Guess what..

[LittleSunflower]

Guess who starts on her new Red NovoEcho Pen for half a unit for every 20g of carbs (lunch only) tomorrow?
finally!
I was persistent and we’ve finally got to this stage
Any advice for tomorrow?
I was told I can inject into my stomach 15 minutes before my lunch or just before I take my first bite. They also didn’t have any BD needles which I was prescribed so I have a substitute for the time being as pictured.
I am still on the Levemir Flexpen, 3 units in the morning now.

(I did get given a blue pen at first from the diabetes centre at the hospital but I’ll save that for when I request Levemir in the cartridges too. The GP prescribed the red one so I’m going to use that for Novorapid, even though it took 8 days for them to prescribe the cartridges and needles after I kept calling every other day)
The results from my urgent blood test were all ok so my weight loss is from my diabetes & I have my new 3 year medical review driving license 🙂
Things are feeling a lot more positive apart from the fact I’m sat at severely underweight - hoping I can start eating a bit more carb wise with the insulin to gain weight again.

@Inka & @rebrascora … hope you are both keeping well? X

 

[rebrascora]

Congratulations and well done for persisting in chasing them up... I know you wouldn't find that easy.

I am not going to wish you "Good Luck" tomorrow because that suggests you might need luck and you don't. You will be fine. I would maybe prebolus 10 mins in advance and see how you get on but it depends on what sort of spike you are getting from your lunch at the moment. If the spike isn't above 10 then maybe inject just before you eat. If you are regularly going above 10 after lunch then prebolus by 10 mins today and see what happens and if your levels still spike above 10, then try 15 mins the next day and see what happens. We know you are pretty sensitive to insulin which is why I am suggesting this.
Please let us know how you get on.

 

[Inka]

Excellent news @LittleSunflower ! Finally! This should enable you to get that weight back on and feel a lot better too. So pleased you finally have the tools you need. XX

 

[everydayupsanddowns]

Great! Always exciting to get a new diabetes gadget 😛

Hope you find the half units helpful 🙂

 

[LittleSunflower]

The first few days have been scary but totally worth it. I am now taking 0.5 units for every 17g of carbs, with every meal. I also had a meeting with my DSN at the hospital yesterday to discuss correction doses.
My target range is 4-8 (with the exception of 10)
So if I was a 13 before my dinner, I would take an extra 0.5 unit for correction along with the amount to cover the carbs.
I am weighing my food and eating a lot more! I feel a lot more confident with my intake and all of the thinking/mathematics that goes with diabetes!

I have a question though, I seem to be going to around a 12-13 after breakfast. This is with the half unit to cover the carbs -injected 10-15 minutes prior to eating.
My breakfast only contains 17g of carbs (2 slices of wholemeal bread with Vitalite spread on, but I cut the crust off.
One full slice should contain 15.1g of carbs but as I cut the crust off, it doesn’t) any idea why this is happening? I’m a bit reluctant to have milk with any cereal as my sugars shoot through the roof with milk too, especially weetabix which I miss eating!

I still drop in the night to normal levels
I can go to bed on an 11 and wake up a few hours later with the libre saying I’m going low or it can take me through the night and I wake up at a around a 5-6. It’s like my pancreas is working throughout the night, it gets to morning and it gets overwhelmed that I’m eating within 30 minutes of being awake and can’t cope hence the breakfast spike.
Any advice is welcome, thanks x

 

[Ellie Jones]

Your overnight could well be hormonal,

Hormonal levels fluctuate during the day, and can impact on your insulin sensitivey, the lowest ebb for hormones are around 2am-3am in the morning. Then they start raising as you get to your waking day.

Prior to going onto the insulin pump, my mornings was a nightmare as I could get up in the morning with something like 5.5mmol then within an hour I've zoomed up to 16mmol with no food, so theoretically still fasting.

Hopefully the 0.5 unit will help a lot, I remember when I first had pens due to being sensitive to insulin I had the Lilly & Lilly childrens pen, the cartridges if I remember rightly were only 1.5mls not the standard 3ml but the pens we decorated with things like Elephants, umbrella's etc. I was so gutted when the stopped producing the Pens and Cartridges. And struggled for a few years as no 0.5 unit pens available in Adults. Until I go the pump.

 

[SB2015]

Glad that you now have the half unit pen @LittleSunflower

It is always a juggling act, and all we can do is get the best match that we can. Hormones are not on our side and don’t stay the same through the day and the dawn phenomenon can make breakfast a challenge. If this is a consistent issue, have you tried altering the timing of your prebolus. I need a much bigger time gap in the morning than I do for the rest of the day. If you do this some extra testing will help.

I have a lower carb breakfast during the week but we always have breakfast together Sat and Sun and it is higher carb, so I just accept that my rise is a bit bigger on those days.

I found things very frustrating on pens, even with half units, so was glad when I eventually switched to a pump.

 

[trophywench]

Aw Ellie - I'd have loved more interesting looking pens!

 

[rebrascora]

Some of us have found that injecting our breakfast bolus plus a small correction to cover Foot On The Floor (FOTF) or DP as soon as we wake up and then eating breakfast when our Libre shows our levels starting to drop helps to prevent that spike. I usually inject 1.5-2 units to cover FOTF plus my breakfast bolus and for me is is usually 45 mins before I see on the Libre that the insulin is starting to kick in and eat my breakfast then. I have my breakfast made ready to eat in case it kicks in sooner and I just scan every 5 mins and watch for the arrow changing direction whilst I drink my coffee and potter on in the kitchen etc. If you wake up already high then it usually takes longer than if you wake up nicely in range.
I should say that 45 mins is extreme although it took me even longer with NovoRapid (usually an hour +). I am currently using Fiasp which is slightly faster. Using this strategy I can sometimes get it so that a 30g carb low GI breakfast doesn't even create a blip on my Libre graph but you do have to be vigilant and not lose track of time and what you are doing.

