Insulin dosage

[paul.johnson]

Hi, havent been on here for ages and ages,
Just a query ??? I keep hearing about insulin corrections for spikes and the likes of,But ? Can you for instance... Have an extra injection of Novorapid at night as i get hungry sometimes at work
I work permanent nights doing 12 hr shifts now
I have been keeping my injections to a normal daytime routine i.e.Breakfast/Lunch/Dinner so as to keep some sort of normality with family,which has not caused a problem,but now im on 12 hr shifts,i get hungry during the night,So was wondering if i could eat something during the night and have a bit of Novorapid ( i know this means an extra injection,but i like food..lol )
Any body else out there who works a night shift and would like to share there regimes ????
thanks

 

[Northerner]

Hi Paul, the answer to your question would be yes! The great beauty of being on a fast and slow acting insulin is that you can choose when to eat and inject for each time you wish to eat. The main thing to bear in mind is that you don't want to 'stack' the insulin if at all possible as things can become more difficult to manage. By this I mean that if possible you should avoid injecting more insulin within 4-5 hours of your last dose as this will mean that you still have insulin 'circulating' from your previous injection and so it is more difficult to estimate how much you need to cover the food you are about to eat. If you do wish to eat again less then 4-5 hours then you need to make a judgement and reduce your new dose accordingly. The easiest solution (although not the easiest thing to acquire!) would be an insulin pump 🙂

Do you carb count?

 

[Copepod]

Definitely, eat when you're hungry / it's convenient etc and inject to match the carbohydrate intake and other aspects eg activity, temperature etc.

I no longer work regular shifts, but several times a year, I marshal on adventure races, mountain marathons and triathlons, which usually mean irregular patterns of being awake / asleep, activity, food etc. Sometimes I have to be awake for long periods when I'd usually be asleep, or at other times, I basically sleep (in tent / bivvy bag / car / shed), but know I'll be woken severla times through the night as teams pass by. So, I find basal bolus / MDI insulin regime is ideal. It still feels a bit odd to have "breakfast" before my morning long acting jab, or an extra meal during the night, but it's fine. If your night shifts are as cold / wet / active / interspersed by long periods of boredom as mine, I'm not surprised you get hungry through the night! For a snack of below approx 10g carbohydrate (varies for person to person), you might find that fills you up, but that you don't need insulin with it. To avoid weight gain, you might want to have slightly smaller portions at your family meals. As you're on permanent nights, I'd be a bit concerned that you're not getting enough sleep, so you might want to consider sleeping through some midday meals.

 

[FM001]

My job before my last one meant working nights every other week, always ate during the night so I could function properly as it's a long time from evening meal to breakfast. I would take my break at 2am which allowed sufficient time between that dose to lapse before my breakfast dose at 7am, what I found was that I was more sensitive to insulin during the night so would inject considerably less than what I was injecting during the day, may not be the case with you but worth testing regularly just to see.

 

[paul.johnson]

Many thanks for replies..
As i work a 4 on 4 off shift pattern now. 12hrs
I take my long acting ( Lantis ) at midday, 32 Units and my readings are around 7 or below next midday
Novorapid 6 units @ 7am = 6 ish before lunch
Novorapid 6 units @ 1pm = 5 ish before Tea
Novorapid 12 units @6pm = 9 ish before 10pm
These are on working days
So as long as i give myself 5 hrs minimum after my last injection at tea and 5 hrs before my breakfast i could have a roll or something,after calculating the carbohydrates i would eat ?
i dont want to inject more times but it would only be a couple of nights a week,as im not hungry all the time,but sometimes i am more active,workwise than other nights
perhaps this would stop the guilt i feel sometimes,when i have a roll or pie during the night without monitoring,i just say sod it and have one.lol

 

[Phil65]

Many thanks for replies..
As i work a 4 on 4 off shift pattern now. 12hrs
I take my long acting ( Lantis ) at midday, 32 Units and my readings are around 7 or below next midday
Novorapid 6 units @ 7am = 6 ish before lunch
Novorapid 6 units @ 1pm = 5 ish before Tea
Novorapid 12 units @6pm = 9 ish before 10pm
These are on working days
So as long as i give myself 5 hrs minimum after my last injection at tea and 5 hrs before my breakfast i could have a roll or something,after calculating the carbohydrates i would eat ?
i dont want to inject more times but it would only be a couple of nights a week,as im not hungry all the time,but sometimes i am more active,workwise than other nights
perhaps this would stop the guilt i feel sometimes,when i have a roll or pie during the night without monitoring,i just say sod it and have one.lol

Hi Paul,

The beauty about MDI is you can eat whenever and whatever you want as long as you balance your insulin and exercise with what you eat. It sounds like that you have been told to take x amount of insulin at certain times of the day, if you carb count and know your insulin/carb ratios you should be able to change this with no problem at all. It makes no sense to have the same amounts of insulin at breakfast,lunch and dinner on a daily basis....the only way you would get good control on this regime would be to be on a very boring and strict diet!!

 

[Northerner]

...
So as long as i give myself 5 hrs minimum after my last injection at tea and 5 hrs before my breakfast i could have a roll or something,after calculating the carbohydrates i would eat ?
...

