at night. This extra meal sends my blood sugar readings really high each night.

My diabetic nurse and dietician have both told me that I do not need to take a 4th shot of novorapid fast-acting insulin before my supper, but these high readings are worrying me. I don't want to have to cut out supper because everyone tells me that the insulin and diabetes has to adjust itself to my routine and way of life, not the other way around and also I get pretty hungry at night.

What would you recommend?
How many insulin shots are you taking every day?
Also, what doses of insulin do you take for every meal?

Your help in this matter would be greatly appreciated.

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I find the response from your diabetic team worrying, since mine tell me to inject Novorapid every time I way more than 10g carb.

I carb count, so the dose depends on the meal. Usually between 1 and 3 units.

You're new so they're probably not wanting to overload you with things. I would express your concern with your evening meal and they may change their advice

Well if you insist on supper and your bg goes high then it's logical that you need insulin to cover the carbs in your food, going to bed with high bg readings and staying their all night is not good in the long-term. Your DN's concern will be with injecting quick-acting insulin before bed and the potential to go hypo in your sleep, you could try a smaller portion of cereal or alternatively eat foods where the carb content isn't too high and you may get away with not injecting, can't say for certain and the only way of knowing is by testing postprandial.

Have you tried eating your tea later in the evening so that your not as hungry before bed?....like you I use to eat supper but stopped this and now just eat 3 meals a day, found it much easier to keep the weight off by doing so and have almost eliminated night hypo's .

Hi I take between 2 and 6 shots of novorapid a day based on how much carb I eat the same as Hale. what kind of cerial are you eating? could you change the cerial for an omlette or eggs/bacon or salad? that would count 0 carbs and then wouldnt increase you BG.

You also nearly got it right

everyone tells me that the insulin and diabetes has to adjust itself to my routine and way of life, not the other way around

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you need to adjust your insulin to your life, but that will fit the diabeties to your life. Its a balancing act and you shouldnt let the diabetes take over for sure!

K_at_Home said:

Thank you all so much for your replies! You've been very helpful and enlightening!

Usually between 1 and 3 units

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I take between 2 and 6 shots of novorapid a day

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Wow, I'm shocked to hear this. My smallest dose is 6 units of novorapid and I'm taking 10 units for both lunch and dinner
The dietician seemed so happy when I told her my diet too, she said I was doing well.

I don't want to have to adopt a high protein diet. Right now my diet is pretty healthy (mostly fruit and cereals) and I can't really afford to lose any more weight.

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Everyone's insulin doses are different. I am very insulin sensitive so need small doses. Others are less so

Sounds like your diagnosis is quite recent, I know for me the advice I was given in the first few weeks changed as I got my levels more stable and worked out a bit more about how both insulin and carbs affect me. Initially I was advised to eat a small supper (20g or so of carbs) without any novorapid to ensure I didn't drop low overnight. I'm on fairly small doses so it didn't take much for the novorapid to send me too low, especially if I've had a fairly active day.

For the first few weeks I was on fixed doses of novorapid while I got used to all the new routines, then I started couting the carbs in each meal and working out a dose accordingly. Things got a lot more flexiable then.

Once I reached the honeymoon period my insulin needs dropped quite a bit, my insulin carb ratio went from 1:5 to 1:12, at that point I really didn't need novorapid with supper.

Now I'm out of the honeymoon I have different ratios throughout the day, I now do take novorapid if I have more than 10g or so for supper but I still need a lot less than I take at other times of the day.

