Insulin advice

[Catlady 1]

Hi
Just before Christmas my consultant started me in insulin (my oral meds incl jardiance giving high spikes after food, making me dizzy straight after eating etc-def improvement). I was given set units for each of my meals as we feel our way towards what my body needs. Clearly it is more than the suggested. So, my question is, after insulin, what is the peak my blood sugar should be allowed to go to? 10? 12? 13? Even at 13 it comes down quickly now which is great, and HBA1C coming down very well.
I’ve found it hard having to add carbs to my meals now as used to limit them. Still do, but make sure to have some to avoid hypos (which I had when diet controlled years ago, and also when on metformin and other oral meds). I am on insulin, jardiance and metformin, with review at the end of the month. Have to say, insulin has been the best thing for me.

 

[dannybgoode]

I'm not too worried what I spike to do long as I'm back in range before my next meal/bolus doses.

If I'm still high at that point I add a little correction to the mix.

If you're sticking to fixed doses you'll find your BG all over the place - sometimes you'll have too much insulin and sometimes too little. The only way to prevent this is to eat the right amount of carbs for the dose you're taking.

I started on insulin when diagnosed on 6 Dec 24 and within a week just started adjusting doses myself as fixed doses were just not working for me.

I was going low after breakfast and going very high after tea. Lunch was just a lottery. So I started off at the 1U of insulin for 10g of carbs and have tweaked it a little based on how my reading was before next meal

Don't forget a hypo is a defined thing with a BG of under 4. On Metformin, even on a strict diet, true hypos are extremely rare. It's important though on insulin to check if you're feeling like you BG is too low. If you feel it is and check but it's 4 or above you don't need to treat it as a hypo (although if it were below 4.5 I'd be keeping a close eye on things and may have a slice of bread or some other slower carbs just to keep things safe).

 

[Catlady 1]

Thankyou, very useful. Yes I have been doing much the same in terms of testing things and adjusting, bit wasn’t clear on whether spiking considered too high.
Feel confident to know others do similar. I live abroad and sometimes I may lose something in the language.

 

[Inka]

@Catlady 1 What insulin(s) do you take (full name inc any letters or numbers after the name)? If you’re on a bolus/fast insulin and you’re spiking up to 13, try having your insulin injection slightly earlier. That can reduce the spike. If you only spike briefly and then come down, that’s ok, but if you’re spiking then dropping fast, that suggests you need to inject more in advance.

Are you carb counting properly and having the set amount of carbs you need for each meal?

NB - impossible to answer fully without knowing the precise insulin you’re on.

 

[dannybgoode]

I would also add your peak reading will somewhat depend on your starting reading which is why it's important to do a reading before dosing for your next meal.

If you're at 8 then a rise to 13 is only +5 and then if that comes down nicely to 8 again before your next meal and/or within the acting window of your taps insulin then you've dosed about correctly for it but with no correction.

If your starting reading is 5 then a peak of 13 is a rise of 8 so a more substantial rise.

That's why it's important to know where you're starting from.

 

[SB2015]

I’ve found it hard having to add carbs to my meals now as used to limit them

I am guessing that you have added in carbs because you are on fixed doses of insulin. If you are able to switch to adjusting your doses at meals you can then eat as few or as many carbs at a meal as you would match the insulin to the number of carbs you choose to eat.

Something else that could help to reduce spikes after your meal is the timing of your injection for the meal. Generally we are advised to inject about 15 min before we eat to allow the insulin to get active when the carbs get going. Worth discussing with your team.

 

[Catlady 1]

@Catlady 1 What insulin(s) do you take (full name inc any letters or numbers after the name)? If you’re on a bolus/fast insulin and you’re spiking up to 13, try having your insulin injection slightly earlier. That can reduce the spike. If you only spike briefly and then come down, that’s ok, but if you’re spiking then dropping fast, that suggests you need to inject more in advance.

Are you carb counting properly and having the set amount of carbs you need for each meal?

NB - impossible to answer fully without knowing the precise insulin you’re on.

