Delayed insulin response

[Gareth Davis]

Hi I’m type 1 and the libreview data has been a revelation. I was constantly battling with ‘bouncing’ with a high peak after eating then a fall 2 hours later. By undertaking tests over a year it is evident that in the morning, Humalog takes around 90 mins to work. Then I can have a small bowl of cereal and I am stable. This delayed effect seems to reduce over the day but I am working on that. Apart from having to wait for breakfast this seems to have sorted my problem. Clearly this is a bit of a unusual effect and it would be interesting to see if anyone else has this. Cheers Gareth

 

[Ljc]

I believe a fair few of us in here experience the same. I used to have to inject 50 minutes before brekkie. The trouble with having to wait so long before you can eat is, it’s easy to forget you’ve jabbed earlier and now need to eat, I got involved in other things and ended up hypo , so I set an alarm to remind me .

Watch out for things changing , mine has, I now jab and eat straight away.

I have learned such a lot due to my Libre

 

[Inka]

@Gareth Davis I don’t have a Libre but breakfast was my spikiest time too. I sorted it like you by moving my bolus more in advance. It’s something I often recommend as do others here.

For my breakfast I have to take Humalog 30 mins in advance - twice as far in advance as for other meals or snacks. When I was pregnant - and thus heavily insulin-resistant - I had to take it one hour in advance.

Taking it enough in advance not only stopped my spike, I was able to reduce the amount of insulin too.

 

[Spozkins]

Yep! I think many people also experience insulin resistance early in the morning requiring a bit more insulin than they might for the same carbs later in the day.

I dont really eat breakfast because I find it a bit too much of a hassle to work around. If my BG is any higher than 6 then I can guarantee my BG will go a bit mental before coming back to planet earth and it'll take me a while to reign it in!

Also second @Ljc 's sentiments about things changing. My bg seems to be quite sensitive to changing depending on hormones, stress, daily activities and health. So definitely keep looking for those patterns.

Sounds like you're on the right track though and coping well! Keep at it

 

[SB2015]

Hi @Gareth Davis

Like you using a Libre was an eye opener. That was how I discovered the need for pre bolusing for meals and found out the timelag needed at different times throughout the day. I wonder whether the longer delay in the mornings is in part due to the addition of a rise from the Dawn Phenomonon.
It sounds like you are already making effective use of the Libre data.

As others have said things also change with the seasons, and the basal rates, and ratios need tweaking. This is all a lot easier using the Libre.

 

[helli]

@Gareth Davis a couple of thoughts
- is your rise entirely due to breakfast or do you have a compounded rise due to food and Foot On The Floor?
- have you thought about faster acting insulins like Fiasp?

 

[Ljc]

I thought Fiasp might be helpful too.
I don’t know the criteria for getting a pump but it might be worth looking into @Gareth Davis

 

[Robin]

Same thing happens to me, @Gareth Davis. I have to bolus an hour before breakfast, and I need more insulin per carbs than the rest of the day. I don’t think it’s insulin resistance, though, more a case of my liver pumping out extra glucose, so as the insulin starts to kick in, all it’s doing for the first hour is mopping up extra glucose coming into the system without food. If I don’t have any breakfast, or just eggs, I still have to put two units of insulin in to mop up the liver output.
The Libre is great, isn’t it, for spotting things like that happening.

 

[Inka]

@Spozkins I find that missing breakfast just means my body pumps out more glucose. If my morning blood sugar is much above 7, I’ll sometimes correct a little, but if it’s below 7, bolusing enough in advance and using the right ratio works for me.

Interestingly, if my blood sugar is high on waking - say 12 or something - I’ve found getting a bolus and food in relatively quickly as well as the correction works better than waiting to be below 7 before eating. I wait to be below 10 as a kind of compromise. Again,I’m presuming it’s because of the morning insulin resistance and Foot on the Floor.

 

[trophywench]

@Inka it is exactly your latter paragraph that made me change to a pump.

Actually replicating the function of a fully functional pancreas is not possible whilst leading a normal life in impossible - but we can usually get better control with a pump within reason, without too great inconvenience to most normal lives, end of story.

