Type 1 Novorapid dose?!?!

[Jaylee]

Hi @rmz80 ,

I'm a little intrigued about your diagnosis regarding your profile.
Are you T1 or now T2 diet managed?

 

[DCUKMod]

There is no guidance in the instruction leaflet for NovoRapid as to which approach to take. I shall write to the manufacturers (Novo Nordisk) with our comments and hopefully post a reply next week.

@rmz80 - I don't know if you've ever tried using a Libre, or other 24/7 blood glucose monitoring gizmo? I must say, when I first used the Libre, it was a real revelation about the impacts of some foods eaten and insulin responses. In my case, the insulin response was ans is my own, on-doard insulin, but you can certainly see the impacts.

However, going back to @GJT71 's original question - DJT71, how much insulin other people take is a complete red herring to your personal well-being. If, to balance other aspects of your life, you eed to take on board significant amounts of insulin, to remain in the healthy blood sugar ranges, so be it.

If, for whatever reason your current carb ration concerns you, due to the amount of insulin you are using, then that's a different question.

When are you next due to see your medical/diabetes team? If you had DKA over Christmas, do you have a follow-upo soon? That could be a decent time to engage with them, to work on either your insulin sensitivity, carb ratios, timings of your injections, checking out your injection sites, or whatever

 

[rmz80]

Hi @rmz80 ,

I'm a little intrigued about your diagnosis regarding your profile.
Are you T1 or now T2 diet managed?

My medical records show I am type 1. However it is over 2 years since last seeing a diabetes consultant as they keep cancelling appointments. I suspect I was misdiagnosed and could be now classed as Type 2 “in remission” as I don’t need medication (since Oct 2017) and eat a standard Eatwell diet.

My GP does prescribe BG test strips to confirm levels are OK

Hopefully this gives me one advantage on a site like this as I can read type 1 posts as I was type 1 for 8 months then read the type 2 posts.

 

[Rokaab]

My medical records show I am type 1. However it is over 2 years since last seeing a diabetes consultant as they keep cancelling appointments. I suspect I was misdiagnosed and could be now classed as Type 2 “in remission” as I don’t need medication (since Oct 2017) and eat a standard Eatwell diet.

Whilst I'd rather not derail the thread, @rmz80 you really need to get that sorted out as having type 1 on your records if you are not may cause issues if you're ever admitted to hospital, or trying to get medical, travel, car, or life insurance, if in the UK it affects your driving license (as in if you're T2 on no meds instead of T1 you wouldn't need to have a medically restricted license for a start).

 

[kitedoc]

Hi @Diabell and @rmz80 , please see this study of 2016 - published in 2017
https://www.nbci.nlm.nih.gov/pmc/articles/PMC5505415/

 

[rmz80]

Thank you for undertaking that. I guess it is like trying to fit a curve on a graph of insulin action to that of the glucose whilst the interaction between the two takes place.and Damned if you are too high in BSL in one place and too low in another !!

Novo Nordisk replied back to my question listed below.

Which is the recommended action to take to confirm correct dosage of NovoRapid after injection and meal for a type 1? To test at estimated peak BG level (around 2 hours) or at around base level (approx 4 ½ hours)?

Their reply was:

Unfortunately, under the Code of Practice which governs the pharmaceutical industry, Novo Nordisk are unable to advise people on an individual basis. We can only recommend that you return to your Healthcare professional and follow up any further questions that you might have with them, in relation to your own personal medical history and treatment requirements

From my notes; there are two contradictory answers to this question.

The 2 hour test seems to be most mentioned; however the 4 ½ hour test is also mentioned.

**********************************************

In a NHS hospital PowerPoint presentation the following points are listed

An Accurate Carb Ratio or Factor:

Returns the blood sugar:

to within 30 mg/dl (1.7 mmol) of where it started

by the time selected for your duration of insulin action (DIA)

with no lows within 5 hours after carb bolus given

************************************************

P.S. The “duration of action” of NovoRapid is listed as 3 to 5 hours in Novo Nordisk information.

I’ll think leave the answer to this question to someone else !

 

[kitedoc]

Hi @rmz80, The good old company line !! I suppose it is true that each person may have a different response to their Novorapid at a different time of day, season etc.
Each 'pilot' with fuel coming on board has to fly under a certain altitude without later crashing, each flight, three times or whatever per day no matter the weather or other conditions, without autopilot but including night flying!

 

[rmz80]

Perhaps these may be 4 solutions to this problem.

The first would be to split big meals into two which is what I do with lunch. By having half the lunch at 10:30am and the second at 3pm you can avoid going high at 2 hours. This would mean the occasional test at 2 hours to check in range with the main test at about 4 ½ hours. Otherwise you’d end up with no fingers with all that testing.

Secondly; adjust time of injection before meal, say 15 min before eating may be an answer. One disadvantage is when in a restaurant and the meal is late.

Thirdly: Dose to 9 mmol@2 hours and retest at 4 ½ hours to see if near base. If over corrected; eat some jelly babies (or Haribo Gold Bears which are a better size)

Lastly a horrendously complex solution. You could implement “Insulin Stacking” and a computer; this would require some mug sorry “patient” to test such a system.

 

[Scott-C]

Lastly a horrendously complex solution. You could implement “Insulin Stacking” and a computer; this would require some mug sorry “patient” to test such a system.

Insulin stacking is actually fairly easy and safe if you've got cgm and learn over time from what it's telling you.

I know not everyone has cgm but times are changing - it's becoming increasingly common place, especially with scripting of libre slowly becoming more liberal in some parts of the country.

Stephen Ponder's book Sugar Surfing, and William Lee Dubois's Beyond Fingersticks both cover pre-bolusing and insulin stacking in depth.