Hi
I am on the fast acting one, Humalog 100 units/ml if I read that correctly.
Interestingly the hospital just gave amount before a meal, not based in carb counting, but I think that is because what I need is not totally known yet. I have been carb counting, and so far finding that need about 1 unit for 8 g carb. Tricky though as only just got over the lurgy going around, and had antibiotics, so of course that affected things.
Thanks for the advice, it does sound as though I am approaching things right.

 

[Catlady 1]

I am guessing that you have added in carbs because you are on fixed doses of insulin. If you are able to switch to adjusting your doses at meals you can then eat as few or as many carbs at a meal as you would match the insulin to the number of carbs you choose to eat.

Something else that could help to reduce spikes after your meal is the timing of your injection for the meal. Generally we are advised to inject about 15 min before we eat to allow the insulin to get active when the carbs get going. Worth discussing with your team.

Thankyou. I was told to inject right before eating, but I read about the delay you mention which def worth trying.

 

[rebrascora]

Injecting a certain amount of time before eating is what we call "prebolus" or "prebolusing" and the length of time required can vary at different times of day, breakfast usually needing the most prebolus time and evening the least but can also vary with your premeal reading, so if you are already high before the meal, you will usually need to wait longer between injecting and eating and if you are in the 4s and 5s generally less time. It also varies according to what you are going to eat. So something slow release, perhaps a fatty food where the carb disgestion will be slowed by the fat, will need less prebolus time than a food which is easily digested, like a smoothie or soup or perhaps mashed potato. Different insulins also have different speeds of activity, so if you change insulins, you may need to adjust your prebolus timings.

To give you a rough example of how much this can vary in practice.... I was initially started on Novo(not so)Rapid and I found that I regularly needed well over an hour prebolus time at breakfast for my yoghurt berries and seeds and could be as much as 2 hours if I woke up with my levels high, but just 20-30mins at lunch or dinner. I now have Fiasp which is a quicker insulin and if I wake up in the 4s or 5s I just need about 25-30mins but above that about 45mins for the same breakfast of yoghurt berries and seeds, but just 10-15mins at other times of day, sometimes a bit less. These timings for me generally keep my meal spikes below 10mmols. Rather than actually time them these days I just keep an eye on my Libre and watch for my levels starting to drop which tells me that the insulin is starting to kick in and if I eat about mid 5s with levels slowly dropping, then I can usually keep my graph pretty flat.
I must stress that this is what my body needs and many other people would hypo if they waited so long so you have to start with 5 mins if you currently don't prebolus at all and then slowly and carefully experiment with increasing it by a few mins every few days until you find a point that you are happy with the spike not being too high but most importantly, not risking a hypo.

It can be done by finger pricking if you don't have Libre but I was needing to do about 16 finger pricks a day to work it out that way, whereas Libre or other CGM makes it soooo much easier.

 

[Inka]

Hi
I am on the fast acting one, Humalog 100 units/ml if I read that correctly.
Interestingly the hospital just gave amount before a meal, not based in carb counting, but I think that is because what I need is not totally known yet. I have been carb counting, and so far finding that need about 1 unit for 8 g carb. Tricky though as only just got over the lurgy going around, and had antibiotics, so of course that affected things.
Thanks for the advice, it does sound as though I am approaching things right.

That sounds like you’re working things out sensibly 🙂 Yes, illness (and some antibiotics) will mess with your blood sugar, so bear that in mind as you begin to work out your insulin to carbs ratios.

Do try injecting the Humalog in advance of your meal. Start off by moving it 5 mins earlier, stick at that for a few days, then move it 5mins earlier again if needed.

 

[goodybags]

Hi @catlady some of us aT2’s do need insulin
it I’ve been taking the one I take but different to yours (I’m just on a mixed insulin) for approx 10 years now

One thing I was going to ask you though
Did they recommended a CGM (I’m unsure currently how many times your FP testing at the moment) but probably quite a bit

 

[Catlady 1]

Hi. Yes I have a cgm, thankfully free now I’m on insulin, I was self funding them before