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Novorapid with meals

Discussion in 'Insulin' started by CranberryIce, Apr 23, 2018.

  1. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    At the moment those readings are pre and post meals. On days I snack in between those meals- lets say post breakfast & before lunch- I test and I am higher than I would like to be- Do I just give my bolus according to the snack I’m going to eat and avoid correcting? As it is likely thats it going to drop by my breakfast basal?

    If thats the case would explain why I constantly go hypo. I used to snack in between meals everyday and would give my bolus with my snack and correct any readings out of range. Then end up hypo later on.
     
  2. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    A basal test should help me establish that?
     
  3. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    You can bolus for snacks in between meals but you need to consider the insulin still on board....you might need 2 units to correct between meals but then you may have 2 units still to go...

    A lot of the new meters can offer up that calculation for you but it's possible to work it out manually.....

    A trick with snacking would be to have something low in carbs or carb free...
     
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  4. Scott-C

    Scott-C Type 1 · Well-Known Member

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    I think it's maybe a hangover from the days when faster insulins first came in.

    The medical profession were both (a) enthusiastic about these wonderful new insulins, thinking, great, fast insulin - bolus at or after a meal and it'll all be ok, and (b) they're very conservative - docs and dsns seem to prefer the notion of us having spikes as long as we're ok by next meal as opposed to the risk of hypos if the pre-bolus timing is too long.

    There's a bit of a paradigm shift going on at the moment now that libre/cgm is becoming more common than it was.

    Whereas DAFNE tends to be, "don't test between meals unless you're hypo, and save corrections till meals", some hospitals are now actively promoting the notion of making small adjustments between meals if you've got libre/cgm.

    As the other posts have said, pre-bolusing makes an incredible difference to post-meal spikes. It's a different mindset compared to strips alone and takes a bit of practice.

    Here's an example.

    I'll take a shot, I can then watch to see the cgm trace start to track down - that's an indication that the insulin is in stream and working. My assessment of it, in relation to how far I'll let it inflect down and to when I eat, might be influenced by what level I started at, whether it was trending up or down, and what I'm going to eat. I don't go anywhere near letting it rule my day though: I'll generally have an idea about how long a pre-bolus I'll need for a particular meal, and can sort things with an adjustment later on anyway, so it's not like I'm sitting watching a graph all the time, but it's a useful thing to pay attention to if you're just starting out with this sort of thing.

    White rice spikes hard and fast for me, so I'd pre-bolus quite a bit for that, say, 20 mins, and it'd still be kinda unpredictable, so I generally avoid white rice unless I'm out at a Thai restaurant, (b'cos Thai green curry really doesn't work without white rice!). But brown rice, because of the fibre tends not to spike, so I'd pre-bolus about 10 mins as I'd likely start going too low with brown on 20. I'd also be adjusting the timings based on other things which would affect absorption, like how much fat etc is in the meal, and the portion size.

    And then, the other thing I'd do, and this is the big difference from DAFNE, is that if I'm using cgm/libre, I'd be keeping an eye on how it's trending over the next hour or two.

    If I started getting a sense that the graph trace is inflecting too sharply upwards, I wouldn't be slow to consider firing in a 1, 2 or 3u correction shot so that what might have turned into a serious spike will get pinned before it even happens.

    Remember that we can never be entirely certain about our carb counts, nor how our digestion is panning out on that particular day, nor how much of the insulin in that bolus will actually end up working as opposed to getting killed by insulin antagonists before it does anything.

    There's an inherent uncertainty in all of this. What cgm/libre brings to the game is the ability to see how it's panning out along the way in real time. That opens up the possibility of making small adjustments in real time to keep it in line, instead of a large adjustment at the next meal.

    It takes practice but it's worth the effort. You can end up doing neat things like waiting till the trace starts inflecting down, so that the food is then playing catch up with the insulin, so you don't actually end up with a spike at all even on a 75 to 100g meal. But there is a risk of getting that wrong and going too low.

    Stephen Ponder's book Sugar Surfing is a good read about this sort of thing, helped me a lot when I got libre.

    Good luck, it's a brave new world you're in with libre!
     
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  5. dancer

    dancer Type 1 · Well-Known Member

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    Another problem I had before going on the pump, was my BG jumping from within target before breakfast, to mid/high teens 2 hours after. If I raised my breakfast bolus to try and prevent this, I would go hypo later in the morning.

    @CranberryIce, there could be lots going on, so some basal testing is a good idea, to find out exactly what that is.
     
  6. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    Yes low/no carbs would be better for me.

    I recently got the ‘Aviva expert’ metre- assuming that has it? As I got my libre at pretty much the same time, I’ve only ever used that to test bg but not record food or insulin actions on.

    I feel so embarrassed for not knowing any of this and for asking so many questions.
     
