NovoRapid not lasting duration?!

[Postleneo]

Just thought I'd share in the hope of some advice. Was having major problems with high post meal spikes especially after lunch where was hitting up to 21 mmol 1 hour after eating dropping to 8 - 10 mmol at the 2 hr mark but nicely at target 4-4.5 hours following injection. At breakfast was just under 9 mmol at 2 hrs and on target again 4-4.5 hours following injection. After ajusting my bolus to take insulin 20 mins before meals opposed to 15 mins before i have noticed that i am neareast **** it at the same readings at the 2 hour mark at breakfast and 3 hours later at the same readings - at lunch at the 2 hr post meal mark am approx 9 mmol.... but then seem to 'flat line' and BS dont seem to drop any more... if they do its negligible. ie this morning at breakfast started at 6.8 mmol at 5:10am....2 hrs later at 7:10am was 6.5 mmol then 5 hours after that at 10:15am was 6.4mmol so insulin now seems to last only 2 hours?!.... i have just changed to Toujeo from Lantus last week and was wondering if this could be the cause or if there are any other underlying issues as was always lead to beleive that the NovoRapid lasts 4-5 hours so would have thought there would be a much larger drop in the latter 2 hours - hope this makes sense.

 

[azure]

i think drawing the conclusion your Novorapid only last two hours is wrong, judging by what you say. Have you done a basal test to make sure that's ok?

Remember there will be many things affecting your BS, including exercise, food digestion, basal, etc, etc

 

[Postleneo]

i think drawing the conclusion your Novorapid only last two hours is wrong, judging by what you say. Have you done a basal test to make sure that's ok?

Remember there will be many things affecting your BS, including exercise, food digestion, basal, etc, etc

Hi and thanks for the response - not done a basal test as blood sugars seem to be stable over night no particular peaks or troughs and wake up now with almost the same levels as when i went to bed and between meals levels seem to be quite stable... ie after the initial rise after meal and the drop 2 hrs later/// bs appears to be quite stable until next meal with minimal changes... so presume that finaly my basal is correct.... on saying that i try to eat same things at same times and with past experience i can have great readings for a week maybe two then bizarly seem to go all over the place making me re-adjust my ratios... quite frustrating

 

[noblehead]

I would certainly basal test.

What do you eat for breakfast, it might be your Novo is still active after two hours but is dealing with a delayed rise due to the content of your previous meal (for example if it had a high percentage of fat/protein).

 

[tim2000s]

Here you go @Postleneo - the Clamp graph for Novorapid/Novolog:

Definitely not two hours, but bear in mind actual time to action for many people is 30-60 mins, and that fast carb meals (i.e. Bread, Toast, Cereal) can be having an effect within fifteen minutes and you can see how spikes in bg happen.

As @azure says though, double check basals are correct, because issues with Bolus are often related.

 

[Postleneo]

I would certainly basal test.

What do you eat for breakfast, it might be your Novo is still active after two hours but is dealing with a delayed rise due to the content of your previous meal (for example if it had a high percentage of fat/protein).

For breakfast i wake at 5am test then usually have a 30g banana 20 mins after injecting at a ration of 1:11 have been doing this for past couple of months.... at two hour post nanna used to be around 8.5 mmol then by 11:30am around 5 - 6 mmol lately like i say been down to the pre meal readings at two hr mark and near **** it the same by 11:30am.... totally confused with this .... happy that readings are good but cant understand why no further drop??

 

[tim2000s]

For breakfast i wake at 5am test then usually have a 30g banana 20 mins after injecting at a ration of 1:11 have been doing this for past couple of months.... at two hour post nanna used to be around 8.5 mmol then by 11:30am around 5 - 6 mmol lately like i say been down to the pre meal readings at two hr mark and near **** it the same by 11:30am.... totally confused with this .... happy that readings are good but cant understand why no further drop??

That typically suggests that your bolus insulin is also accounting for some form of rise that your basal isn't covering.

 

[catapillar]

For breakfast i wake at 5am test then usually have a 30g banana 20 mins after injecting at a ration of 1:11 have been doing this for past couple of months.... at two hour post nanna used to be around 8.5 mmol then by 11:30am around 5 - 6 mmol lately like i say been down to the pre meal readings at two hr mark and near **** it the same by 11:30am.... totally confused with this .... happy that readings are good but cant understand why no further drop??

