How on earth can i work this one out?

[gillrogers]

So my lyumjev is now working tooo quickly. So now resorting to eating and bolusing when my bg starts rise on my shuggah app. However as Im sensitive to activity and the weather my basal changing making it really difficult to work out how when i should be bolusing now.

For example, yesterday i started rising 8 minutes after I finished eating my breakfast. Today, same breakfast but with a half unit correction it was 10 minutes. (Guess that could have been the correction half which i gave at the start of me eating)

Yesterday luch was 15 minutes after eating, today was 30 mnutes after eating, then staryed dropping fast half hour after that. (Dropping like that half hour after bolusing is usually an indicator to me that my basal level has dropped as my basal at lunchtime always brings me down a unit or two if its too high as seen in bassl tests) So i guess the dropping basal was staving off the start of the rise in bg.
Yesterday dinner was 35 mins after eating, today was 27 minutes after eating. Again prosably down to a slightly high basal?

I have been expecting big spikes like i got before i staryed on lyumjev, as ive come down from a 7 min prebolus to no prebolus and now after eating bolus over about 3 weeks. But the big spikes didnt happen. I might get to 13mmol ( before i was hitting 18,s). But tonight i did get to 15mmol.

I guess ive got to run a count down timer and cut a minute off the time every day? But i dont know where to start from as seems each meal time is now differant.

Dbn prooving difficult to get hold of to guide me as i think i just need to go back to the old lispro junior quick pen.

Seems im constantly solving one probkem to move onto another one and cant get past a predicted hba1c of 64 now. .

 

[Inka]

Hi @gillrogers The speed our blood sugar rises is affected by a number of things, including the food we eat, our digestion and the rate of absorption from our bolus site. In your situation, I’d just go back to my original bolus insulin and see how that worked now. You don’t need your DSN’s permission to do that, but do check your insulin is in date and in proper condition, or simply order some more.

 

[Lucyr]

I’m a bit lost here. It doesn’t matter whether your shuggah app shows your bg rising 8 minutes after you eat or 10 minutes after you eat or 3 minutes after. It will vary depending on what you eat, what time of day it is, what exercise you’ve done. Take the bolus immediately before eating if you’re worried about dropping later on and don’t prebolus except when you’re confident that you have time to watch your bg.

 

[helli]

Take the bolus immediately before eating if you’re worried about dropping later

If I did that with Fiasp when my BG is in the 4s, I would hypo immediately. It can work faster than I can digest food ... even dextrose.
Your advice is great for the "older" fast acting insulins like NovoRapid but definitely a bad idea for Fiasp and maybe Lymujev.

@gillrogers I am not familiar with Lymujev but wonder if it works similar for you to the way Fiasp does with me. Have you looked at your BG before eating to see if it affects the speed the insulin works?

 

[Lucyr]

If I did that with Fiasp when my BG is in the 4s, I would hypo immediately. It can work faster than I can digest food ... even dextrose.

Take it after eating then, my point is you don’t have to keep logs of when your bg starts rising, that’s not a thing you have to monitor. The OP giving the times the bg is rising proves that going hypo immediately after eating like you did isn’t a problem they are facing, since their bg is rising after meals.

 

[helli]

my point is you don’t have to keep logs of when your bg starts rising, that’s not a thing you have to monitor.

I believe it is known as sugar surfing which I think @rebrascora does (apologies Barbara if I have this wrong).
It can be useful if you have the flexibility and time to do but as Gill is finding it is challenging when you have to go to work or have less flexibility.

@gillrogers what is your BG like before breakfast? I am wondering if it is worth running a little bit higher so you can bolus just before eating and a drop will not take you into hypo land. Maybe have a small biscuit (without insulin) as soon as you get up if your levels are in the 4s or 5s and then bolus when you have breakfast after your shower (assuming this is your morning ritual).
Unfortunately, finding an approach that will work for every scenario is never going to work so we need to make adjustments and compromises.