  7. catapillar

    catapillar Type 1 · Well-Known Member

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    The aviva expert had a bolus wizard, but before you can use that you really need to be confident that your basal dose is correct, because to complete the information for the bolus wizard to work you need to know what your insulin to carb ratio is, at different times of the day, how long bolus insulin lasts in you, how may mmol/l 1 unit brings your blood sugar down. To know the answers to these questions, you need to know that your basal insulin isn't doing anything other than keeping your blood sugar flat.
     
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  8. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    That makes sense. The dreaded basal test! I have taken notes from the link you sent. Does it matter which segment of the day I start testing with? As I have tried for three days now to test 6am-12pm but morning lows/highs have stopped me. Lastly, would I have to test all four (or every part) of the day before making any changes?
     
  9. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    I would say overnight is the best time as you will have no food or bolus working....so ideal time.....the libre will make basal testing almost effortless...
     
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  10. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    Just as long as I am in range before (without correcting)
     
  11. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    Yeah...no corrections......
     
  12. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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  13. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    Night time basal done

    Evening meal (6pm) I was 10.9 (corrected plus bolus for my meal- which I *may* have not carb counted accurately and went under rather than over to avoid hypo). I injected 15min before my meal this time to see the effect.

    7.30pm I had peaked to 12.6 and then every hour after that I was slowly coming back down.

    At 10.30pm I was still 10.2 did not correct as I could ‘feel’ it coming down and had decided if it is now down by 12 I would have corrected.

    12am- I was down to 8.4 o within range to basal test.

    I also gave my basal dose at 7.30pm rather than at 10.30pm

    Every hour in the night I was between 5 & 6.

    By the time I came to having breakfast I has risen to 6.9 (could that mean my evening basal had ran out?). I know I have to repeat the test again before making changes. Does it mean that my evening basal dose is ok? Hard to tell as I am not sure that my evening high was because of my carbs or not.

    Argh feel like I am never going to get out of this spiral :(
     
    #33 CranberryIce, Apr 25, 2018 at 12:48 PM
    Last edited: Apr 25, 2018
  14. porl69

    porl69 Type 1 · Well-Known Member

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    I thought I had my basal perfect until 3 days ago. Had been injecting 11 units of Tresiba for 8ish weeks now with very good morning bgs and a good line on my Libre. 3 days ago woke up 17.8, yesterday 18 and this morning 15. Big correction dose for the last 3 mornings then my bloods have been pretty good. Will see what happens tomorrow. Bloody T1D lol :D
     
  15. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    It really is!

    I have never been able to get my HBa1c lower than 53-55 as my pre-meal time readings are always good or close enough to target range. Libre has taught me its the huge spikes I am having in-between meals- which I have never tracked/understood before.

    I am trying to be more vigilant with the foods that am I eating and the spikes they cause. Since doing this, I have ditched most of my breakfast cereals- as they caused the biggest spike.

    Again, before I would have just thought as long as I am carb counting it doesn’t matter how much sugar/fat is in the item my bg will fall in range as long as my Novorapid matches. Was never the case- it was constant corrections, lows and then highs.
     
  16. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    Good news then.....

    getting your bolus in before hand has shown to be good for the BG profile, up by 2 mmol or so, then back down to target range...

    you could argue that your basal is right, as it has held you within = or - 2 mmol.......you did start the test at 8.4 right enough which may indicate a unit may need to come off the basal....

    best thing to do is repeat it again.....

    good job....
     
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  17. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    Yes.. finally some relief :D

    So since moving my basal dose time, pre- injecting before meals and ditching the cereal I have mainly been in range for most of the time. I still have a rise of about 2mmol after my meals- which is better than it being twice as much, as it was before. Is 2mmol the kind of rise I should be seeing?

    I am finding by 4.30pm I am dropping again (lunchtime basal given about 12pm). yesterday I was below 5 at that time and had to drive so ate something to bring me up- which I then had to correct for later on as it sent my bg to 9.3.

    The same happened today at about 4.30pm, I was below 5 and 'felt' hypo so had a small snack. I dont know if it would have come up by itself or if I was continuing to drop (libre said steady)- maybe next time i'l watch it and see what happens. I think part of it is I am so used to seeing readings between 7-9 that 5 'feels' low.

    Yesterday I went to bed on 6 and had a hypo at 2am so I should be decreasing by basal today? Is there a way of calculating how much to decrease it by? Or do I do 1 unit see how it settles?
     
  18. catapillar

    catapillar Type 1 · Well-Known Member

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    You're taking basal am, pm and at noon? I imagine that's causing some of the lows.
     
  19. CranberryIce

    CranberryIce Type 1 · Well-Known Member

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    Sorry typo! Bolus at noon xx
     
  20. dancer

    dancer Type 1 · Well-Known Member

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    @CranberryIce don't make too many changes around the same time. Wait till you see a pattern before increasing/decreasing Lantus or Novorapid. I used to wait at least 3 days, to make sure there actually was a pattern.

    Going hypo in the early hours of the morning suggests your evening basal is too high, but not if it's a one off. Wait to be sure there's a pattern.
     
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