Post meal insulin

If you know for certainty you have under doses, you can do a top up.
However, if you are reacting to a high bg, you Must take into consideration insulin on board as insulin last for about 4 hours.
Take care not to "rage bolus" - taking doses on top of doses when you have insulin on board.

Some of us do tend to run high when the food starts breaking down, then when novorapid kicks in you'll see a drop. However as @helensaramay said you need to learn about the peak times and time frame of novorapid - Novorapid starts working within 10-20mins, peaks around 1-2.5hours and lasts around 4hours. You have to give novorapid the chance to work before correcting, otherwise you'll hypo and will hypo for a long time because we can't extract that insulin out. So lets say you have breakfast at 8am and your BG is 6, your next test is around lunch time, thats when you'll have food and check your BG again to see if it is okay. For correction doses, again ask your team but please give novorapid that 4 hour window to work.

Hi, @sudsandsoda , it's certainly do-able, I do it a lot, but I'd hesitate to recommend it to a recently dx'd until they are more familiar with the time pattern of insulin.

I'd recommend Stephen Ponder's book Sugar Surfing for detailed info on this sort of thing.

His philosophy is that if you've got cgm so that you can track in real time what is happening, and you identify a trend which looks like it is going to go too high, it makes perfect sense to nudge down with an extra unit or two now rather than deal with a messy hyper at the next meal.

But the difficulty lies in how to interpret the trends. It can be too easy to jump the gun and over-react to every slight movement only to find that the next 5 or 10 min readings track back into line ok.

There are some diabetics who pre bolus for the meal, wait for the novorapid to kick in and then have food. However you do have a chance of running hypo when food takes longer than expected, but that will prevent spikes.

sudsandsoda said:

Ok thanks Scott. I understand the risks, and I’m certainly still learning. Not something I’m planning to do as such, I guess I just wanted to know if it was ever done.

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Sure, no probs, but keep it in mind for the future, as it's a valuable technique.

If you end up trying it, I'd highly recommend having a way of tracking insulin on board, iob.

Some meters do this, the libre reader does it via the professional options section, access code CAA1C, and the android app xDrip+ does it even if not being used as cgm.

The reason knowing iob is useful is that if I see I'm heading towards 9 or 10, and iob says I've only got 1u iob remaining, that's unlikely to stop the trend, so I'd be inclined to correct with a few units before I get there, whereas if I've still got 5 or 6u iob, that'll likely take care of it, so I wouldn't correct, just watch and see how it plays out.

Here's an example, 13u about 20 mins before a 90g meal, there's a decline down, then a rise, then about 8:50 I'm reckoning the trend would go above 8, so 3u on top and that pinned it. 3u would normally be too much, but I thought I'd kill two birds with one stone by adding a bit extra to not only pin the rise but have some more to cover a light supper at about 10:00pm.