Hypos

[mum2westiesGill]

I'm currently having lots of hypos ie on waking, during the day/evening, during the night.

Things I've changed and when:
1 - BI dose decreased/Tuesday 20/11/2012 - on advice from my DSN
2. - Evening meal ratio changed from 1:10 to 1.5:10 - ditto

Would it be too many changes if I also started to take my Humalog right after eating a meal?
I normally take it 15 mins before to let it start working then just on the very odd occasion have taken it after.

Read this in the leaflet
"Humalog is a rapid-acting insulin. Take Humalog within fifteen minutes before eating or right after eating a meal".

 

[Copepod]

The best time to take a short acting insulin, in relation to eating, depends a bit on what you eat - for high fat meals, it makes more sense to take after eating, as the fat will delay the time taken for carbohydrate to be digested and enter your blood stream to be dealt with by insulin, while for fat free meals, taking before eating - in case of Humalog, anything from 15 mins to immediately before eating.

So, it might be worth adjusting when you take your Humalog, depending pn what you eat, rather than a blanket change from 15 mins before to after eating all meals.

 

[bev]

The best time to take a short acting insulin, in relation to eating, depends a bit on what you eat - for high fat meals, it makes more sense to take after eating, as the fat will delay the time taken for carbohydrate to be digested and enter your blood stream to be dealt with by insulin, while for fat free meals, taking before eating - in case of Humalog, anything from 15 mins to immediately before eating.

So, it might be worth adjusting when you take your Humalog, depending pn what you eat, rather than a blanket change from 15 mins before to after eating all meals.

Hi Copepod,

Sorry but that advice is a little outdated now. Gary Schnieder (think like a pancreas) makes it clear that unless you bolus at least 20 to 25 minutes before eating then you are not giving the insulin time to start working on the foods. Whether it is fatty food or not - the carbs in the fatty food will start to be released within 2 minutes and the insulin has to be there ready to start working. We recently attended a conference where he gave many talks and this was the overriding message that he wanted us all to take away with us. It makes no difference whether you are an adult or a child -'fast-acting' insulin just isnt that fast!🙂Bev

 

[AlisonF]

I agree with Bev. From looking at my CGM data, if I inject with/after a meal, no matter what that meal is, I will see a far greater rise than if I inject 15mins or more before. The only time I'd inject with/after the meal is if I was low before eating.

It sounds like the hypos aren't just after your evening meal, in which case it's more likely the issues are caused by your basal adjustment, assuming you haven't adjusted your carb ratio at other times of day too.

For next time, personally I'd have changed either the basal or the bolus ratio first, given it a few days to see the impact and then changed the other one if necessary. That way you have a better idea of which change is causing the hypos.

 

[bev]

I agree with Bev. From looking at my CGM data, if I inject with/after a meal, no matter what that meal is, I will see a far greater rise than if I inject 15mins or more before. The only time I'd inject with/after the meal is if I was low before eating.

Hi Alison,

I was also worried about this (as were many other parents!) and we asked GS what to do if either hypo or hovering around 4ish and he said just to treat the low and still inject/bolus - it will have no effect on the low as it takes so long to start working. We didnt quite believe him but quite a few have tried it and it works fine! You still test after 15 minutes - but its fine to bolus before then. Alex bolused 25 minutes before eating the other day but forgot to eat and it was only when it had been 50 minutes did he remember and he was fine - still at his pre-meal level 50 minutes earlier.😱🙂Bev

 

[Copepod]

I have heard the new views about always injecting before a meal, but that does assume you know that food will arrive on time / you won't be required to work in the waiting period / not be burned before you eat it / you won't be evicted into street by a fire alarm etc - all of which would have caught me out if I always injected Humalog 15 - 20 mins before a meal.

 

[AlisonF]

I'd agree with that Bev. I should have been clearer. If I was properly low I'd treat, but if I'm around a 4 and can see from the CGM that I'm trending downwards I just delay the injection, because for me if I do it in advance of the meal in that case I'd end up low.

Copepod - sadly most of the time I have to prepare my own food so I know when it's going to arrive, and I just have to apply some discipline about actually eating it when it's ready. In all these year's it's rare that I've been caught out. If we're in a restaurant I tend to bolus for half the food before it arrives and then do the other half once it's in front of me and I know its edible.

 

[mum2westiesGill]

Thank you for your replies so far.

One more change I've made is to bring my BI/lantus to an earlier time so rather than taking it at 11:00pm I'll be taking it earlier in the evening. I'm doing this by one hour each night until I get to the time I want.
No more changes though now for a few days.

The worst hypos have been if I've woken early or in the early hours, especially if it's had to be an assisted one with my hubby ie the whole of my body is twitching and jerking = not very pleasant at all 😡 !!!

I'm wondering also if a bit of supper ie a sandwich (with lots & lots of jam 😱 lol) might be an answer to get me right through the night.

 

[bev]

I have heard the new views about always injecting before a meal, but that does assume you know that food will arrive on time / you won't be required to work in the waiting period / not be burned before you eat it / you won't be evicted into street by a fire alarm etc - all of which would have caught me out if I always injected Humalog 15 - 20 mins before a meal.

Hi Copepod,

Of course it is your choice to inject whenever you feel it is appropriate - no problem with that at all.🙂It was just the advice you gave about fatty foods and it not hitting the bloodstream - that is incorrect. The food that is being eaten is irrelevant in terms of how soon before eating you bolus for it. The difference for fatty and non-fatty foods are that you can (on a pump anyway) spread the insulin over a period of time as the fat does delay digestion and can be spread over anything from 1 hour to 8 hours. Most good teams now advise people to bolus well before eating to avoid the post-meal spikes. Yes - there can be interruptions to eating - but they are so rare that the health benefits in terms of post-meal spikes outweigh these 'risks'. Alex always carries glucose of some sort with him in his bag so if there was a delay he wouldnt be stuck. You would be very unlucky to experience your examples very often!😱Bev

 

[bev]

Thank you for your replies so far.

