Confused

[Lianne]

So have I got this right it’s ok for short acting insulin to not make any impact for 4-5 hours and I have to put up with high sugars in that time ?

 

[DaveB]

Hi. Short-acting (Bolus) should start working normally after 1/2 hour but can continue to have effect for up to 4-5 hours particularly if the meal is fatty or complex carbs. If you find higher sugars during this time than you're happy with it might be OK to take a small correction dose BUT beware of stacking your insulin i.e. taking more before the first dose has finished. To be safe, wait for 5 hours and then check again before taking a correction dose.

 

[Lianne]

My short acting doesn’t work for at least 4 hours it’s been like that for a while (with all foods even rising with salad) and specialty nurse said that’s fine as long as it’s normal by next dose but after 3 hours it can still be at 15-20 and as you know you feel rubbish when it’s like that

 

[rebrascora]

If you are going up into the teens after eating a salad then I think it is likely that your basal insulin dose is not correct and your levels are slowly creeping up.
How long have you been diagnosed and do you have any tech like a Freestyle Libre to monitor your levels. Have you been on an education course like DAFNE.
Personally I am quite confident to stack my insulin corrections because I am reasonably experienced at managing my levels, I have done DAFNE and i have Freestyle Libre all of which give me confidence to manage my levels and like you I feel awful being high. Untimately, if I need to stack corrections then it indicates that my basal insulin dose is not correct or I have seriously miscalculated a bolus dose which considering I eat low carb, is pretty unlikely so I have to consider increasing my basal insulin the next day, taking into consideration other factors like activity levels etc. If you have not been given enough education to adjust your basal insulin then speak to a DSN about it. Do keep an accurate food diary when you are having problems like this along with your readings so that you can discuss them in detail with your DSN or consultant, but personally I think that we are responsible for the day to day management of our levels and we should be encouraged to experiment a little to find what works for us but always keeping an eye on safety. So if you are going to be at home all day and you have the means to test regularly and levels are not coming down in response to a correction after 2-3 hours and are still in the mid teens then I would certainly feel it reasonable to inject another small correction. Many people find that if their BG is high to start with, that correction ratios need to be higher to deal with it as their normal ratios are not so effective, so whilst 1 unit might bring me down 3 mmols if my BG is at 9, it might only bring me down 1.5mmols if I am already up at 13. Keeping yourself safe has to be the first and foremost consideration when using insulin. After that I think experimenting to find out what works for your body is more important than following rules!
Those are just my thoughts!

 

[Inka]

My short acting doesn’t work for at least 4 hours it’s been like that for a while (with all foods even rising with salad) and specialty nurse said that’s fine as long as it’s normal by next dose but after 3 hours it can still be at 15-20 and as you know you feel rubbish when it’s like that

I agree with @rebrascora that it sounds like a possible basal issue. What’s your blood sugar before you eat?

Are you carb counting and adjusting your bolus/fast/short-acting insulin to match what you’re about to eat?

How far in advance of your meal are you bolusing ?

 

[Lianne]

If you are going up into the teens after eating a salad then I think it is likely that your basal insulin dose is not correct and your levels are slowly creeping up.
How long have you been diagnosed and do you have any tech like a Freestyle Libre to monitor your levels. Have you been on an education course like DAFNE.
Personally I am quite confident to stack my insulin corrections because I am reasonably experienced at managing my levels, I have done DAFNE and i have Freestyle Libre all of which give me confidence to manage my levels and like you I feel awful being high. Untimately, if I need to stack corrections then it indicates that my basal insulin dose is not correct or I have seriously miscalculated a bolus dose which considering I eat low carb, is pretty unlikely so I have to consider increasing my basal insulin the next day, taking into consideration other factors like activity levels etc. If you have not been given enough education to adjust your basal insulin then speak to a DSN about it. Do keep an accurate food diary when you are having problems like this along with your readings so that you can discuss them in detail with your DSN or consultant, but personally I think that we are responsible for the day to day management of our levels and we should be encouraged to experiment a little to find what works for us but always keeping an eye on safety. So if you are going to be at home all day and you have the means to test regularly and levels are not coming down in response to a correction after 2-3 hours and are still in the mid teens then I would certainly feel it reasonable to inject another small correction. Many people find that if their BG is high to start with, that correction ratios need to be higher to deal with it as their normal ratios are not so effective, so whilst 1 unit might bring me down 3 mmols if my BG is at 9, it might only bring me down 1.5mmols if I am already up at 13. Keeping yourself safe has to be the first and foremost consideration when using insulin. After that I think experimenting to find out what works for your body is more important than following rules!
Those are just my thoughts!

Hi diagnosed 25 years ago yes to dapne and yes to free style ratio is 2 units 10 carbs (very low carb diet) and 3-1 on correcting I’m just concerned it’s all failing and the professionals don’t seem bothered and I’m fairly active (dog Walker)

 

[Lianne]

I agree with @rebrascora that it sounds like a possible basal issue. What’s your blood sugar before you eat?

Are you carb counting and adjusting your bolus/fast/short-acting insulin to match what you’re about to eat?

How far in advance of your meal are you bolusing ?

About 10-15 minutes before eating

 

[Inka]

About 10-15 minutes before eating

Have you tried bolusing a little earlier for meals where you spike? As an example, on Humalog I have to bolus 30 mins in advance for breakfast, but far less in advance for lunch and evening meal.

You say you’re eating very low carb? How low?

 

[rebrascora]

Which basal insulin are you using? Have you done a basal test?
Which fast acting insulin are you using? Timing is important and I need to inject as much as an hour or sometimes more before eating breakfast and about 20 mins at other times of day.