Yes, that is exactly what I would do Paul. As Copepod says you might have to do a bit of testing to find out the correct amount of novorapid you need for the snack as your ratio of insulin to carbs may be slightly different at that time of night, especially if you need the snack because you are more active. By leaving a 5 hour gap between injections there will be no overlapping of doses 🙂

 

[paul.johnson]

That sounds excellent,shall trial when i go back to work,This could make things so much easier..
One final question on this topic
If i didnt want breakfast when i get home at 6 am and my Blood reading was between 6 - 8 could i miss injecting my morning injection completely,or is that pushing it too extremes ?????

 

[Northerner]

That sounds excellent,shall trial when i go back to work,This could make things so much easier..
One final question on this topic
If i didnt want breakfast when i get home at 6 am and my Blood reading was between 6 - 8 could i miss injecting my morning injection completely,or is that pushing it too extremes ?????

Yes, the beauty of using fast and slow insulins is that you only need to inject the fast novorapid when you want to eat - if you don't want to eat, you don;t inject 🙂 You must always take your lantus though.

 

[Copepod]

Paul - glad the advice given makes sense to you and will make your life easier when you return to work, with a bit of tweaking to get it right for you.

I've sometimes omitted "breakfast" food & insulin at the end of a night shift, with no ill effects, but rarely, as I'm, usually hungry, as my night shifts tend to be cold and active. 6 - 9mmol/l is a safe level for going to sleep, with the proviso that you haven't just cycled / hiked / kayaked a long distance or just unloaded a van / trailer full of bikes / kit bags / kayaks - might not apply to you, of course, but sometimes it applies to me.

 

[trophywench]

The easiest solution (although not the easiest thing to acquire!) would be an insulin pump 🙂

Do you carb count?

Assuming that you DO carb count there is a far far cheaper answer, which ought to be a lot more available to you than a pump.

What you need if you want or need to snack closer to a mealtime than 4 or 5 hours, is what is termed a 'Bolus wizard' which is a feature of pumps. You test your blood, and tell the wizard the answer, and also tell is how many grams of carbs. It already knows what insulin you have in you and when you had it - so it works out the dose for your sback making an allowance for 'bolus on board'.

Yeah brilliant I hear you say, how do I get one of them? Ask your DSN is the answer !!!

There are 2 meters on the market that have this capability - the Roche Accu-Chek Expert and the Abbott Freestyle Insulinx. Because they need setting up to all your own tolerances, ratios, timeblocks etc and if you aren't used to these questions and programing em in to a pump, you might land up a bit baffled at first, they are only available via a DSN who will go through it all and help you set it up - as far as I know. (Friend in Cornwall has just got the latter yesterday - had to do a session where there were 6 of them getting the thing)

The Expert has been around a while now but the Insulinx is fairly new.

 

[Copepod]

Agree with Trophywench - there are cheaper and less hassle options than an insulin pump. Only if these don't give acceptable results, should a pump be considered. For a typical night shift with predictable activity patterns and regular hours, bolus wizard would be ideal.

Personally, I use my brain, as it's easier for me than expecting a machine to understand cold nights awake in a tent or waking at irregular times through a cold night, interspersed with bursts of action to rapidly unload vans, trailers etc, give medical aid etc.

 

[paul.johnson]

This sounds very good,thanks for all of your advice,😱
My brain is racing around .lol
Does any one know about the Lantis effects i.e. Does it have peaks and troughs,is it stronger at lowering blood sugar at the beginning or end of its 12 hr cycle.
Being told from the beginning,diagnosed 86,I had two injections mixed and told 3 meals a day.
move onto human insulin and told 4 injections a day,3 meals a day,seems like i missed the point of acting rapid insulin,was only told i dont have to wait 30 mins before i eat after injecting
thanks again for all your help

 

[novorapidboi26]

Lantus and Levemir are virtually peak-less......................but I would assume it would be most effective in the middle, but maybe not...........

 

[Copepod]

Profiles of Lantus and Levemir activity here: http://www.diabetes-support.org.uk/info/?page_id=408 Some people find that splitting long acting dose helps - with experimentation to find the best ratio (eg 50:50 / 30:70 etc) and time spaces.

Humalin I is another long acting insulin, less used these days, but about half the cost and it suits me well, as I find 2 long acting injections in each 24 hours easier to fit into my life.

 

[Northerner]

...
Being told from the beginning,diagnosed 86,I had two injections mixed and told 3 meals a day.
move onto human insulin and told 4 injections a day,3 meals a day,seems like i missed the point of acting rapid insulin,was only told i dont have to wait 30 mins before i eat after injecting
thanks again for all your help

Paul, you really should have been given more education about how to use your lantus and novorapid for greater flexibility. I would suggest asking your diabetes nurse about courses that are available to you - DAFNE and BERTIE are the two best known, but there may be something different in your area. We've had quite a few members in your position who have been moved from 2 injections to 4 but never given the proper education, mayb e partly because they assume you already know everything. I think you would gain a great deal from going on a course 🙂

 

[FM001]

That sounds excellent,shall trial when i go back to work,This could make things so much easier..
One final question on this topic
If i didnt want breakfast when i get home at 6 am and my Blood reading was between 6 - 8 could i miss injecting my morning injection completely,or is that pushing it too extremes ?????

My own experience was that if I didn't eat breakfast and went to bed until lunch or later then I would wake with my bg in the teens, fasting from say 2am when I last ate to lunchtime tricked my body into thinking I was fasting so I would experience a liver dump during my sleep, by eating breakfast I would find I could avoid the hypers altogether.

May not be the same with you just thought I'd offer my own experience of working nights.