 

[rebrascora]

Although I hate the term "Sugar Surfing", yes, that is a technique that I find myself using. Not something I researched and tried but just something that I naturally fell into of my own accord (mostly to deal with protein release with me being low carb) and then subsequently discovered it was a recognized and documented strategy.
That said, I do not "keep logs" of when my food kicks in and BG rises and I am not sure sugar surfing requires that. I log my insulin doses so that I can keep track of them and how much is left when I stack corrections and sometimes the carbs I eat, although this is of less help which is why I am less structured with it. My diabetes management is mostly reactive and intuitive, so I respond to what my Libre shows me is happening and what I think will happen from past experience.

I must confess I read Gills post in the early hours of this morning and was completely baffled by it and decided to come back to it when my brain was better engaged after sleep, but I am still struggling to understand what you are trying to illustrate Gill with your timing of BG rise and a few minutes difference one way or another should be no big deal when insulin works over at least a couple of hours. Even if it starts kicking in quickly, it doesn't all release at once, so you should still have plenty of leeway and as has been explained, food digests at different rates and even the same food can digest a bit quicker one day than another.

The way I sugar surf is that I inject my insulin and then I watch and wait for it to start kicking in, particularly at breakfast time when timing is more critical and then I eat when I see the insulin starting to bring my levels down. I don't pay attention to the timing of anything as such I just keep a close eye on my levels and eat when they start to drift downwards. Mostly for me it is about 45 mins on a morning prebolus time with Fiasp but I don't keep tract of the time, just watch my levels.
This morning I am pretty sure it was less than 45mins and can check on my log (because I log when I inject and when I eat), but my waking reading was 4.7 so I would expect it to be less because Fiasp works faster when levels are lower..... Just checked and I injected 4 units at 8.45am and ate at 9.11am during which time my levels had dropped from 4.7 to 4.2. In that scenario, when levels are close to the red line, I sometimes have a JB to slow the drop and then have my breakfast straight after but I didn't this morning and my yogurt, seeds and berries have digested and brought me up to a nice 5.8 without dipping into the red. Yes, I probably cut that a bit fine but I don't have to be driving anywhere this morning and experience tells me my body will digest my breakfast and release the glucose pretty quickly, so I don't worry about it.
So this morning my prebolus time was just 26 mins and probably should have been slightly less considering how close I was to the red line, whereas it is usually about 45 mins, so yes, the timings change day to day but I make sure that I prepare my breakfast first so that it is there ready to eat when my levels start to drop and I drink my coffee and catch up with the news whilst I wait for my insulin to kick in. Your body is clearly more sensitive to insulin so this system may well not work for you and maybe this is why you are timing how fast your food digests ie. approaching it from the other perspective, but you have to accept that there will be variation from day to day and 10-15 mins difference should not be a big deal and factor that into your strategy. Bodies are not consistent and they don't provide uniform results, so you have to allow for that variation. Keeping your BG mostly between 4 and 10 should allow for that variation.

My gut feeling is that you may be trying too hard to "Control" it rather than "herding" your levels which is much less precise but gets you there with a few wobbles either side of the direct route. Not sure if that makes sense to you. I come from a farming background. 🙄

 

[gillrogers]

If I did that with Fiasp when my BG is in the 4s, I would hypo immediately. It can work faster than I can digest food ... even dextrose.
Your advice is great for the "older" fast acting insulins like NovoRapid but definitely a bad idea for Fiasp and maybe Lymujev.

@gillrogers I am not familiar with Lymujev but wonder if it works similar for you to the way Fiasp does with me. Have you looked at your BG before eating to see if it affects the speed the insulin works?

