Fasting question

[brett]

decided to check if I needed more basal today as I find to have a reading under 8 two hours after bolus thee is too much bolus till my next meal as I have very significant drops 3to4 hours after my meal bolus. Have tried injecting 30 mins before my meals which doesn't help. So I thought to up my basal and reduce qa but thought I'd check first. So tested this morning at 8.7 this morning, now 6.3 at 5.30. I was 6.5 2 hours prior so seems basal ok as I have hhad a steady drop . However been very cold and clammy last 2 hours so checked my ketones and they were 0.9, higher than the recommended 0.3. Any thoughts appreciated.

 

[pgcity]

When did you last eat? I believe you can get keytones from fasting. I usually only miss one meal at a time to test my basal. You're tougher than me.

 

[brett]

did have a late snack last night before bed about 11. Thought id go as long as poss. Have to say I was surprised how long I went as I usually eat quite alot of food. Couldn't of gone on much longer though!

 

[Northerner]

I would agree with pgcity, the ketones will be what are known as 'dietary' ketones. Ketones are a by-product of burning fat stores for energy, so they can be present when either you haven't eaten for a while (the dietary type) or if your body has insufficient insulin circulating to process the glucose in your blood (the dangerous DKA kind!). Using fat for energy is also more difficult for the body, and if you are not used to it then this may be why you felt 'cold and clammy'.

I also get quite a dip in my levels 3-5 hours after eating/injecting sometimes, but this is usually because I've overestimated my meal bolus or because the food has digested too quickly and before my insulin peaks. Trying to choose low GI food can help because it means you get a much slower release of energy that more closely matches your insulin duration, so you might rise steadily to 8-9 and then gradually fall again to 5-6 before the next meal. In an ideal world, of course! 🙄

 

[brett]

Thanks for the info, have tried everything to stop the dramatic drops 3~5 hours having low gi food , a greater quantity of low gi food and injecting 30 mins before which helps slightly but still needing a 20 ~30 carb snack in between meals. it can't be too much bolus as through trial and error to not have a hypo before next meal without a snack I need to be 12 plus 2 hours after meal with no correction. this leads me to think my qa insulin lasts for 6 hours or my metabolism just works faster than average or even both. Well before diagnosis I would get what I now realise to be hypo warnings which I would instinctivly have sugar. Could they be valid reasons?
I do feel less anxious about the ketones though thanks.

 

[Northerner]

It does sound as though your novorapid is taking some time to peak and tail off. What sort of levels do you get 1 hour after eating?

 

[brett]

Very rarely check my 1 hour readings, but they are normally ?. Was just about to answer that but looking through my monitor I hasn't got any (shakes head in shame), will get back to u you on that one tomorrow.

 

[brett]

Well, ive done 1 hour readings midday onwards today heres what I did.

11.59 9.2 and injected qa 30 mins before lunch, didnt do correction for the 9.2 so not to need a snack.
Lunch was a wholegrain chicken salad roll from bakery, an apple and a small bag of peanuts .
13.35 12.0 1 hr after food/ 1.5 hrs after injecting
14.30 10.5
15.30 8.1
16.33 5.2
Now at 17.30 pm 4.7 and eating tea in about an hour .

So, as you can see there is a drop of 3mmol 3.5 to 4.5 hours after injecting. Had I been 3 mmol less before lunch I would of been needing a snack after 3 hours. Not a big deal I know but that is the one thing I ready hate is having to eat when not wanting to or hungry.

 

[trophywench]

Well your bolus is too high by the sound of it to me! Nowt to do with yer basal.

 

[brett]

If I bolus less, I go to 13+ at the 2 hour mark, although I'm still usually 5~6 pre tea. Surely peaking that high regular isn't good?. Can't be basal too high as only recently started having 3 units of levemir in the evening.

 

[brett]

Think I might try injecting 1 hour before food as it seems my qa takes alot longer to work than my stomach does to digest my food. Hopefully this will catch the peak and stop the lows. I will test 30 mins after injecting and before I eat. Lets see what happens tomorrow.

 

[DeusXM]

It sounds to me like (weirdly) your bolus is hitting its peak action very, very late - most of its work should be done after 2.5 hours. It also sounds like you're injecting earlier as well so it's not really as if you can move your timings much further either.

