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Taking insulin without food

Discussion in 'Insulin' started by LeanneSpain., May 26, 2018.

  1. LeanneSpain.

    LeanneSpain. Type 1 · Well-Known Member

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    Hi. I went to see diabetic nurse yesterday. I had told her sometimes i take novorapid in morning with no food if my blood sugars are high to correct them by lunchtime. I don’t eat a breakfast. She said never ever take fast acting insulin without food as the insulin has no food to work on and can cause problems. This is the first iv heard. Wondering does anyone else take insulin with no food as id imagine correcting a blood sugars (between meals) would be the same scenario?!
     
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  2. therower

    therower Type 1 · Well-Known Member

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    @LeanneSpain. Only this morning I had 3 units novorapid without any breakfast. BS was 8.1 at time but I know from experience that once I'm up and about my BS will rise. 2 hrs later when I did have breakfast my BS was 4.7, at which point I had a further 6 units to cover my Full English but remembering to allow for the IOB.
    This highlights a problem with diabetes. We are all different and with experience we know what works for us.
    The DSN advice is correct for newly diagnosed/ inexperienced diabetics but if you have good control and confidence in how you manage your diabetes then do what is right for you.
    And yes you are correct in that basically you performed a correction dose, something commonly used by experienced diabetics.
     
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  3. LeanneSpain.

    LeanneSpain. Type 1 · Well-Known Member

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    Maybe she meant just first thing in morning on an empty stomach. Something about it causing ketoacidosis as the insulin is working on the fat not the food (that’s why im thinking she means morning/fasting)
     
  4. Antje77

    Antje77 LADA · Moderator
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    I take quick acting insulin every morning upon waking up and I don't eat breakfast except a little milk in my coffee. My DN thougt I was crazy, but she can't argue with my numbers.
     
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  5. LeanneSpain.

    LeanneSpain. Type 1 · Well-Known Member

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    Im the same. I drink tea with milk and take novorapid every morning with no food. But shes got me worried now.
     
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  6. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    I don't think you need to be concerned- insulin doesn't react with fat - it doesn't react with food at all.
    You see the results of what insulin does as BG levels reducing, unless there is insulin resistance - a different but associated problem - but the nurse seems to be rather in the dark about why you need to inject insulin.
     
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  7. Grant_Vicat

    Grant_Vicat Don't have diabetes · Well-Known Member

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    Hi @LeanneSpain. I must have had fast acting insulin hundreds of times to counter high sugar readings. Any reading over 24 mmol/L I would double my normal dose,but as @therower says, it's personally suited from many years of observing cause and effect. I would often get very high readings when fending off viruses and so on. Anything that causes high adrenaline can cause the same problem. If you hadn't done that, you would probably be "blocking" another hospital bed unnecessarily. The main problem is the number of tests required before reaching a level where eating is possible. Also, as I guess you realise, sugar readings can suddenly plummet after a long string of 16 ish readings or similar. Libre users would be able to give you sound advice there - I never made it to owning one! Good luck with future control.
     
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  8. Antje77

    Antje77 LADA · Moderator
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    Don't worry. She probably has learned insulin deals with eaten carbs(sugars). So no eaten carbs, no insulin, as that would surely mke you hypo. She probably doesn't know many people's livers dump glucose in their bloodstream upon getting up. To your body, this glucose is exactly the same as glucose from food, so you need insulin to use it, otherwise it just sits in your blood doing damage to your body.
    DN's don't know everything, and they're very scared of bad hypo's. Next time ask her what problems she expects. If it's hypo's, you can prove you're fine, as you have been doing this for a while already without hypo's :)
     
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  9. LeanneSpain.

    LeanneSpain. Type 1 · Well-Known Member

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    She said about ketoacidosis as the insulin is working on fat not food
     
  10. Scott-C

    Scott-C Type 1 · Well-Known Member

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    There's a thing called "foot on floor", kind of like dawn phenomenon. If I wake at 5, I'll easily go up to 8, 9, 10, just by getting up and moving around, as my liver starts releasing glucose for the day ahead. So I pin it with a couple of units even though I generally don't eat till about noon.

    That way, I'll be going into "brunch" at noon with a decent level instead of doing a correction for an out of range.

    Some dsns are still tied to the idea of saving corrections till meals, but if I know I'm going out of range, it makes sense to correct there and then. Even without food, the correction dose is simply doing what it's meant to do - lower blood sugar by letting the excess glucose into cells to be used as energy.