One more change I've made is to bring my BI/lantus to an earlier time so rather than taking it at 11:00pm I'll be taking it earlier in the evening. I'm doing this by one hour each night until I get to the time I want.
No more changes though now for a few days.

The worst hypos have been if I've woken early or in the early hours, especially if it's had to be an assisted one with my hubby ie the whole of my body is twitching and jerking = not very pleasant at all 😡 !!!

I'm wondering also if a bit of supper ie a sandwich (with lots & lots of jam 😱 lol) might be an answer to get me right through the night.

Hi Gill,

What would be the point of eating to keep levels from dropping overnight when it would be easier to reduce you Lantus? I will ask you again as you havent replied to my two requests previously. Does your clinic use CGM's?🙂Bev

 

[pgcity]

That's a big change in your bolus ratio. For 50g of carbs you used to take 5units and now you would take 7.5. That's 2.5 extra units. I would be hypo taking that much more.
Have you tried 1.1:10? It makes the maths harder but you can increase it slowly until you get it right.
Do you have different ratios throughout the day? Mine are very different

 

[mum2westiesGill]

That's a big change in your bolus ratio. For 50g of carbs you used to take 5units and now you would take 7.5. That's 2.5 extra units. I would be hypo taking that much more.
Have you tried 1.1:10? It makes the maths harder but you can increase it slowly until you get it right.
Do you have different ratios throughout the day? Mine are very different

My ratios are:
Bfast - 1:10
Lunch - 1:10
Dinnr - 1.5:10 - my DSN said to put my bolus ratio up a by a couple of units at teatime then reduce my BI??

 

[Austin Mini]

Hi whiskysmum, here is a link to an insulin chart, which I posted some time ago, it may help you see when your insulin starts and how long it will last for before it comes in effective. I hope it helps you plan your injections.
http://127.0.0.1:4664/redir?url=fil...&src=1&schema=8&s=g6xj8-YFpuN39UKj_6yHIJXjjp0

 

[Northerner]

Thank you for your replies so far.

One more change I've made is to bring my BI/lantus to an earlier time so rather than taking it at 11:00pm I'll be taking it earlier in the evening. I'm doing this by one hour each night until I get to the time I want.
No more changes though now for a few days.

The worst hypos have been if I've woken early or in the early hours, especially if it's had to be an assisted one with my hubby ie the whole of my body is twitching and jerking = not very pleasant at all 😡 !!!

I'm wondering also if a bit of supper ie a sandwich (with lots & lots of jam 😱 lol) might be an answer to get me right through the night.

I know they say to only make changes to your lantus every two or three days, but personally, if I was having night hypos or waking to them I would be reducing it each night. This is what I did when I was on lantus - if I had a night hypo or woke in the low 4s I would reduce it again the next night until I was OK.

 

[mum2westiesGill]

Hi Gill,

What would be the point of eating to keep levels from dropping overnight when it would be easier to reduce you Lantus? I will ask you again as you havent replied to my two requests previously. Does your clinic use CGM's?🙂Bev

Hi Bev,

I've reduced my lantus/BI a couple of times and most recently on Tuesday 20/11/2012. I wondered if having supper would help keep my levels up overnight. Re the CGM's, appologies for not replying to your two previous requests, I haven't asked yet but it's on my to ask list next time I see my DSN.

 

[mum2westiesGill]

I know they say to only make changes to your lantus every two or three days, but personally, if I was having night hypos or waking to them I would be reducing it each night. This is what I did when I was on lantus - if I had a night hypo or woke in the low 4s I would reduce it again the next night until I was OK.

So looking at my diary for this week
I had a hypo on Monday am - so when you were on lantus you'd have reduced it on Monday pm
I had a hypo on Tuesday am - so when you were on lantus you'd have reduced it on Tuesday pm
ditto for Wednesday - ditto
ditto for Thursday - ditto.........
then if you were ok one morning you'd leave it alone?

 

[Northerner]

So looking at my diary for this week
I had a hypo on Monday am - so when you were on lantus you'd have reduced it on Monday pm
I had a hypo on Tuesday am - so when you were on lantus you'd have reduced it on Tuesday pm
ditto for Wednesday - ditto
ditto for Thursday - ditto.........
then if you were ok one morning you'd leave it alone?

Yes, that's what I did. My feeling was that it was better to keep reducing and try and minimise the dangers of night hypos, especially since I live alone. If, on the other hand, I was getting highs in the night or waking, I'd probably only make the changes once every couple of days, since waking a bit high is far less dangerous than dropping low 🙂

 

[mum2westiesGill]

Yes, that's what I did. My feeling was that it was better to keep reducing and try and minimise the dangers of night hypos, especially since I live alone. If, on the other hand, I was getting highs in the night or waking, I'd probably only make the changes once every couple of days, since waking a bit high is far less dangerous than dropping low 🙂

What amount did you reduce it by ie 2u, 4u, 6u? And was it the same amount for highs but obviously increasing it?

 

[Northerner]

What amount did you reduce it by ie 2u, 4u, 6u? And was it the same amount for highs but obviously increasing it?

Originally I only had a 2-unit pen so it had to be 2, but then changed to a pen that allowed single unit changes (very important when you start needing only 5 units, as I did). Obviously, if you are on a large dose it might be better to think in terms of percentage changes e.g. on 40 units, 4 units would represent a 10% change, but on 10 units, 4 unit changes would represent 40%.

 

[mum2westiesGill]

Thank you 🙂