Novorapid either works or it doesn't

[MarcTurner83]

Hi everyone,

Wanted to ask for some advise.

I use Novorapid and will use the usual method to calculate the dosage required (carbs in grams divided by 10) and will have it maybe 10 to 20 mins before eating, but my blood sugar remains high for hours before tumbling down.

Are there any tips or tricks?

My understanding is that it should start working in around 20-30 mins?!?!

Thanks

P.s Using the Freestyle Libre now, what a toy!!!

 

[AndBreathe]

Hi everyone,

Wanted to ask for some advise.

I use Novorapid and will use the usual method to calculate the dosage required (carbs in grams divided by 10) and will have it maybe 10 to 20 mins before eating, but my blood sugar remains high for hours before tumbling down.

Are there any tips or tricks?

My understanding is that it should start working in around 20-30 mins?!?!

Thanks

P.s Using the Freestyle Libre now, what a toy!!!

Marc, I'm not an insulin user, so can't impart any wisdom, except to say two things. Firstly, I have read many members talk about tweaking the timings of their injections, depending upon what they intend to eat, as some foods digest (and therefore, simplistically, impact blood glucose) more quickly than others.

Secondly, I'm sure the Libre could give you some exciting clues about how your body works in conjunction with your Novorapid. As I say, I'm not an insulin user, nor any drugs at all, but I learned such a lot from using a Libre.

I don't use the Libre full-time, but I did see some blood glucose action I could never have caught just by undertaking finger prick testing.

I'm sure others, with more relevant experience will be along in due course.

 

[catapillar]

So I assume you are confident your insulin to carb ratio is 1:10 and you have checked that is the ratio that actually works for you, it's usually the start off point to work out what your ratio is.

You say you blood sugar stays high. So what is the level like before you eat? Novorapid will usually start working at about 30 minutes, but if blood sugar is high it will take longer to start working. If I'm in double figures it can be an hour or 90 minutes plus before my blood sugar moves. If you are starting off high do you give a correction as well as your food bolus? Do you wait for the correction to work and bring you into normal range before eating? Are you checking your bolus is working before you eat? So, do you wait for the libre graph to start curving down before eating?

You say blood sugar tumbles down hours later. Is that taking you hypo? That does suggest 1:10 might not be the right ratio for you. Proper use of pre bolusing might also mean you can adjust your ratio a bit.

You might also want to basal test and check there's not a lack of basal that's causing the novorapid to have to try and compensate.

 

[urbanracer]

The previous comments are very valid but dare I say that not all rapid insulins are equal for all people.

I found the performance of Novorapid Aspart to be anything but rapid. For me, Humalog Lispro is much more effective.

 

[therower]

What is your diet? How many hours after do sugars drop? What injection sites do you use? Does this happen throughout the day? All possible causes.
One statement in your post was that your sugars " remain high " this suggests they start high. High sugars can demand a totally different carb ratio than sugars that are within range.

 

[MarcTurner83]

Thanks everyone, before lunch Im usually around 5-6, then if I have a sandwich for example I would have had the equivalent Novorapid to compensate, and the sandwich will take me up to say 13-14, it will remain there until say 3-4pm then it will sharply come down over. Not always taking me into a hypo but on the odd occasion. I try not to get impatient and have more NR as I risk doubling up. Need to find a way as Ive only been diagnosed since summer of 2015 and already I have worrying signs as a result of my latest retinal scan. Thanks so much for all your input, maybe Novorapid isnt for me

 

[urbanracer]

Thanks everyone, before lunch Im usually around 5-6, then if I have a sandwich for example I would have had the equivalent Novorapid to compensate, and the sandwich will take me up to say 13-14, it will remain there until say 3-4pm then it will sharply come down over. Not always taking me into a hypo but on the odd occasion. I try not to get impatient and have more NR as I risk doubling up. Need to find a way as Ive only been diagnosed since summer of 2015 and already I have worrying signs as a result of my latest retinal scan. Thanks so much for all your input, maybe Novorapid isnt for me

As @therower has pointed out, injection sites could be one of the possible causes. Do you use your stomach, legs or any other areas?