    Bg isn't stable in non-T1s. It just appears so, because the alpha and beta cells are nudging it up and down in response to changes throughout the day. There's no reason why we shouldn't either.

    I can understand their caution, as strips give us limited vision on what's happening. But, now that cgm is starting to become more common, giving us a real time graph of what's going on, some hospitals are encouraging the use of "Sugar Surfing" techniques, the book by Stephen Ponder. It's the idea of looking at the cgm trace every so often, and then doing a 1 or 2 u, or 5g nudge when it's starting to go out of range. The book is recommended in the pdf linked at the foot of this page, run by Edinburgh hospitals:
    http://www.edinburghdiabetes.com/cgms-1/

    It's riskier without cgm but still do-able on strips.
     
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  11. Jaylee

    Jaylee Type 1 · Moderator
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    The "correction dose" will work on the excess levels of sugar in the blood.

    However. i can understand your DN's concern.. You wouldn't wish to push it too far the other way. ;):)
     
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  12. bulkbiker

    bulkbiker Type 2 · Oracle

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    Surely though taking insulin to correct a higher than normal blood sugar can't cause ketoacidosis? I thought that was high blood glucose due to lack of insulin and high ketones. Sounds a bit like the nurse has it the wrong way round. Not being a Type 1 I'll ask you as you guys will know a lot more about it than me. Sounds like @LeanneSpain. was given wrong advice from nurse?
     
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  13. Mep

    Mep Type 2 · Well-Known Member

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    The only time I've had a problem with giving myself insulin without food is when I then do an activity afterwards. Eg. I took a corrective dose at work because I was 13 or something like that, about 10-15 mins later when I got to my car which was several blocks away I was down to the 5's. I felt strange (like my sugar was dropping fast) so I had some sweets before I drove off... half an hour later I was 3.7. All this was from taking 4 units which I thought will bring me down to normal level. I think it was the walking I did that made the difference that time.
     
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  14. Scott-C

    Scott-C Type 1 · Well-Known Member

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    That'll be your GLUT4, @Mep !

    Glucose transporter 4 are chemicals inside cells which come to the cell surface to let glucose in to be used as energy.

    They do that in response to insulin, but also by muscle contraction, so you can end up with a double whammy if you exercise after insulin.

    That's why when I'm calculating a dose, it's not just the carb count I look at, I'll also be thinking about how active I've been in the last few hours as glut4 may still be in play from that, and how active I'm likely to be in the next few hours. I'll likely shave a fair bit off the dose if there has been or will be activity.

    Lengthy wikipedia article on:
    https://en.m.wikipedia.org/wiki/GLUT4
     
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  15. Antje77

    Antje77 LADA · Moderator
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    I think she needs to go back to her textbooks...
     
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  16. Jaylee

    Jaylee Type 1 · Moderator
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    The shortage (or non existence) of active insulin will cause ketoacidosis..
    The body would resort to consuming itself (fat storage.) for energy & BS levels would rise without it... (Layman's terms.)

    Nurse sorta got it wrong.. :rolleyes:
     
  17. bulkbiker

    bulkbiker Type 2 · Oracle

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    That's what I thought @LeanneSpain. hopefully that answers what I saw as your question..
     
  18. LeanneSpain.

    LeanneSpain. Type 1 · Well-Known Member

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    Thats what I taught too. She has it backwards im thinking. Im off to see diabetic doctor in next few weeks so im goina mention it and correct the nurse on this
     
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  19. Jaylee

    Jaylee Type 1 · Moderator
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    No pun intended? ;):D
     
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  20. ickihun

    ickihun Type 2 · Master

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    Poor nurse. If she can find them.
    My dn would try that rubbish on me. She looks after type2s and type1s.
    Ive never been advised to correct but I do. Otherwise I'd end up possible facing ketoacidosis. My own insulin cannot work as well under my skin (insulin pathway struggles due to body fat). Im hugely insulin resistant.
    Now.
    The only way my dn would advise against corrections for me is because the more insulin I inject the more fat cells are made and I do not burn off my calories. (Cannot walk, often) I very rarely use my calories so everyday I make fat cells. In the past this hasn't been an issue due to exercise and being hugely active.
    Maybe your dn is trying to prevent insulin resistance for you and unnecessary hypo treatments.
    Listen to your nurse but next appointment ask her what she ment and tell her you understand ketoacidosis risk as untreated high bgs and no insulin for your body to work with. Maybe she will advise an appropriate education course.

    We often have to keep our dns right as they are so over worked these days.
    I'm thinking she confused it with insulin resistance.
    Poor nurse.
     
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