That’s the problem. It seems as though doing my touch toes on day I’m not active at the hall has made me more sensitive to the speedy additive in the lyumjev that kicks starts it. In theory with lyumjev I should not have to prebolus at all and didn’t last summer but as the winter went on I found I was having to. But now we are out of winter I suddenly found myself dropping fast straight after injecting on the prebolus. So went back to injecting and eating straight away. That was ok until I had a really busy weekend and found that I was needing to bolus after eating. It’s that speedy additive in the lispro lyumjev. I did wonder if I’d got a faulty batch with a bit too much additive in. But when I checked I found I started this drop back before I opened the new box and new vial.

 

[gillrogers]

My gut feeling is that you may be trying too hard to "Control" it rather than "herding" your levels which is much less precise but gets you there with a few wobbles either side of the direct route. Not sure if that makes sense to you. I come from a farming background. 🙄

I think your right. In fact I know you’re right.

Suggah surfing ! Like that! Made me chuckle!
I wrote my post late last night. Totally down and fed up with these problems one after the other. It doesn’t help with my basal changing too regularly in response to my sporadic activity changes.
And just had the most stupid response from a dsn on my query. She replied like I had asked to have two different types of bolus for different levels of activity which wasn’t what I’d asked for! I had asked to go back to ordinary lispro ‍♀️

 

[rebrascora]

My basal needs change on an almost daily (well mostly nightly) basis too. Some nights I get to injection time and feel like I should be tossing a coin to decide how much to inject. The half unit pen helps and I usually split the difference if I can't decide. It also helps that I am now much more chilled about getting it wrong and if you don't worry about getting it wrong it usually goes right.
My daytime dose is larger and my daytime needs are usually more stable, so I find it is much less critical, plus I can correct with carbs or insulin during the day easily enough.
Frustrated for you that your nurse didn't understand your request to change back. I assume Lispro has been removed from your repeat prescription list and you don't have any left. You may find it challenging going back to it now after being on the Lyumjev for a while. Is there any problem sticking with it and just injecting during or after eating rather than before for the time being, especially if your routine is likely to change again towards the autumn/winter when the Lyumjev was helpful.

 

[Lucyr]

But now we are out of winter I suddenly found myself dropping fast straight after injecting on the prebolus. So went back to injecting and eating straight away. That was ok until I had a really busy weekend and found that I was needing to bolus after eating.

Could you clarify whether you are having hypos at mealtimes or whether the hypos are a couple of hours later.

 

[gillrogers]

You may find it challenging going back to it now after being on the Lyumjev for a while. Is there any problem sticking with it and just injecting during or after eating rather than before for the time being, especially if your routine is likely to change again towards the autumn/winter when the Lyumjev was helpful.

Actually you’ve got a point there that I didn’t think of. You got me thinking now that it might be better to stay put then and see if I can work it out again.

 

[gillrogers]

Could you clarify whether you are having hypos at mealtimes or whether the hypos are a couple of hours later.

Sorry Lucy. Managed to stave of the hypos because of noticing what was happening but I started a fast drop and kept going for a good half and hour straight after injecting and it happened at the next meal time and the next day. DSN said it was the prebolusing. Since I’ve stopped prebolusing that’s stopped happening.

 

[Lucyr]

Sorry Lucy. Managed to stave of the hypos because of noticing what was happening but I started a fast drop and kept going for a good half and hour straight after injecting and it happened at the next meal time and the next day. DSN said it was the prebolusing. Since I’ve stopped prebolusing that’s stopped happening.

So, bolusing immediately before eating has got rid of the potential hypos that’s good. And the current concern is that your bg goes up after meals?

Sorry if I’m repeating things you’ve already said just getting a bit mixed up and trying to understand what your current main problem is.

 

[gillrogers]

So, bolusing immediately before eating has got rid of the potential hypos that’s good. And the current concern is that your bg goes up after meals?

Sorry if I’m repeating things you’ve already said just getting a bit mixed up and trying to understand what your current main problem is.

Thats ok lucy. Sorry ive been a tad busy. Yes thats right. But thankfully my spukes havent been the 16 and higher that i wad expecting. Im sliwly working out new timings