I don't understand what it is you're concerned about - you have good in target readings that are flat lining?isnt that the aim?

 

[Postleneo]

That typically suggests that your bolus insulin is also accounting for some form of rise that your basal isn't covering.

Could this be the DP... used to have to inject an aditional unit of bolus to counteract the DP rise (used to have a 4 mmol rise between hours of around 5am - 7 am... but now dont inject for the rise as have been eating within 30 mins of waking and by doing this dont seem to be getting the DP - or if i am it is more suptally.... still get the rise if i lay in on weeknds though... but not as much

 

[tim2000s]

It could be linked. The only way you can really tell is if you basal test.

 

[noblehead]

For breakfast i wake at 5am test then usually have a 30g banana 20 mins after injecting at a ration of 1:11 have been doing this for past couple of months.... at two hour post nanna used to be around 8.5 mmol then by 11:30am around 5 - 6 mmol lately like i say been down to the pre meal readings at two hr mark and near **** it the same by 11:30am.... totally confused with this .... happy that readings are good but cant understand why no further drop??

Right so that rules out a delayed bg rise due to your food, I'd do as Azure suggests and do a basal check.

 

[Postleneo]

I don't understand what it is you're concerned about - you have good in target readings that are flat lining?isnt that the aim?

Hi .. yes it is... mornings are ok but basically at lunch the 'flat line is higher readings that i wish for... ie inject enough insulin to bring me down to my goal of under 7 mmol before previous meal but now my bs seem to only drop for 1st 2 hrs ie may come down to 9 or 10 mmol 2 hrs post meal and remain about 9 - 10 at my next pre meal time.... and just a little worried if this was a temporay thing or think about re adjust insulin/ carb ratios.... yet again

 

[Postleneo]

Cheers guys will do basal check.. and post results in due course

 

[azure]

Hi .. yes it is... mornings are ok but basically at lunch the 'flat line is higher readings that i wish for... ie inject enough insulin to bring me down to my goal of under 7 mmol before previous meal but now my bs seem to only drop for 1st 2 hrs ie may come down to 9 or 10 mmol 2 hrs post meal and remain about 9 - 10 at my next pre meal time.... and just a little worried if this was a temporay thing or think about re adjust insulin/ carb ratios.... yet again

But you don't know if the bolus insulin is controlling a rise - that is, still working but you don't see it.

It's a hard balance to get things right (or as right as possible with Type 1 - never perfect) but the basal check will help

 

[Postleneo]

But you don't know if the bolus insulin is controlling a rise - that is, still working but you don't see it.

It's a hard balance to get things right (or as right as possible with Type 1 - never perfect) but the basal check will help

Cheers for that - never done a Basal test - i take my Toujeo as my basal at 8:30pm - could i possibly trouble you for some advice as to the best way to procede? I am also currently also using a freestyle Libre system as i wanted to find out what was going on with my BS throughout the night

 

[azure]

Cheers for that - never done a Basal test - i take my Toujeo as my basal at 8:30pm - could i possibly trouble you for some advice as to the best way to procede? I am also currently also using a freestyle Libre system as i wanted to find out what was going on with my BS throughout the night

Here's some info about basal testing:

https://mysugr.com/basal-rate-testing/

Sorry the BS is in US units. There are UK pages but I find this one and other U.S. ones clearer. There's a BS converter here so you know what they're talking about:

http://www.diabetes.co.uk/blood-sugar-converter.html

Basically, you split the day into segments and test one segment at a time so you don't have to go without food too long. Your Libre should make testing much easier, but I'd still finger prick at intervals too.

 

[Postleneo]

Here's some info about basal testing:

https://mysugr.com/basal-rate-testing/

Sorry the BS is in US units. There are UK pages but I find this one and other U.S. ones clearer. There's a BS converter here so you know what they're talking about:

http://www.diabetes.co.uk/blood-sugar-converter.html

Basically, you split the day into segments and test one segment at a time so you don't have to go without food too long. Your Libre should make testing much easier, but I'd still finger prick at intervals too.

Cheers for the info.... Much appreciated

 

[steve_p6]

I'm sure there is a quote somewhere about check the obvious first. If you have just changed your basal insulin then that is where you need to start looking for a culprit, and the basal test as suggested is the right path.