 

[MarcTurner83]

Stomach, but I try to spread across the region but maybe I should try my legs good point!

 

[urbanracer]

Stomach, but I try to spread across the region but maybe I should try my legs good point!

The point @therower was trying to make (I think) is that for most of us the stomach is the most effective area. Injecting in the legs usually means that the insulin takes longer to get to where it needs to be.

I also find that legs are not that that good unless you're going to be a little active afterwards.

 

[MarcTurner83]

Phew! Thats alright then

 

[therower]

@MarcTurner83 . It maybe a combination of things. It's important to only tackle one area that could be of concern at a time.
Would I be correct in assuming that you use a basal insulin/ background insulin? Although you are focusing on your bolus/novorapid insulin it's imperative that your basal insulin is working correctly for you before you can focus on your bolus insulin.
If you know your basal amount is correct and keeping you stable then you can focus on your bolus ratios.
At a glance at what you've said it may be that your basal regime is to much and your bolus ratio is to low. This is only a possibility, but I'm sure if you get your basal right and then your bolus things may become clearer.
Have you undertaken a carb counting course?

 

[Scott-C]

Might it be lipohypertrophy? Run your fingers over the injection area, and if there's what feels like a a soft avocado textured lump under the surface, that might be lipohypertrophy, basically enlarged fat cells caused by insulin, which will mess up absorption rates.I see you were dx'd in 2015, don't know how long lipo takes to develop. I had the same problem a few years back, had been injecting for many years at the side of my stomach, thought I was putting on a bit of middle aged weight, but turned out it was lipo, so moved to stomach proper to give the sides a rest and that sorted it.

 

[Kristin251]

I don't eat any carbs to speak of but many who do prebolus. I prebolus 10 min for just a protein and fat meal. I also have to split boluses in the morning. I keep rising so I inject for bf then inject again an hour later. Then another small dose about 2 hours later. This stops the rise without taking the whole dose at once. When I do that I go low then pop up. Splitting my dose keeps me much steadier. This is my version of a pump.
Maybe try a different lunch. Like putting your sandwich toppings on a salad or large piece of lettuce?

 

[azure]

@MarcTurner83 There's no reason why you shouldn't be able to eat a sandwich. You've got good advice above, so follow it to see if that works - ie basal test, bolusing further in advance, checking Bolus ratio.

If none of those give you any joy, try Humalog. As @urbanracer suggests, many people do better with it.

 

[MarcTurner83]

Lots of food for thought, thanks everyone!!

 

[noblehead]

Stomach, but I try to spread across the region but maybe I should try my legs good point!

Why not use your arms, I often injected my bolus doses in the arms and didn't find it lagged too far behind injecting in the stomach.

 

[Scott-C]

Why not use your arms,

Yikes! I'm fine with injections, but for some reason the idea of sticking a needle in my arm freaks me out!

There was a girl on my DAFNE course who did it, and, honestly, I had to look away, which sounds like a terrible thing for a fellow T1 to say, but, still...arms...needles...

Maybe a throwback to when I was in hospital at dx. Junior nurse had about ten goes at getting an intravenous needle in, can still remember the needle scraping along the surface of the vein...aaargh!

 

[noblehead]

Maybe a throwback to when I was in hospital at dx. Junior nurse had about ten goes at getting an intravenous needle in, can still remember the needle scraping along the surface of the vein...aaargh!

Understand your fear @Scott-C I've had that too with a junior Dr, made an awful mess of the back of my hand and a more senior Dr was called and they got the needle in first go.

Regards to injecting in the arms, some say it's difficult but its quite easy really, just raise the arm up and come in underneath with the pen is the easiest way to inject there.