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NR working too fast?

Discussion in 'Type 1 Diabetes' started by tomrose, Nov 6, 2019.

  1. tomrose

    tomrose Type 1 · Active Member

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    Hi all,

    Just wondering if anybody else has experienced this -

    If I pre-bolus my meals (with Novarapid) I almost always go hypo after eating, regardless of what I eat (high fat, low fat etc.) and then my blood sugar rises later.

    I'm just wondering if either:
    1. My body is slow at absorbing carbs
    2. I'm not injecting my NR right

    I hardly have any fat on me, especially on my stomach, so I always find it difficult to find a spot for the NR injection. Should I perhaps try changing sites..?

    Any thoughts would be great.
    Best wishes
    Tom
     
  2. urbanracer

    urbanracer Type 1 · Moderator
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    There is no right or wrong method with T1 management, the challenge seems to be in finding out what works for us as individuals.

    Many T1's in the forums refer to Novorapid as Novosluggish so in that respect your experience is different to most.

    But you write that "almost always hypo after eating" and this suggests to me that your ratio is wrong. Could it be that you need less bolus for food, but a higher basal to control what happens later?

    Our insulin requirements may change over time so have you performed a basal test recently?
     
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  3. scotteric

    scotteric Type 1 · Well-Known Member

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    There could be a million reasons, but it could be that you are mistiming the insulin. Many meals, even meals you wouldn't think will digest slowly, often do. You could try taking less NovoRapid and/or take it right before eating instead of pre-bolusing, and then take more 2-3 hours later. You could also try using Regular (also called Novolin R, Humulin R, Actrapid or Toronto depending on the brand and where you live) which has a different profile - takes 30-45 minutes to start working, peaks in 2-3 hours and lasts 6-8 hours depending on the dose. This insulin may suit you better than NovoRapid based on what you are describing.
     
  4. JAT1

    JAT1 Type 1 · Well-Known Member

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    If I were you, I would take the Novorapid just before eating. (That's when I take mine.) It takes some time for the food to leave the stomach and also for the Novorapid to start working. The aim is to get the timing right so that both the insulin and the food hit your blood stream at the same time. Sounds like your Novorapid gets there too early and causes the hypo because the carbs aren't there yet. Then later the carbs arrive and there is not enough Novorapid. Keep a diary and find out what works for you.
     
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  5. tomrose

    tomrose Type 1 · Active Member

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    Thanks all - some really useful points. My insulin needs have been changing lately so that might have something to do with it. I have taken to injecting just before a meal and am fine with that hypo wise. The problem is I have a rise later (3-4hrs after...) pretty much regardless of what I eat. Weird.
     
  6. becca59

    becca59 Type 1 · Well-Known Member

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    Have similar issues @tomrose I tend to split most of my doses. I give small amount bout 15 mins before eating and then the rest an hour and a half later. Sometimes even split Into three if my meal is carb and fat heavy.
     
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  7. Jaylee

    Jaylee Type 1 · Master
    Retired Moderator

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    Hi Tom,

    As mentioned above, there are many "variables" that may cause this..

    Are you "pinching up" when injecting?

    You could be hitting muscle? (Just noticed from your other posts you excercise/work out.)
    Hitting muscle tissue could throw the insulin action a little too fast.
    Then the later rise could come from the (understandablely needed.) added carbs from treating the hypo...?

    It all gets a little trial & error regarding bespoke needs regarding insulin...
     
  8. tomrose

    tomrose Type 1 · Active Member

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    Hi Jaylee,

    I do try to pinch, because if I don't I 100% hit muscle and it stings like crazy.

    I guess what I mean is even if it appears that I time the injection well with the meal (i.e not hypo after food and good sugars), then about 4hrs later my blood sugar will still be rising (even without eating any carbs). Which suggests to me they are still being digested from the meal, but there isn't any quick acting insulin left to cover the rise...

    it is a minefield!
    Tom
     
  9. Jaylee

    Jaylee Type 1 · Master
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    Hi Tom,

    Yep, it can be a minefield.. We know our personal metabolisms better than anyone else.!