While things settle down it might be worth thinking about other options for supper with slightly less carbs. A handful of nuts, cheese & crackers, berries & yoghurt (I buy frozen ones and mix with greek yoghurt)

Do take notice of the dietary suggestions, Hun. I know it's annoying to have to be told to change everything about your routine but perhaps the reason your insulin needs are so high is because your diet is mostly fruits and cereals, both of which send blood sugar sky high. It does sound ridiculous doesn't it? The cereals are thought of as 'healthy' and greasy food is 'bad' and now you're being told to eat eggs and bacon and such! But honestly, cut the cereal. Especially Weetabix. It can do crazy things to your blood sugar x


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I'd take dietary advice on this board with a pinch of salt - what's bad for one person may not be bad for you, etc. Personally, I find a (single) weetabix before bed doesn't have much effect. The main thing you can do is experiment and see what works for you. If you want to stick to fruits and cereals, you probably can - ultimately your Hba1c will tell you how well that's working out for you. But you may find small adjustments (eg cornflakes to porridge) have big wins.

LittleWolf said:

Do take notice of the dietary suggestions, Hun. I know it's annoying to have to be told to change everything about your routine but perhaps the reason your insulin needs are so high is because your diet is mostly fruits and cereals, both of which send blood sugar sky high. It does sound ridiculous doesn't it? The cereals are thought of as 'healthy' and greasy food is 'bad' and now you're being told to eat eggs and bacon and such! But honestly, cut the cereal. Especially Weetabix. It can do crazy things to your blood sugar x


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If you're insulin dependant and carb count you can eat as much cereal and fruit as you like! If its high GI then you take the insulin a little while before to avoid the spike

Not fair >_>

But isn't there a lot of evidence to suggest that eating high carb and injecting lots of insulin isn't good for you because it's a growth factor hormone? Can you not induce resistance to injected insulin? It accelerates ageing and disrupts the balance of other hormones in the body.

I know my PCOS is caused by the action of high insulin levels on the ovaries causing them to produce testosterone and such. It just seems a little crazy for a T1 (like my much lies partner) to believe it is cool to eat as much junk as they like as long as they cover it with insulin.

I don't know if I'm speaking out of place because you T1s (though it is being suggested I might be slow onset T1 :/) have enough to worry about without someone telling you what to eat. It seems the attitude is to carry on as normally as possible whereas with T2 your whole diet goes out the window. Why are T2s not just put on insulin immediately and told eat whatever? My guess is they already have high insulin levels and too much insulin isn't good for you besides the risk of Hypnos

But I don't see a DN or anything. I don't know as much about this as you guys I suppose. Just flailing about aimlessly as confused as the next person @_@


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I wouldn't go eating haribo or fruit juices etc unless I was hypo. And I avoid processed food and takeaways on a regular basis (I have always preferred home cooked) But no doctor or dietician (both of which I see regularly) would suggest that you give up fruit! Fruit is part of a healthy balanced diet.

Personally, I don't like cereal. But that's because I don't like milk! So I have porridge instead. I rarely go above 9mmol/l (I aim to be below 8.5 but there is always room for error in calculating the carb) and no doctor had ever said I am wrong in this. I take 3u back ground a day and about 7u total of quick acting insulin. I wouldn't call that a lot!

Helpful tip for you though, cherries are EXTREMELY low GI and you can eat as many as you like without a spike

Thanks and sorry. I'm in no position to be advising or preaching to anyone. I don't even know what I am @_@

I like cherries though. Made a cherry pie the other day...


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LittleWolf said:

Thanks and sorry. I'm in no position to be advising or preaching to anyone. I don't even know what I am @_@

I like cherries though. Made a cherry pie the other day...


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No no I'm only diabetic for 5 months so still learning myself. I just believe there should be a compromise between a healthy diet and not letting my diabetes rule my life. So far so good for me on that front!

I don't even like cherries, but it doesn't stop my dietician encouraging me to eat them haha

That's true. Only I can't ignore the guilt and worry when I see BG go up 10mmol because I ate something silly like banana. The 'maybe I shouldn't have done that' feeling. I mean you guys have the advice of a diabetes team etc so therefore know more about it. I've just realized I shouldn't be running around telling people what to do when I'm not diagnosed so I dont know if my own experiences are even applicable...

Cherries are also good for gout though.