 

[everydayupsanddowns]

I’m another who typically has to wait much longer in the mornings between dose and eating to limit the post-breakfast rise.

It partly depends on how well tweaked my basal is that week (i need to adjust my basal insulin profile every few weeks), bit also depends on how twitchy my liver is feeling that month/year.

It used to be 45-60 minutes minimum years ago, Then dropped down to 20 minutes, now back at around 30 minutes.

Keeps us on our toes eh!?

 

[Deleted member 25429]

I have to inject as soon as I wake up . Then I wait half an hour inject for breakfast wait half an hour then eat breakfast. This works for me, it’s all trial and error

 

[Gareth Davis]

Hi I’m type 1 and the libreview data has been a revelation. I was constantly battling with ‘bouncing’ with a high peak after eating then a fall 2 hours later. By undertaking tests over a year it is evident that in the morning, Humalog takes around 90 mins to work. Then I can have a small bowl of cereal and I am stable. This delayed effect seems to reduce over the day but I am working on that. Apart from having to wait for breakfast this seems to have sorted my problem. Clearly this is a bit of a unusual effect and it would be interesting to see if anyone else has this. Cheers Gareth

Hi all and thanks for the responses. Its good to know that I'm not the only one. I have been doing a bit more experimentation and my bodies response depends on the BG Levels to start with. If I wake up relatively high say at 9-10mmol then after injecting (6 units without having food) I have a rise in BG by say 3 to c.12mmol. This bump takes around an hour to come back down to where I started. over the next 30 mins I am low enough to have a small breakfast (15g) and we can move on. If my starting levels are lower (say 5mmol) I would take 3 units of humalog and the response is shorter (40mins) with less of a bump. Again I can then have a 15g breakfast. This response seems to reduce over the day and by evening I am closer to the standard Humalog profile. Cheers Gareth

 

[rebrascora]

Hi Gareth.

I am another one who has to prebolus a very long time before breakfast. Fiasp is about 45 mins, Novo(not so)Rapid is over an hour but can go beyond an hour and a half. I use the Libre to scan regularly after 30mins to see when it is dropping and I can start to eat breakfast. I inject as soon as I wake up to cover "Foot on the Floor" (1.5-2u same as @Robin) as well as breakfast and any correction and then potter about until I start dropping and then I can eat. I find that even if I am high (been in the 9s the last few days) a large (for me) bolus of 7 or 8 units will enable me to have my normal breakfast of 30g carbs with almost no spike if I time it right, but getting that insulin injected the moment I wake up and before I get out of bed is key.

I was thinking of asking if I could try Humalog to see if that was any quicker but by the sound of your experience I would be wasting my time, so it has been really useful to read your post.

 

[nonethewiser]

Bolus 25 mins before brekkie when bg in range, little longer if high less if low. Only get foot on floor when not eating, otherwise all good.

Breakfast is usually same carbs, 50g with 5u bolus.

 

[Jenny101]

Hi all and thanks for the responses. Its good to know that I'm not the only one. I have been doing a bit more experimentation and my bodies response depends on the BG Levels to start with. If I wake up relatively high say at 9-10mmol then after injecting (6 units without having food) I have a rise in BG by say 3 to c.12mmol. This bump takes around an hour to come back down to where I started. over the next 30 mins I am low enough to have a small breakfast (15g) and we can move on. If my starting levels are lower (say 5mmol) I would take 3 units of humalog and the response is shorter (40mins) with less of a bump. Again I can then have a 15g breakfast. This response seems to reduce over the day and by evening I am closer to the standard Humalog profile. Cheers Gareth

Like you it was a revelation when I first wore the Freestyle Libre. I suffer from the Dawn Phenomonon and, as I now have a pump, can correct that with my basal rate. I'm on humalog and release insulin 20 mins before breakfast, 20 mins before lunch but only 5 - 10 mins before tea. When I eat something sweet I wait 30 minutes.

 

[trophywench]

There again - Novorapid generally starts within 10 minutes for me and I've had the hypos to prove that. I've been using Novorapid since 1998. Why wouldn't I ?

We are all different.