 

[rebrascora]

Really pleased to hear that you have a half unit pen and are gaining confidence in using it at each meal. Experience is a wonderful teacher.

 

[Inka]

I’m so pleased you have the half unit pen now 🙂 I’m glad it’s working for you.


“My breakfast only contains 17g of carbs (2 slices of wholemeal bread with Vitalite spread on, but I cut the crust off.
One full slice should contain 15.1g of carbs but as I cut the crust off, it doesn’t) any idea why this is happening? I’m a bit reluctant to have milk with any cereal as my sugars shoot through the roof with milk too, especially weetabix which I miss eating!

I’d bet that the answer is the time you bolus for breakfast. The same happens to me. If I bolus at the perfectly reasonable time of 15 mins in advance, I’ll go up to 11 or more. But if I bolus 30 mins in advance, I’ll be around 6. Same breakfast (cereal and milk) totally different blood sugar result. I need to bolus twice as far in advance for breakfast as any other meal - and I’ve lost count of the number of others who do too.

I also need my biggest ratio at breakfast - ie 1 unit of insulin at breakfast covers less carbs than at other times.

You can eat Weetabix. The problem isn’t the WB or the milk - it will be the insulin (timing, dose). It invariably is. Now you have the Novorapid, you can eat relatively normally 🙂

 

[LittleSunflower]

Thank you for all of the replies.
I have started experiementing with the time of pre-bolusing. I have definitely seen a difference from the usual 10,15,20 minutes beforehand. I now inject when I wake up and wait around 30-35 minutes before eating my two slices of no crust wholemeal toast. I only went to a 10.1 the other day which is a big change!
It’s been creeping back up but that’s definitely hormone related at the moment. I find I can go higher but also come down really quickly without even realising how much I’ve dropped, then I wonder why I feel a bit funny.
I do wonder if I will need 1 unit to cover breakfast, even though it doesn’t work out like that mathematically carb/ratio wise now a couple of you have mentioned br


A few questions;

I was told to leave at least 4-5 hours inbetween Novorapid doses, is this correct?

Is there a certain Sugar level I shouldn’t inject Novorapid with?
for example, if I test my blood and it says 5.5 and my lunch needs atleast 2 units to cover, is this safe to inject and wait the 10-15 minutes before I start eating like normal?
I did this the other day, started eating my lunch and felt very funny. I checked my blood and I had dropped to a 4.1 with hypo symptoms. I was a bit confused as I was eating, on what to do and if to treat it as a hypo; as I was told to only treat a hypo at a level of 3.9 although I do get hypo symptoms around a 5.0 as I had been running high for so long.

(I do still have the libre but as I’m still quite new on Novo, I always test my blood before injecting to be sure)

With Novorapid, If I have my dinner later than usual, say 7pm, I am finding around 10pm that I’m going into the 15s before bed, ketones tend to still be Lo which is a good sign but I’ve risen without having my bedtime snack. I don’t want to correct that level as I still drop to normal levels in the night.
Why is this happening?

I am still injecting in my stomach only, someone posted a photo of where abouts on the stomach injection sites can be, I can’t find the image at the moment, is it possible for someone to share this again?

I have actually been squeezing my stomach a bit to inject, even though I was told to put the needle straight in, no squeezing necessary - is this personal choice? I find it much more comfortable at this point in time.

Many thanks for all of your help and guidance, Little Sunflower x

 

[Inka]

It’s very common to need different ratios for different meals - breakfast usually needs more insulin for the same amount of carbs @LittleSunflower

1) Leaving the 4-5 hours between NR doses isn’t necessary, but it might be wise for you to do so initially until you feel more confident. The concern is that newbies forget they still have one lot of NR acting when they take another dose.

2) No, you can inject NR at any sugar level BUT never inject when you’re hypo because your brain won’t be functioning 100%. So, if you’re 3 before lunch, treat that hypo, then inject and eat. You might want to eat straightaway on that occasion rather than waiting. 5.5 is a perfectly normal level. Yes, it’s safe to inject then because what you’re injecting will be dealing with your carbs. In your example, you might have waited to long to eat or eaten low GI carbs. I sometimes inject and eat my lunch within a few minutes as I find I react to the insulin quicker at that time. If you have a hypo as you’re eating, just have a Dextro or 2 and carry on with your meal.

3) Going into the 15s if you eat your evening meal late, suggests your basal might be wrong, or, like me, your body pumps out glucose if meals are missed or delayed. You’ll need to experiment a little to find what works for you. And yes, don’t correct if you’re dropping to normal during the night.

4) I’ll look for the injection chart in a moment and put in a second post. But basically, it’s tummy, outer thighs, top of bum, top of arms. I always pinch up even though I only use a 5mm needle when I inject with my pen. If it works for you, do it.

 

[Inka]

https://forum.diabetes.org.uk/boards/attachments/4365afc2-1729-49e0-bdf6-132b83da74ae-jpeg.16641/

Sorry - thought I’d posted it. It shows lower bum but I’ve never used that area.