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Hi there.. I am writing this on behalf of my sister.

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If your sister confirms that the Novorapid has genuinely started working and she’s still getting spikes after that meal, then maybe she’s simply not having enough insulin? Has she tried eating the same meal (to remove one variable) and slightly increasing her insulin?

Ratios often vary for different meals (ie breakfast, lunch, etc) and I’ve found my ratios can slightly change over time, going both up and down.

If your sister knows her basal insulin is right, and she’s spiking after meals even though she’s injecting the correct time in advance (correct for her), then she needs more bolus insulin, I’d think. Any increase should be cautious and gradual.
 
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