Sorry for derailing the thread and I know the lo carb thing is controversial any way you look at it


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That is quite shocking.

You ALWAYS need insulin, if you have a substantial amount of carbohydrate.

I've done the DAFNE course so need 2 units of insulin per carbohydrate portion (10g)

However for example if I have 2 sugars in a cup of tea, I don't need extra insulin.

If your having a bowl of cereal your def going to need insulin for it.

Also you mention your on once daily Levemir, speak to your Diabetes team about changing it to twice daily. I say this because they now say Levemir only lasts 16-18 hours and not the full 24 hours like first thought.
That might be the cause of your high blood sugars.

Remember everyone is here to offer you advice and support.

Kev.


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Kev it works from 16-24 based on the person (mine generally lasts at least 24 and my body seems to store some of it also!)

I was told for my lg who is 4 upto 20g carbs is fine for snacks/supper - but she was shooting up at night too. we did a few night readings when long lasting should of been at the peak so should be dropping down & likely times to hypo but my lg even without supper would be in the 20's! she doesnt follow the norm pattern of what should happen & her randomness has no pattern to it either & she been diagnosed 1.5yrs & baffling the consultants & nurses - it is trial & error working out what dose of insulin you actually need in relation to what ratio you are on. Recently changed from lantus to levemir on 2 injections & she seems hungrier than ever & readings still high. they normally say leave 12hrs between but with her being high in night we been told to bring 8pm one to 5pm to see if that helps her - otherwise will have to change fast insulin of novarapid to even faster reacting one. everybody is different & can't compare to one another as we all react differently. good luck & hope they find your right dosage soon =)

Hi. My views for what they are worth. First if you eat carbs fairly freely and take enough insulin to match the carbs you may put on weight and be more subject to hypos due to larger swings. I've roughly continued my previous tablets only regime by still controlling my carbs enough to keep my number of units reasonably low. I take around 9 units of Levemir at night and have one or two shots of NovoRapid a day varying between 3 and 8 units depending on lunch and dinner carb level. I don't have enough carbs at breakfast to need a morning NovoRapid. I believe I still have some natural insulin production so don't have the same need as a full T1. Yes, Levemir doesn't last 24 hours. My DN preferred to add NovoRapid to my basal regime rather than do a split basal dose. Means I have full control but need two pens. I wouldn't have cereal at night. Cereal is a carb that causes most diabetics to spike and best avoided at night. I only take NovoRapid if I'm having a meal of, say, more than 30gm carbs. I'm afraid I have serious reservations about the average NHS dietician based on some of the postings I've seen. Do watch the carbs and a healthy diet for a diabetic is different from a non-diabetic as we don't process carbs properly. Sadly you do need to make some adjustments to your lifestyle, but a good balance is still possible.

Hi. Sorry hear about your diagnoses. I remember getting diagnosed.

I always have a bowl of cereal before bed and I give myself 3 units just so there is some insulin there.

Everyone has different insulin requirements. And everyone eats differently. I eat a lot of carbs because I don't really eat much else. Potato is my main source of food. It's common for me to give myself 10 units for a meal. So don't feel bad.

Diabetes is an art. Trial and error is the key. If you give yourself a bit of insulin and then go too low, it's okay. Just change it next time.

A bit of advice. Keep lucosade and your tester by your bed. You will wake up with a low. I've been diabetic for nearly 10 years and I've only ever not woken up with a hypo three times. One of those times a 'friend' had played a trick on me swapping my insulin tubes so I thought I was giving myself 20 units of levimer and it was actually novo rapid. Needless to say we are not friends any more.

Keep testing. That's the key. Listen to how you feel, and test if you feel funny. You might think you feel high an actually you are low (I've had that happen too).

Go to boots and buy glucose tablets. Get the ones in the tubes. They are easier to get into in a hypo than those wrapped up ones.

And don't worry if things seem to go wrong. Don't worry if you have an odd high or low reading. It's all about learning your body and how your body works.

Best of luck.


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