Here's an example from mines today, see pic below..

Pre-bolused 7u to get some in stream about 20 mins before a Chinese buffet at 12:40, from past experience reckoned another 4u on top would cover it, put it down as 70g, but buffets are always a bit of guesswork, I reckon after seeing the line it was likely nearer 90, but the accuracy of the carb count didn't really matter that much because I knew that the stacked 11u was roughly in the ballpark for that meal and I could simply watch to see how it played out and adjust as necessary.

So, by about 2pm, I'm starting to get clues from the blue dots and also the purple estimated prediction dots, the remaining IOB count and green insulin decline line that it was starting to trend up unduly and the iob wouldn't pin it, so stacked another 3u in at 14:20 after the trend was confirmed, so pinned it to about 7.6 before a decline to 6.

Yes, stacking can require a few more injections than normal, but I find injections to be as much discomfort as using a lipsalve, and they're not always needed: if you eat a similar meal later, you'll have the past knowledge of what worked for that meal stored away, so there's an improved chance of nailing it with one shot the next time.

There's a fair number of us doing Sugar Surfing and stacking now. Knowing IOB and seeing how bg is trending makes it remarkably risk free.

It does take a bit more glancing at my phone/watch than other methods, but I'm willing to do that as putting a little more effort into staying in range makes me more content with life.

The graph can look quite complex but, like anything new, after a while using it, you start to see much more in it and can make much more informed calls on whether to stack or not.

 

[kitedoc]

Hi @rmz80, Thank you for a thoughtful set of solutions.
Option. 1 - is like a form of extended bolus of insulin, one is extending or spreading the carbs/protein instead (but also of course perhaps doing two smaller doses of insulin) with some stacking effect. Each meal can be delayed for ? 30 to 45 mins after insulin as a further refinement. as in option 2.
There is perhaps the alternative of eating a protein/fat only meal or very low carb meal with insulin dose adjusted and doing the BSL at the 3 hours mark. In theory the less carb and insulin puts in at any one time the less fluctuation in BSL.
And it raises the question, could a protein-only meal be handled by some long-acting insulins or basal rate of an insulin pump alone ??
Insulin stacking obviously can work but needs careful monitoring as exemplified by @Scott-C in his screen readings.
The issue is allowing sufficiently for the wearing-off of short-acting insulin so insulin levels do not 'overstack' and having to consider evoking the complexity of option 4.
Option 3 is the least complex but so ruled by the vagaries of the types and amounts of carbs. The adjustment option of timing of insulin and interval before eating (Option 2) is an important strategy in this scenario.
Option 3 (plus 2) is reminiscent of the pre-CGM era which I very much identify with now that I am at the 52 tooth year on insulin.

 

[rmz80]

Hi @kitedoc You've put a lot of work into your answer.
I do an Eatwell diet (50% carb) but when going out of the day I take my Atkins book with me. This saves me taking fast insulin. Usually going to McDonald's and getting a Big Mac after throwing the bread bun away

 

[becca59]

Hi @kitedoc You've put a lot of work into your answer.
I do an Eatwell diet (50% carb) but when going out of the day I take my Atkins book with me. This saves me taking fast insulin. Usually going to McDonald's and getting a Big Mac after throwing the bread bun away

Do you not find that eating just the protein rises you anyway if you eat it alone. I still end up needing some bolus just for the protein. So if I need to inject for the protein I feel I might as well eat a small amount of carb anyway. Which ultimately keeps my sugar levels more stable. The protein rise being far more unpredictable.

 

[rmz80]

Do you not find that eating just the protein rises you anyway if you eat it alone. I still end up needing some bolus just for the protein. So if I need to inject for the protein I feel I might as well eat a small amount of carb anyway. Which ultimately keeps my sugar levels more stable. The protein rise being far more unpredictable.

Ive never needed to “Protein Count” just “Carb Count”

 

[kitedoc]

Hi @kitedoc You've put a lot of work into your answer.
I do an Eatwell diet (50% carb) but when going out of the day I take my Atkins book with me. This saves me taking fast insulin. Usually going to McDonald's and getting a Big Mac after throwing the bread bun away

Thank you @rmz80 , it was your post which prompted it so please accept my thanks.
Yes, the bunless burger is a great way to manage to it. They should of course offer you a discount !!

 

[Alan689]

are you feeling ill at all? Cold coming on or similar?
What was your level 5hrs after eating?

Hello so I’m an 18 year old male recently diagnosed with type 1 diabetes. My daily insulin doses are 24 units of nova rapid and 24 of lantese slow release insulin. My sugar levels average about 16mmol and once a day it peaks to 20 and above. Should I be taking more insulin? Since I’ve been diagnosed my levels haven’t been normal. What should I do? Also I would like to mention I recently started taking more units of nova rapid just to sometimes bring it down if it’s too high

 

[RoughcutAU]

Hi Alan689! Welcome to club nobody asked to join.

This is on an old post so might be better to start your own post.

To answer your question we are not allowed to suggest dosage/specific advice - this one really is for your Diabetic Team (nurse/doctor etc).

It would appear you are probably on a pretty basic starter program of fixed doses. This is based loosely on things like weight etc and not your individual needs as each persons body works differently and consumes a different diet.

The most important thing you can do is keep testing and keep notes of BGLs and also what you are eating. Your team will eventually use this data to get you onto a more tailored dose for you and get you carb counting. The first year is a huge learning curve … don’t fret on the mistakes - its all learning.

I should know - ive just passed my 1st diaversary in August.

Take care buddy!

 

[EllieM]

Welcome to the forums @Alan689 . As @RoughcutAU said, this is a very old thread. Would you like me or another mod to move your post to a new thread of your own?