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(rapid) short-term insulin no longer "short"

Discussion in 'Type 1 Diabetes' started by jmackinnon, Sep 10, 2019 at 5:52 PM.

  1. jmackinnon

    jmackinnon Type 1 · Member

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    I've had diabetes for more than 25 years. I am always changing my eating habits, and take my insulin shortly before my meals in most instances, and always circulate my injection locations (short-term in stomach, long-term in butt).

    For the past few months my morning insulin doses have not been "kicking in" within 10-15 minutes like they are supposed to, but instead take 2-3 hours. I wake up, take my insulin, eat my breakfast (which varies - and yes, I take the appropriate amount based on carb intake). An hour or more later, my blood sugar spikes (based on the amount of carbs, but typically to 19-20's mmol/L = 360 mg/dl) as though I didn't take any insulin at all. Then finally - up to 3 hours later - the insulin kicks in and drops me back down to the appropriate level based on the dosage I took for my breakfast. Has anyone experienced this before? I am very concerned and my doctor and endocrinologist don't seem to have a solution for the problem (besides changing injection locations or insulin types, both of which I have done). Odder still, later in the day, my insulin kicks in as normal, within 10-15 minutes after injection, like nothing is wrong. Most injections I take before lunch (if more than one) take 2-3 hours to react. So frustrating! Any thoughts are welcome!
     
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  2. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Hello, welcome!
    What bolus insulin do you take?
    I don't know about you, I think some people are a bit insulin resistant in the morning and need a different insulin to carb ratio in the morning. However if it is novorapid, some have changed over to fiasp which is far better. For me it is far better because I don't have to wait 45 mins in the morning to eat breafast. Also some times I'm a slightly high in the morning, plus dawn phenomenon and a tad insulin resistant makes my mornings a bit more difficult and it takes time for sugars to come down. As the day goes by, it gets easier with insulin but it is just the mornings that I have issues with.
     
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  3. jmackinnon

    jmackinnon Type 1 · Member

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    Thank you for the reply MeiChanski. I am currently using Apidra, which states that it is rapid acting and my doctor said was similar to the novorapid which I used to take (until it stopped absorbing properly at all, so I switched). It sounds like you experience something similar, however this is a recent phenomenon for me (started in full effect 3-4 months ago). And it is typically 10:30-11am by the time the insulin starts kicking in (after taking the needle at 7am). Unfortunately I've looked into the fiasp and it is not covered by (any) insurance in Canada, so it is not an option for me.
     
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  4. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Oh I'm sorry to hear. It is troublesome that you just want to eat breakfast and wait. I was wondering if you can speak to your team again or possibly a dietitian. I know I've been doing low carb and adjusting my insulin for breakfast does lighten the morning frustration. If I eat a full carb breakfast, I'll be high until afternoon if it was on novorapid. Fiasp does seem to help and unfortunately it's not an option for you. Another option would be Humalog which I can't comment how it works. I only know novorapid and fiasp. Fiasp being the cooler one out of the 4 rapid insulin options in the UK.
     
  5. Alexsalter47

    Alexsalter47 · Well-Known Member

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    just only just moved over to tresiba, im on nova, whats Fiasp? worth me moving over to that? nova works great to knowledge for me. maybe its worth it?
     
  6. sl0042

    sl0042 Type 1 · Member

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  7. sl0042

    sl0042 Type 1 · Member

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    I have the same problem my insulin does not kick in for 3 hours. I am on Apidra; I moved to Fiasp the fast acting insulin. On the sheet it says it must be taken 0 - 1 minute before eating; it still took 3 hours so now I am back on Apidra.
    I would welcome an insulin that worked quickly because it would stop my blood sugar going up & up for 2 - 3 hours.
     
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  8. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Fiasp is a much more rapid acting insulin than novorapid. Some have experienced that novorapid takes too long and have changed over to fiasp. You can ask your nurse about it :)
     
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  9. jmackinnon

    jmackinnon Type 1 · Member

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    Is it only in the morning that it takes so long? Or does it act quicker as the day progresses?
     
  10. sl0042

    sl0042 Type 1 · Member

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    Every time I use it the insulin takes 3 hours to kick in both with Fiasp & Apidra..
    My slow acing one is Tresiba & seems to work well in controlling overnight levels.
     
  11. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Two thoughts which an endo would usually ask about:
    Injection sites. Over time (52 years in my case) it can be that injections into previously used sites is not as easy to avoid. Poor absorption may result giving less effective insulin action on controlling bsls. Changing insulins as an option to deal with this seems a bit daft when the the problem is where the injections are being given and the need to try previously unused injection sites.
    Diet: as you would know type of food affects bsls. Carb counting will only do so much. And in practice trying to match up insulin action to thr resultant bsls from a meal is nigh impossible on a consistent basis. My take on things.
    Maybe consider a low carb diet as a part of this solution.? Just a suggestion.
    Such an approach would need discussion with an enlightened doctor/DN and still need to consider finding unused injection sites i suspect.
    Best Wishes.
     
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  12. Marie 2

    Marie 2 LADA · Well-Known Member

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    I have DP, DP commonly makes you insulin resistant for hours after you wake up. Most of the time I just skip eating in the morning because it's too hard to control. But I have to take more insulin if I eat anything in the morning. Also it takes a lot longer for my numbers to come down once they have gone up.
     
