Insulin absorption query

[gillrogers]

So when I started this journey I had high resistance and ended up on lyumjev. High resistance would have been down to miss diagnosis of type 2 for 8 years and huge stress levels.

Been on multiple injections now for just over 3 years. Have been able to ditch the lyumjev as have nothing like the resistance I used to have. Moved back to Humalog. Now finding im injecting through my meal and it’s getting further and further. Lunch I’m injecting 15 minutes after eating! When the weather gets warmer I will be injecting further away from the start of my meal as I absorb it quicker when hot.

Am I right in thinking I’m absorbing it too quickly? If I get up an move around before an hour to an hour and a half I’ll start a fast drop down. And it can be as much as 3 mmol in 15-20 minutes. That’s ok if I’ve started out of range and get to 16ish before that starts, then I have to sit down for 30 mins or so to stop it. My point being if this happens when I’m in range I’m heading to a hypo before it starts coming back up. Therefore movement is adding to the speed of my absorption.

So DSN have agreed im.sensitive to insulin when I get moving and i dont mean excersise, i mean simple things like washing up the dishes will set it going.

DSN keeps telling me to bolus 10-15 minutes before eating. But at the moment unless i start peaking higher than 4mmol from where i started im very reluctant to. So as every day im reducing my bolus time by 1-2 minutes and im only peaking by 4 -5 mmol and i keep doing that then this is suggesting my resistance is still dropping. Even with bolus hiccups where i loose about half an mmol im still not peakng the big highs as expected.

DSN still saying i dont have a prpboem. Am i being stupid? I need to know my thinking is going in the right direction.

 

[helli]

Where did you get the idea of needing to peak at least 4mmol/l after eating?
Given someone without diabetes has a BG that ranges between 4 and 7 mmol/l and some food will be digested slower, I aim to keep my peaks less than 4mmol/l. (I rarely achieve this but it is my goal when timing my bolus with respect to food.)
This can mean that my BG will reduce after injecting but that is not a concern when I know I have carbs on board which will raise it.

Looking at it a different way, are your carbs being digested "too slowly"? Has your digestion been investigated?

 

[gillrogers]

No one has told me about need ing a peak of 4mmol. Over the last year or two it seems to be that's where i need to be before i start moving about . If i start moving about sooner i will get that drop.

This mirning ive cut my bolus timing back again by two minutes again and ive peaked at just over 14.

Nurses dont think im digesting too slowly , ive always started rising 20 mins after eating and still do. Ive not had my digestion investigated as i dont have any odd digestion symptoms like wind or indegestion. And everything else in that department is working properly. ‍♀️. My lunch and tea time ratios have dropped but they do at this time of year. But my breakfast one hasnt yet.

 

[gillrogers]

So dsn has now come bqck saying i can try Humalin S with my humalog! How does that work? Shes given me no indication how it works other than its slower. Ive looked it up and i remeber either Inka or Helli saying about it. DSN hasnt given me any transitional information as looking at it there would need to be a significant change to bolus ratiosvas it lasts 12 hours and i could probably drop the basal. Anyways ive asked her and hopefully shell come back with something that makes sense.

 

[helli]

It was not me but I see that Humulin S is a fast acting insulin so I would expect it just to replace your NovoRapid.
Whenever I have changed bolus insulins, the dose has remained the same and only the timing has changed.
You will still need your basal

 

[gillrogers]

It was not me but I see that Humulin S is a fast acting insulin so I would expect it just to replace your NovoRapid.
Whenever I have changed bolus insulins, the dose has remained the same and only the timing has changed.
You will still need your basal

This will be differant according to the Lilly insulin portfolio. Its lasts 12 hours if im reading the graph right. I hope im reading it wrong lol. The lispro/humalog lasts 5 hours in me (6 according to the graph) . It was like for like with lyumjev and lispro/humalog.

 

[Lucyr]

If I get up a move around before an hour to an hour and a half I’ll start a fast drop down. And it can be as much as 3 mmol in 15-20 minutes. That’s ok if I’ve started out of range and get to 16ish before that starts, then I have to sit down for 30 mins or so to stop it. My point being if this happens when I’m in range I’m heading to a hypo before it starts coming back up.

I still think your problem is not with your blood sugars but rather an anxiety problem with it all. The previous graphs you showed were nowhere near hypo, and having a fast drop from 16 is a good thing not a concern.

Ideally you should do more of this type of activity when high if you’re finding that you can get bgs down quicker that way, to then start your meals at a more normal bg without needing to correct as much.

 

[gillrogers]

I still think your problem is not with your blood sugars but rather an anxiety problem with it all. The previous graphs you showed were nowhere near hypo, and having a fast drop from 16 is a good thing not a concern.