If it is any consolation I am currently experiencing similar problems with my Fiasp. This past week it just doesn't seem to be having any effect unless I get out and exercise after injecting my corrections which isn't always possible, especially with the way the weather has been. Today I bolused 3 units for breakfast. I was nice and stable in the mid 6s and had been for over an hour before I bolused and I left it about 30 mins before I ate. Had a cooked breakfast of 2 small eggs, bacon, black pudding, mushrooms and salad. I have had 2 correction doses since then amounting to a further 5.5 units (2.5 and 3units stacked) and I am still on 11! Heading out for some exercise now to try to bring things down via that means but my morning Levemir will be increased again tomorrow to hopefully prevent the need for corrections. I do understand how frustrating it is! Hopefully this phase will pass and we will be back to good control again soon.

 

[rebrascora]

Since you are eating low carb, do you bolus for protein? 40% of protein breaks down into glucose if you don't eat enough carbs and it starts releasing 1.5-2 hours after eating but can continue to release for several hours afterwards so sometimes it will use up whatever corrections you inject.
I am inclined to think that increasing daytime basal to cover protein and fat is sometimes more helpful that trying to bolus for it, if low carb is a long term strategy.... but it depends upon which basal you are on. Obviously you can't do that with long acting ones like Tresiba otherwise you risk going low overnight.

 

[Lianne]

Have you tried bolusing a little earlier for meals where you spike? As an example, on Humalog I have to bolus 30 mins in advance for breakfast, but far less in advance for lunch and evening meal.

You say you’re eating very low carb? How low?

Really the only carbs is porridge in a morning dinner and tea is usually none I struggle with earlier dose as I’m a dog walker but could try

 

[Lianne]

Thank you guys it makes me feel better that it’s not just me before I eat it’s always between 6-8 it’s just that i between bit feeling rubbish could do with some interaction with professionals but they just keep saying carry on with food diary (which I am) but never ask me for it

 

[Pumper_Sue]

My short acting doesn’t work for at least 4 hours it’s been like that for a while (with all foods even rising with salad) and specialty nurse said that’s fine as long as it’s normal by next dose but after 3 hours it can still be at 15-20 and as you know you feel rubbish when it’s like that

Sounds like your basal insulin is way out.

 

[Inka]

Really the only carbs is porridge in a morning dinner and tea is usually none I struggle with earlier dose as I’m a dog walker but could try

So pretty low carb then. That will increase your insulin resistance and mean you’ll probably have to count the protein as said above.

I think the first thing I’d do is a basal check to make sure that’s right. If your basal is wrong it makes everything else much harder.

After checking your basal, to move your bolus, I’d start with breakfast and do one meal at a time. It might not be necessary for lunch and evening meal anyway. Move it in 5 minute increments. When I did it, I moved it 5 mins earlier and kept it at that time for 3 days or so so I could get a proper picture of how it worked, and then moved it forward another 5 mins, and so on.

 

[stillgoing]

Just a thought. How about eating some carb. Its what the body is designed to run on. Standing by to be shot down. T2 is a very different condition so low carb may be good for them. I was taught to balance meals with carb, protein, fat ect.
Hope you both get your problems under control.

ps If I took my bolus that early(1 hour) I would be flat on the floor. Breakfast I take 5 mins before other meals I take after the meal otherwise I hit hypo before the food gets in there. It also means I know what I've eaten because sometimes my meal isn't what was promised 🙂

 

[Inka]

Agreed @stillgoing I find eating carbs makes control a lot easier. Sometimes just having a few carbs with a meal eg 20 or 30g can have a good effect. It sounds counter-intuitive but it works because it increases insulin sensitivity. Also, I find the interplay of insulin and carbs is far more predictable than insulin and protein, and just works better.

 

[stillgoing]

I'm not a medic but I suspect that the effect of eating is stimulating the liver (or kidneys) to deliver glucose into the system so that you can process the food. It takes a lot of energy to digest food. You then have no control of how much the liver spills as that is the job of the pancreas.

You give your numbers after 2-3 hours. How are they doing by next time (5-6 hours) If not back to normal talk to DSN of get moved to a consultant. Something very odd going on here I think.

good luck.

 

[rebrascora]

I had about 25g carbs with my breakfast this morning... 20g in the black pudding (barley etc) and 5g in the salad. It didn't help at all. I had a 10g carb biscuit last night at bedtime to bring me up from 4.3 and half an hour later I was 10.4 with no other food in my system. My digestive system gobbles up carbs and turns them into glucose in my blood stream just from looking at them but I seem to be very slow to utilize insulin. We are all different and we do what works best for us as individuals.

 

[Lianne]

Just a thought. How about eating some carb. Its what the body is designed to run on. Standing by to be shot down. T2 is a very different condition so low carb may be good for them. I was taught to balance meals with carb, protein, fat ect.
Hope you both get your problems under control.

ps If I took my bolus that early(1 hour) I would be flat on the floor. Breakfast I take 5 mins before other meals I take after the meal otherwise I hit hypo before the food gets in there. It also means I know what I've eaten because sometimes my meal isn't what was promised 🙂

 

[Lianne]

CD

Just a thought. How about eating some carb. Its what the body is designed to run on. Standing by to be shot down. T2 is a very different condition so low carb may be good for them. I was taught to balance meals with carb, protein, fat ect.
Hope you both get your problems under control.

ps If I took my bolus that early(1 hour) I would be flat on the floor. Breakfast I take 5 mins before other meals I take after the meal otherwise I hit hypo before the food gets in there. It also means I know what I've eaten because sometimes my meal isn't what was promised 🙂

laughing because the I’m with you on the promised meal !