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  13. becca59

    becca59 Type 1 · Well-Known Member

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    Am also a DP foot on the floor person first thing. Am on Fiasp which has helped. Though I still inject 15 mins before eating. My morning ratio can be 4 times what it is later in the day. I also only have 10 carbs of Yoghurt/berries for breakfast. Anything higher in carbs had me playing catch up all day so they had to go.
     
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  14. donnellysdogs

    donnellysdogs Type 1 · Master

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    DP and foot on floor for me. Unfortunately Fiasp for me gave me every side effect listed. Had extensive tests and investigations in last 6 months to find out what was wrong... nothing visible with cameras or scans.
    Then I read the side effects after seriously thinking what on Earth is wrong with me.... every side effect I had.
    Have stopped fiasp now and the cramps have 90% gone. As insulin affects muscles, I guess 10% is going to take a time to get out of my system. Still on low dose antibiotics until I see consultants.
    Not one single consultant suggested it could be Fiasp. .

    No rapid insulin is rapid.... but boy, sometimes it chooses to act faster or slower, but it really cannot know what food we are going to eat, stress or even the time of getting up etc... so it really is up to individuals to try and find the most effective routines for themselves.
    Our bodies also go through many varied stages in life, many bodies get larger and our routines with family etc change... evens sending kids to school after summer holidays etc can affect how the insulin will work.

    Have a look at your routines, eating and log what works and doesn’t... unfortunately the instructions for short/quick acting insulin’s always state 2-3 hours for peak acting to come into play...
     
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  15. sl0042

    sl0042 Type 1 · Member

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    Thanks for all the info; Although I am 74 years old I only have had TD1 for 6 1/2 years; I have always had slow response from'fast acting' insulin.
    Apart from the fat round my middle what other sites are good for injecting.
    Thanks
     
  16. jmackinnon

    jmackinnon Type 1 · Member

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    Thanks for these thoughts kitedoc. What you suggest about the injection sites is not applicable I'm afraid. We tried adjusting the sites already to no avail. Not to mention the issue only happens in the morning (though it seems to be getting worse, later into the day now). If the injections sites work fine any other time of day, it doesn't make sense that they would not in just the AM. And low carbs is the way I'm going to go for now until I can find out whether I can get an exception (from my Doctor) for coverage on the Fiasp insulin. I was originally on Novorapid and that stopped working for me altogether (in the same injection sites as present - my stomach), so I switched to the Apidra which worked fine for a while but has recently started acting this way. So I guess Fiasp is next. If I can't get that I guess I'll settle for the Humolog.
     
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  17. ROE100

    ROE100 · Member

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    I understand your frustration.

    Before I did some fasting to check my basal injection I also seem to get a high after the morning injection & B/Fast and then a drop to normal level just before lunch. However my basal testing showed that instead of a flat release of the basin insulin (Lantus) over the 24 hours (maybe 18 hours as some have said) I got a high peak in the morning and then a drop over the rest of the day when fasting. This was on a split dose late PM and early AM injection.

    I have changed my regime to 3 injections of basal insulin which was now made me get flat levels during the night and when I wake and start moving so no more highs after B/fast, So even though I don't have excatly the same as you I now have sudden spikes after lunch and then high for 3 hours and then drop back down to normally levels. So ratio is correct as i woudn't drop back down to normally if the ratio was not correct. So even though my new basal regime has help night and mornings I feel I have justed moved the issue to a different time of day.

    I am currently low carbing, and using Fi-Asp so the suggestions above haven't working for me but as people say we are all different and i hope they work for you while i still try and work this out and i surpose do another fasting day to check my new regime is working as it should.

    All the best hopefully you will get to the bottom of it
     
  18. jmackinnon

    jmackinnon Type 1 · Member

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    Thanks very much ROE100. Sounds like you've had plenty of troubles of your own. I actually used to use Lantus for my long-term as well. At first only needing the one needle a day. It continued working for as long as I can remember, but I eventually had to change it to two doses a day for a more even flow. That only lasted a couple years though until it pretty much stopped working for me altogether (I too did plenty of fasting and adjustments to try and make it work). Finally I switched to Toujeo SoloSTAR at 2 doses a day and it's back to nearly perfect again (as long as I don't eat any carbs, that is). Perhaps you should consider changing brands. It seems to be the solution in a lot of these cases. I've changed mine at least 3 times for my long-term and 4 or 5 times now for my short-term (including the olden days before rapid acting short-term). Hopefully the Fiasp will be my saving grace this time.
     
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  19. jmackinnon

    jmackinnon Type 1 · Member

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    I've pretty much tried them all but I'm only comfortable with my butt and stomach these days. Not enough fat on my arms or legs to make it work comfortably. I've also heard that varying your needle size can sometimes help with absorption as well. I currently use 4mm, but for some the longer 8mm work better for them. Everyone is different I guess. For some there are issues of pooling just beneath the skin (with the shorter needles), others have the issue of going to deep and it getting into the muscle. Try some experimenting perhaps and see how it goes.
     
  20. adeel.mahmood@hotmail.co.uk

    adeel.mahmood@hotmail.co.uk Type 1 · Newbie

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    I have a similar issue with breakfast, been diabetic for 23 years and it's when I have cereal mainly that it happens, then as you said around 2-3 hours later sugar levels are normal
     
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