Hi Lucy, this has nothing to do with my fear. This is an absorption problem. DSN' s are finally seeing it at last. Ive asked them to forget the high numbers and look at the trace. This started last year when iwas starting in the green with the lyumjev and still does wether theres a correction on board or not. In the end they agreed the lyumjev was too fast. I was absorbing it too quickly. So i went back to lispro/humalog. Same thing is happening only this time im more clued up on what im seeing. Yes my fear is stopping me from getting back in the green and while im still on insulin that im absorbing too quickly then thats not going to help. Forget my fear, the fact is that my bolus timing has reduced from 16 minutes prebolus to 2 minutes so far after I’ve started my meal and I’m not getting a higher peak for breakfast and bolusing lunch 15 minutes after I’ve eaten with no high peak. So my absorption is changing.

 

[Inka]

@gillrogers I can’t remember if I mentioned this before, but you could try a regular human insulin. They’re slower and less ‘fierce’ so you might find that reassuring.

 

[gillrogers]

@gillrogers I can’t remember if I mentioned this before, but you could try a regular human insulin. They’re slower and less ‘fierce’ so you might find that reassuring.

Theyve suggested i try humalin s. Im waiting to hear back on how to transition to it as looking at its profile each dose will still be around for my next meal ad it lasts 12 hours as apposed to the humalog lasting 5 hours on me.

 

[Inka]

It doesn’t last 12 hours @gillrogers You’ll probably find it’s more like 5 and then peters out at very low levels. Do you react to the Humalog exactly as the profile shows? No, andi think you should give Humulin S a try. It’s not hard to transition to at all 🙂

 

[gillrogers]

It doesn’t last 12 hours @gillrogers You’ll probably find it’s more like 5 and then peters out at very low levels. Do you react to the Humalog exactly as the profile shows? No, andi think you should give Humulin S a try. It’s not hard to transition to at all 🙂

No i know that but im just currently reacting faster than to humalog for the first hour and a half.

 

[gillrogers]

Now what! They won’t give me the humalog, or should I say can’t as we can’t get it with half doses. They’re now suggesting Novorapid. Thought the idea was to get me on a slower insulin not put me on another fast one. ‍♀️‍♀️

 

[helli]

@gillrogers you have been on my mind recently and I am worried about you.
I had a different thought from those mentioned previously.
I know you are anxious about hypos and have been keeping your BG higher to avoid them.
What occurred to me over the weekend is that, when my BG is higher insulin response time is less predictable. Sometimes it can react very fast and some times it can be slower - it seems to be a lottery about which way it will go.
Therefore, I wonder whether slowly reducing your BG (I think @Inka suggested reducing your target to 9 mmol/l and then if you are comfortable with that reducing it a little more), may help with your insulin sensitivity and reaction time.
This will also reduce the risk of longer term complications.

 

[gillrogers]

@gillrogers you have been on my mind recently and I am worried about you.
I had a different thought from those mentioned previously.
I know you are anxious about hypos and have been keeping your BG higher to avoid them.
What occurred to me over the weekend is that, when my BG is higher insulin response time is less predictable. Sometimes it can react very fast and some times it can be slower - it seems to be a lottery about which way it will go.
Therefore, I wonder whether slowly reducing your BG (I think @Inka suggested reducing your target to 9 mmol/l and then if you are comfortable with that reducing it a little more), may help with your insulin sensitivity and reaction time.
This will also reduce the risk of longer term complications.

Aww bless you Helli Yes thats what we are doing. Going slowly. So my aim is for 9 mmol as oppsed to 7/8 and just these last few days im actually getting there more often. That is also docs plan and dsns. Just taking ages for appointments to work out a proper plan of action but in the meantime this is what im doing. Had my first individual therapy session this morning and it seems its not just my thoughts on my diabetes thats influencing my approach to it but also some long term stuff going back to childhood which in a way doesnt surprise me.

 

[Inka]

@gillrogers you have been on my mind recently and I am worried about you.
I had a different thought from those mentioned previously.
I know you are anxious about hypos and have been keeping your BG higher to avoid them.
What occurred to me over the weekend is that, when my BG is higher insulin response time is less predictable. Sometimes it can react very fast and some times it can be slower - it seems to be a lottery about which way it will go.
Therefore, I wonder whether slowly reducing your BG (I think @Inka suggested reducing your target to 9 mmol/l and then if you are comfortable with that reducing it a little more), may help with your insulin sensitivity and reaction time.
This will also reduce the risk of longer term complications.

Yes, it was me @helli I thought ever so slowly reducing numbers would help:

Rather than that, I suggest you gradually lower the number you’re happier at. If you’re happy in the 9s, then try to lower your ‘I’m ok’ level to the 8s. Do this gradually.
Then lower it to the 7s, etc. You should gradually feel less anxious at these levels. It takes time but it usually improves things.

 

[gillrogers]

So yesterday as i was writing my last comment and then getting my lunch i did a dive down to 7 .6. so went passed my target by almost 1.5 mmol, thats a half correction unit. The speed indicated was indicating to me my basal had dropped. Its been trying to do this on and off for a few days. So as i was bolusing after eating and by now 22 minutes after i just keept my eye and gave a half unit less insulin. That was ok untill 2 hours later i was back to 9 with a down arrow while sitting doing paperwork with 3 hours still to go. So yup the basal has dropped and hopefully will stay dropped this time. It usually does this time of year and then again in very hot weather.