Can insulin be too strong?

[EmmaNew]

Hi. So I had gestational diabetes 5 years ago and controlled it extremely well with diet only. However after yearly checks earlier this year my GTT was too high and after treating me for type 2 with increasing (up to maximum) doses of Gliclazide and Metformin they decided to try insulin by injection (first on Novorapid which I was allergic to and now Apidra). My dad is type 1 and fantastic at keeping good bg so it's not Alien to me and I have really good knowledge of foods. However after finding that 1 unit to every 10g of carbs was way too much for me I started to reduce it to 50 %-75% of 1 unit per 10g but I find that the insulin seems to rush in and my bg comes tumbling down way too low and I end up eating like it's some kind of race just to get the food into my system as quickly as possible and then when it does finally get in I go high again. It's like I need the full dose but it just works too fast. My consultant agrees with me that injecting after food is not a good idea. Does anyone know if I would benefit from an analogue instead? Sorry if tmi but it's driving me mad and now I start to panic every time I take it

 

[AlisonM]

Hi Emma and welcome. It does sound as though you are very sensitive to the insulin. The only thing I can think of is to inject half what you think you need before you eat and then top up after in small increments if you need more. But I'm no expert and I'm sure some of the other T1s may have better advice for you. Analogue is certainly an option worth considering if you can't find any other solution.

 

[EmmaNew]

Thanks Alison. I think next time I get a check up my consultant may swap me onto an Analogue. I think the only reason he didn't last time was because he'd literally just swapped me from the Novarapid. Are there any side effects with an analogue do you know or are they just slower acting?

 

[AlisonM]

I honestly don't know. I'm on Lantus and Novorapid and doing well with them. Again, one of our 'proper' T1s should be along soon and may be able to tell you.

 

[khskel]

The only time this has happened to me is if I've had a higher than normal carb content in my meal and the insulin has hit before all the carbs. It may be worth trying splitting your bolus as Alison suggested to give the insulin 'hit' a smoother profile. I know 60/40 pre post eating ratio has been suggested before but we are all different so experimentation may be in order. I've only ever used Novorapid so can't comment on the difference between that and other insulins.

 

[Copepod]

Novorapid, Apidra and Humalog are all short acting analogue insulins, so Humalog might be an option for you. The important thing is to match your insulin maximum effect with when carbohydrate hits your blood stream. So, if that means injecting after eating, surely that must be worth trying?

There's a graph of insulin action here:http://dtc.ucsf.edu/types-of-diabet...therapies/type-2-insulin-rx/types-of-insulin/ lispro /
lyspro = Humalog; aspart = Novorapid; glulisine = Apidra. So, there's not much to choose between these for profile of action.

 

[Matt Cycle]

Hi Emma

Analogue insulins are altered forms of insulin so include long, medium and short acting. NovoRapid, Apidra, Levemir etc are all insulin analogues. If you think about it the normal working pancreas simply produces insulin it doesn't produce different types for different situations. With MDI to try and replicate this there is a long acting (basal) and a short acting (bolus) to cover meals. In a working pancreas it constantly drips insulin as a background and then releases it when carbs are eaten to cover that. This is what pumps try to do and hence only use fast acting insulin - the drip for the basal and then a release or a split release for meals. To do that on MDI you would have to be injecting all the time! 🙂

Do you only use Apidra? i.e. no long acting insulin?

 

[trophywench]

I wonder what ingredient you are actually allergic to?

Of the 3 normal bolus insulins in common use - Apidra is the fastest acting - it whizzes in, in 10 minutes flat when it's working bang on for you and you appear to be mega insulin-sensitive. Novorapid and Humalog both start a bit slower than that -20/25 ish minutes after you inject.

They all also last for different times too - Apidra c 3.5hrs, Novorapid c 4 hrs both tailing off nice and gradually and Humalog seems like it finishes after 4 hrs the same but often has quite a 'sting' of activity in it's tail, so nearer 5hrs.

You probably need to jab Apidra in, in the middle of eating if you stay on MDI - but IMHO - you would do brill with a pump because you could have an extended bolus with every meal.

Anyway - you haven't tried Humalog yet !!

Where's Pumper Sue - she can't use any of those 3 - and uses animal insulin still, in her pump. Whilst most of the rest of us have to seriously delve into the backs of our brains to remember what the heck they used to behave like for us - she is brill at it as it's entirely currect info for her. And it is much slower onset than any of the modern ones - to get the same effect you always have to inject about 15-20 mins before your dinner is ready - I used to say 'When I put the spuds on, is when I have to jab' There are also possibilities with mixed insulin, but you do have to have a pretty set lifestyle for those which really doesn't suit an awful of people. So you haven't reached the end of all the possibilities by any means - yet !