There's another option here but I'm not sure you're going to like it. At the moment, you're having a lot of difficulty matching your insulin to your carb intake and digestion profile. You can't eat carbs without taking insulin. But you can eat other things without needing to get insulin involved. Potentially if you cut down the carbs, you can take less insulin which puts you in the realm of small numbers.

Think of it like driving a car. If you're driving very fast, like on a motorway, it's extremely easy to oversteer and put yourself in danger. If you're driving slowly, even if you oversteer, it's very easy to safely correct. In this metaphor, your speed is your carb intake, your steering is your insulin. If you eat less carbohydrate, you take less insulin, and thus you're less likely to put yourself into a problem - you'll hopefully eliminate the spike AND you'll avoid the big drop-off at the end.

 

[Northerner]

An alternative might be Apidra instead of novorapid, which has a faster onset and shorter tail-off 🙂

 

[bennyg70]

I had the same problem as you (Or still do sometimes if i dont follow what im about to say) By adding a bit of fat and reducing the carbs a little (Im not a low carber !!!) I found it steadied the spike out.

For example - I throw a few mixed nuts in with my cereals. I also eat a handful with my lunch. Seems to help me.

Sorry didnt spot that you had had some peanuts with your food... Your lunch would be similar to mine, but I dont seem to spike as much. However I do at lunch and breakfast tend to inject an hour before eating.

And as northenr said... Apidra may work for you. It didnt for me, however it could be just what YOU need. In theory it should help this sort of issue.

 

[Vix]

I have a similar problem and I DO eat a low carb diet and have plenty of nuts for that extra bit of fat! If my levels before meals are correct then I always go high about 2hours after eating... but then if I increase my basal I get hypos at night or before my meals.

I've never heard of apidra but you could try it as there's nothing to lose by trying it to see if it helps...

Good luck, sorry I can't be much help but let us know how you get on injecting an hour before food

xx

 

[brett]

Thanks for all your comment, this problem happens at breakfast and lunch but not in the evening. I did wonder about aprida but thought it was similar duration to nova rapid. I will mention this to my consultant, only today I received a letter to make an appointment to see him. Just a 6 monthly regular one.

Injecting 1 hour before lunch did seem to help.
6.7 before lunch injected 1 hour before food.
6.4 before eating
9.7 2 hours after food
4.3 4 hours after food. (4.30)

So didn't go too high (although higher than id like)
But had some lucozade at 4.3 so I could drive home.
6.00 now 5mmol, so seems like qa still working well up to 5 hours.

Less carbs would be very hard for me to do as still trying to add some weight on. Although I do eat around 300 carbs a day,i do aim for the low gi, high fibre ones.

 

[MaryPlain]

Hi Brett

I've always had this problem, which has been improved a bit by changing to a pump, changing to Apidra, injecting before eating and reducing carbs, but has not gone away completely. The only way I ever manage to get numbers under 8 two hours after eating anything (even meals with no carbs at all) is to exercise immediately after eating, which is not always practical.

Another technique which should work in theory is to spread the meal out - ie bolus for the whole meal but delay eating some of it. I haven't quite mastered this yet, mainly because if there's food around I don't have the willpower to resist it, especially if I have already bolused for it - and because I have a very well founded worry that I will forget and go hypo (this has happened). You might be able to be more disciplined than me!

Since being on the pump my HbA1c has been between 6 and 6.5 which I'm happy with as I have a lot fewer hypos now. I definitely found that Novorapid had a very long delayed peak for me and Apidra is much better - the only way to know is to try it!

 

[PattiEvans]

Choose what you do I don't think it's possible to have a completely flat profile after a meal - after all, why should it be? Many non-diabetics get a peak (albeit small) after a meal. It looks to me like you only went up 3mmol after that lunch which isn't really an outrageous spike. If you'd started at 4.4 your peak would have been 7.7 after the meal which would be excellent.

FWIW I'm on Apidra (and in the past have been on both Novorapid and Humalog), it's not quite as fast to kick in as I imagined it would be, and though it's supposed to be over and done with in 4 hours I strongly suspect the real duration is 5 hours.