8 months in T1D and a few questions if i may?

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Rybing

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Type 1
Morning all,

Well, im 8 months in T1D. Im getting the hang of it now very slowly. Never had a clue what i was on about when i first posted here. I am afraid it made me look daft.

44yr old male T1D diagnosed in March after being so very ill with prolonged high bloods, keytones etc

Novarapid, toujeou insulin and metformin.

A few questions if you dont mind.

1. I have between 10 and 15 units of nova with my 3 meals a day. Very little carbs but even so, 1 hour after the meal and the nova im still coming in at 14 or 16. Should i increase slightly?
2. If i have a snack after my evening meal should i take more nova even though im taking toujeou 38 units, shortly after before bed?
3. If im out and about and my bloods go high (it makes me feel awful as i regulary come in at 27 to 31) should i take some nova even though ive no food?

I seem to be fighting a losing battle trying to keep bloods down

Thanks in advance

Ryan
 
Hi there

1 - How far in advance of eating do you take your insulin?
2 - It depends on how many carbs are in the snack, what your BG is at the time and what effect the snack has on you, Toujeou is a long acting and designed to keep you stable in the absence of food
3 - You can take Novorapid to correct high BG, your team should have worked with you to discover your correction factor

Have you done a basal test to check that your basal dose is correct?
xx
 
Good Morning
1. It depends - do your sugars come back down again in the next couple of hours? If so you might just need to take the novo a bit earlier to give it chance to get working before you eat.
2. Yes if there are carbs in the snack you should take novorapid with it, have you been taught to carb count? Toujeo is long acting which does a completely different job, it breaks down slowly over 24 hours to keep you level in between meals, the novorapid deals with the meals.
3. Yes you can use novorapid to correct high sugars, do you know what your correction factor is? Usually something like 1:3, I.e. one unit brings you down by 3 mmol/l. Everyone is different though so don’t just assume that is correct if you don’t know, speak to your medical team. Have you done a DAFNE course? They all stopped during Covid of course but might be running again now, very useful I believe.

If you're regularly hitting the high 20s something is going wrong somewhere, it might be worth doing some basal testing to see if your Toujeo dose needs adjusting. Unfortunately with diabetes nothing stays the same forever and you do find you have to tweak things from time to time.

Lol @Kaylz beat me to it!
 
I've certainly noticed a massive difference in avoiding spikes since pre-bolusing so definitely would suggest looking into timings. For me that can vary from eating instantly to 15 mins before to 30 mins before. Timings depend on what I'm eating and what my current blood glucose is. At no time since I've been on Novorapid (which is 30 years) did anyone suggest pre-bolusing, even when I did DAFNE 14 years ago. I've only found this out from being involved in this forum.

I have a friend who is Type 1 and a DSN and mentioned pre-bolusing to her and she said she didn't dare try it at the moment. So it doesn't appear to be general advice given out by the medical experts. I really think it is one of the keys to better control.

I think, and I can only say this from my reading on here, that the foundation is basal testing though. As yet I haven't done a basal test so can't speak from personal experience.
 
As a 'late onsetter' like yourself @Rybing, I found the advice on here as well as regularly checking things with my DSN invaluable.

Personally, I have to pre-bolus at breakfast to avoid large spikes - I usually wake, bolus, shower, dress and then eat. So I am injecting around 20-30 minutes prior to eating. That tends to reduce the spike considerably. I then inject about 5 minutes prior to other meals and don't see spikes, unless I miscalculate when carb-counting.

I find Toujeo to be very stable - any basal tests I have done have shown this and although it is apparently very expensive and rather strong in comparison to other long acting insulin, it works for me. I also moved from Novorapid to Fiasp earlier this year and it helped with spikes. However, there are times when it behaves like water for a couple of hours and then has a nasty kick in the tail.

Anyway, these are all conversations I think you should be having with your DSN/ consultant so that you can work out a solution that suits you best.
 
1. I have between 10 and 15 units of nova with my 3 meals a day. Very little carbs but even so, 1 hour after the meal and the nova im still coming in at 14 or 16. Should i increase slightly?
Maybe, but what’s your blood sugar at two hours? And before your next meal? And are you bolusing enough in advance of eating?

2. If i have a snack after my evening meal should i take more nova even though im taking toujeou 38 units, shortly after before bed?
The Toujeo is a slow background insulin. It doesn’t deal with food. So, yes, a carb snack might need a bolus depending on carbs, etc. However, I tend to avoid carby snacks in the evening usually as I don’t like to bolus too close to bedtime. So I either have non-carby things or just a 10g snack.

3. If im out and about and my bloods go high (it makes me feel awful as i regulary come in at 27 to 31) should i take some nova even though ive no food?
Yes - if you know how to. Your Novo is for corrections as well as boluses. However, if you’re going that high regularly, you need to speak to your DSN as something sounds off. Maybe you need more basal insulin, or a different basal?

I think you should give your team a call and get their advice.
 
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