 

[EmmaNew]

Hi Emma

Analogue insulins are altered forms of insulin so include long, medium and short acting. NovoRapid, Apidra, Levemir etc are all insulin analogues. If you think about it the normal working pancreas simply produces insulin it doesn't produce different types for different situations. With MDI to try and replicate this there is a long acting (basal) and a short acting (bolus) to cover meals. In a working pancreas it constantly drips insulin as a background and then releases it when carbs are eaten to cover that. This is what pumps try to do and hence only use fast acting insulin - the drip for the basal and then a release or a split release for meals. To do that on MDI you would have to be injecting all the time! 🙂

Do you only use Apidra? i.e. no long acting insulin?

Thanks for your input. I take Lantus - just 6 units at bedtime which works perfectly for me as I wake up between 6.5 and 10 regardless of what I fall asleep at. As you can tell just 6 units is nothing and I must be quite sensitive to that too.

 

[EmmaNew]

So when I tried Novarapid my tongue swelled - even with as little as 4 units so I think they were concerned if I took a larger amount I could go into anaphalactic shock. Apparently it is the preservatives that people can be allergic to.

Just as a for instance a big meal with 150g of carbs and bg at a high of 15 before I start taking 8 units (half the advised dose) brought me to a 3.8 1 hour after food and the jab of Apidra. 3 sugary sweets and 10 minutes later 3.4 a couple more sweets and 30 minutes later creeping up to 4.4. 3 hours later 22.3. That's what happens every meal. If I start my meal on a 7 or 8 I'm really reluctant to inject 5 or 6 units as it just sends me through the floor.

 

[trophywench]

Well - alter your carb ratio and correction ratio again then! These things aren't graven in stone and aren't even always the same at all times of day.

Or - you might need to change what you do for such a high carb meal perhaps. 150g of crab is more than I have all day, most days. There is a theory that if you actually jab more than 7u, you just take it as more than one jab anyway, as higher doses don't seem to be absorbed so well - but you have the opposite problem anyway! LOL

 

[Matt Cycle]

That is quite a drop!

Agree with TW in trying to reduce carbs and seeing how that works out.

The other option is an intermediate acting insulin. You would however lose some of the flexibility you currently have on Apidra and Lantus.

 

[HOBIE]

Welcome ! A T1 your pancreas does not work. A T2 it could work 80% or 20%. Hope you can find out what is going on 🙂

 

[EmmaNew]

Well - alter your carb ratio and correction ratio again then! These things aren't graven in stone and aren't even always the same at all times of day.

Or - you might need to change what you do for such a high carb meal perhaps. 150g of crab is more than I have all day, most days. There is a theory that if you actually jab more than 7u, you just take it as more than one jab anyway, as higher doses don't seem to be absorbed so well - but you have the opposite problem anyway! LOL

Even in a low or no carb meal 2 units will rush in and drop me far too low and then I'll rise too high later. The insulin definitely works too fast but it appears I need a little more than I can take.

 

[HOBIE]

I don't ever think I have ever had 150g meal before ! 70g at most. 😳

 

[EmmaNew]

Lol! not even starter main and dessert?

 

[HOBIE]

I hate deserts. & honest I don't think I have ever had a meal with more than 70g. I have been T1 for very nearly 50yrs. I could & have had 2 lots of starters & main. 🙂

 

[EmmaNew]

🙂 I think I had garlic bread then pizza that day with a cakey dessert. Maybe I'm over estimating my carb intake but that wouldn't explain the later highs. Grrrr. 🙂 I'll get there. Thanks for your advice.

 

[AJLang]

Hi welcome to the forum. The meal that you've just described is very high in fat as well as high in carbs. A high fat meal will delay the absorption of food into your system so the insulin is working faster than the fat/carb being absorbed. This would explain what is happening to you because your insulin is working before the food is hitting your system. As others have said 150g carb is a lot for one meal to be able to balance blood glucose levels. Maybe sometimes but you might want to reconsider this is suitable for you on regular basis.
I know that some people split their bolus insulin for high fat meals so hopefully they will be able to explain how they do this. Also you say that your lantus is working because of the overnight levels but have you done basal testing for during the day to check if the lantus is working effectively for 24 hours? A lot of people find that two injections of Levemir a day (plus a bolus for food) helps them to smooth out their levels better.

 

[AJLang]

Even in a low or no carb meal 2 units will rush in and drop me far too low and then I'll rise too high later. The insulin definitely works too fast but it appears I need a little more than I can take.

If it is a no carb meal then you shouldn't be injecting any bolus. Have you been taught carb counting?