    @urbanracer , suggested checking your basal levels? Could these need a tweak..?
    Sometimes looking at the foundations first, helps gauge what's happening with the other stuff.. :)
     
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  10. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    There could be loads of reasons for this. Personally speaking, carbs are more what you need to focus on than fat as they are much more directly responsible for highs and lows. What type of carbs are you eating - slow release like pasta or faster release like potatoes and bread? If its slow release then your insulin is kicking in faster than the carbs are breaking down.
    Do you eat low carb? If so then your NR is probably too high. If you correct the hypos then whatever you eat will probably still be breaking down after the NR is broken down, hence the highs.
    If you struggle to get the bolus right, double check your basal levels. Have an absolute carb free day - sounds horrible but its easier than you'd think if you're stubborn. Things like eggs and bacon for breakfast, salad-ey lunch (no croutons or dressing unless its sugar free) and steak/fish and veg tea. DO NOT INJECT NOVORAPID WITH MEALS!!! If you go high throughout the day, then you're not on enough basal. If you go low, you're on too much. You obviously correct your highs and lows but then you know to adjust your basal.
    Hope this helps!
     
  11. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    Also, have you tried injecting in your upper thigh, or your bum? And what size needles are you using? I'd recommend BD Microfine 4mm, they've been great for me! :)
     
  12. scotteric

    scotteric Type 1 · Well-Known Member

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    Disagree, the protein in eggs, fish, meat, etc. will absolutely raise blood sugar (the body converts it to glucose through gluconeogenesis) and requires insulin. However, the process is slower and thus Regular insulin works better than NovoRapid for most people if eating low/no-carb. If there is no rise eating these types of meals the basal is likely too high and compensating for the rises that would ordinarily take place.
     
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  13. scotteric

    scotteric Type 1 · Well-Known Member

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    That's likely exactly what's happening. You can compensate by taking more NovoRapid 2-3 hours after eating (or whenever you find helps), using Regular insulin which has a later onset, peak and lasts longer compared to NovoRapid, or by raising your basal insulin to help compensate for late-digesting glucose.
     
  14. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    Would you inject the same amount of insulin for protein content in what you were eating as you would for carbs? I know i wouldn't! A nice big steak with veg one night and the same weight of pasta the next would get pretty drastically different doses.
    This is just a test of whether you are using enough basal to correctly manage and not have to correct with bolus all the time. It's the method that is recommended by my consultant and the dietitian i see regularly, and has helped me figure out my basal needs. I'd recommend trying it, but different methods work for different people, no doubt your method works for you :)
     
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  15. tomrose

    tomrose Type 1 · Active Member

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    I have increased my basal recently which seems to have helped - think I'm just in a situation where my insulin needs are changing. If i just inject it a bit later I seem to avoid the hypo and not go as high.
     
  16. tomrose

    tomrose Type 1 · Active Member

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    Thanks for the suggestion. I have tried splitting doses/ taking some at a later point and it definitely does help :)
     
  17. tomrose

    tomrose Type 1 · Active Member

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    Hi Shannon,

    thanks for all your replies. I wouldn't inject with a low carb meal; which to be honest is quite a lot of the time. My insulin ratio is around 1:20 at the mo as I'm still in the honeymoon phase.

    I do quite often have a carb free, or low carb day and I don't go low. I think my basal is about right if I am doing my 'normal' amount of exercise. I find I might drift up slightly if I'm not cycling to work.

    I think to solve this it is going to be a combination of splitting doses/ dosing slightly later.

    Tom
     
  18. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    With low/no carb dosing later (if at all) would definitely help. I think proteins and fats take quite a lot longer to break down than carbs too. I am a little jealous of a 1:20 ratio, i'm currently on 1:5 ! But then i've been diabetic for 19-20 years, since i was 4. If you're still in the honeymoon phase, good luck with it all! I've found the forum absolutely invaluable for advice, recipes and the occasional grumble about diabetic life :D
     
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