Insulin Profile not matching Carb Absorption

[Gareth Davis]

Hi I am Type1 and it is evident that I absorb carbs much quicker than the insulin profile. This leads to my level shooting up and then crashing down every meal. I am on Humalog (the fastest peakiest profile) and have tried offsetting timewise to combat this but to no avail. In effect my levels bounce up and down over the course of the day with Hypers and Hypos regularly. The doctors dont seem to have a solution so does anyone have the same issue so I can compare notes.

I am monitoring Glucose levels with the Libre system so that gives me good data. This effect is most pronounced at breakfast so as a solution I have stopped eating cereal but it still occurs to a lesser extent later in the day.

 

[Kaylz]

how much experimenting have you done with pre bolus timing?

Have you added fat and protein to the meals to try and slow the rate of the carbs?

Are you rotating sites regularly?

Have you tried reducing the amount of carbs in meals and adding other less carby things?
xx

 

[grovesy]

Have they discussed having a pump?

 

[Gareth Davis]

Thanks Kalyz. Yes I have experimented with timing although the earliest has been 20minutes beforehand. I am now having yoghurt for breakfast with a sprinkling of all bran. and I am now reducing the carb intake of other meals and I am rotating sites. However, I was hoping that there was some insulin out there that can act quickly enough. Cheers Gareth

 

[Kaylz]

Thanks Kalyz. Yes I have experimented with timing although the earliest has been 20minutes beforehand. I am now having yoghurt for breakfast with a sprinkling of all bran. and I am now reducing the carb intake of other meals and I am rotating sites. However, I was hoping that there was some insulin out there that can act quickly enough. Cheers Gareth

some find they need up to an hour between injecting and breakfast especially, I'm personally on Novorapid and need 25 minutes for breakfast, Fiasp is an option but not every CCG has it on their list and a few have found it great to begin with but after a couple of months it becomes less and less effective, are you bolus doses correct for sure? or even basal? I think you should fully all the options before looking to switch to a "miracle" insulin xx

 

[Thebearcametoo]

Have they suggested upping your basal or are they happy with your basal dose? Have you been on different fast acting insulin? That would seem like an option to start with if not as different people suit different insulin’s better. Or yes a pump.

 

[SB2015]

If things are not working it would be worth doing a fasting basal rate test. This is done over a number of days fasting over different meals in each day, and seeing if your levels remain constant without any food eaten. It is a hassle to do, but worth it, as you can then adjust that, and THEN focus on checking your carb insulin ratios during the day (mine vary through the day), and your sensitivity for correction doses. There are so many things that can impact on our insulin needs, and it is just a case of working your way through these one at a time.

 

[Matchless]

I have been using fiasp for couple of years and get much fewer spikes when i do they do not last long.

 

[trophywench]

You're the first person I've ever heard of that's stayed on Fiasp I think!

Link to Basal testing advice - https://www.diabetes-support.org.uk/info/?page_id=120

Because pump users only use 'fast acting' insulin in the pump in fact we kind of have to pre-bolus our basal insulin all day and night - but when we need a bit more or less insulin at 11am, unless we make that change at 9am, it won't do the trick. OTOH because the hourly rates are an awful lot less than a bolus for practically anything we eat, it's very gentle.

Questions for you - by how much does each 10g carb increase your BG on your meter? What's your current insulin:carb ratio?

 

[Matchless]

My carb ratio is 10 to1 for breakfast with about 50grams of toast and about 12 to 1 the rest of the day. i take my bolus as i start to eat.which i can see the carbs on the plate .

 

[SB2015]

I only heard of pre-bolusing on here. It was getting the Libre that showed me the size of my post meal spikes.

I gradually moved my Bolus further forward for breakfast and now, depending on my waking BG, is about 30 min before breakfast. It took a bit of trial and improvement. I also avoid all cereals (these are just a bowl of sugar in disguise so will spike because they convert so quickly to glucose).

Lunches at home are dealt with by a 20 min pre-bolus, but if out I wait until I have the food in front of me, and make sure I do something after to reduce the spike.

Evening meal is similar and we have got into a routine of when OH is cooking he gives me my total carbs 30 min before we are due to eat. I test and decide when to inject and how much as we do try to walk for 15 min minimum after a meal. That certainly reduces spikes, and I need to knock out a bit of insulin for that too. (If it is raining lots, I don’t brother to do a reduction!)

I hope that is of some help.

 

[nonethewiser]

Same timings as SB2015, when Mrs cooks get carb count 20 mins before eating.

Play around with prebolus, worth it so dont forgo food you enjoy.

 

[trophywench]

Err - the questions and the post were meant for @Gareth Davis 🙂

 

[rebrascora]

Hi @Gareth Davis

I too get spikes because I digest carbs very quickly and insulin takes far too long to get going. I am one of those that gives my prebolus (NovpoRapid) as much as an hour on a morning (Fiasp is a bit quicker at about 45mins) but even then I combine it with eating low carb food. The time required does also depend on your starting reading. If you are already high, it takes longer.

I am hoping to get Libre soon and I am expecting that will help level things out. I plan to wait until the arrow shows a steep descent before starting to eat on a morning.
At the moment I finger prick to find the point at which my BG is starting to come down and sometimes I leave it too late...
The other morning I was 4.7 on waking. I injected my 3 units of Fiasp and 38mins later I was down to 3.1....Ooops! Instead of treating the hypo, I just ate my ready prepared breakfast of Low carb "Eat Natural" Granola with a few fresh berries, seeds and creamy Greek Yoghurt and it was back up to 4.7 30 mins later. Even if I wake up hypo (which is rare), I inject bolus and then eat breakfast rather than treating the hypo first as I know my breakfast will hit my stomach running long before the bolus starts to kick in. At the moment using finger pricking, I am stabbing in the dark a bit with timing but hoping that the Libre will give me much more clarity on when to start eating.
I think a combination of lower carb meals, more fat and some experimenting to find the best timing of bolus by utilising your Libre to tell you when to eat (as I plan to do) will be the best fit you will get, but sadly there is no miracle insulin that is capable of working as fast as our natural system used to do.

 

[everydayupsanddowns]

Welcome to the forum @Gareth Davis

As has been suggested, you may find Fiasp is faster acting.

Also Apidra (which doesn’t get mentioned so much these days) always had a bit of a reputation for faster action and shorter tail than NovoRapid or Humalog.

But I’d agree with others that you may well gain benefit from experimenting further with dose timings. These can change over time, mine have ranged from 0-60 minute pre-bolus being needed at different meals and at different stages.

Compared to a functioning pancreas we are always slightly limited by administering the wrong insulin, with the wrong profile into the wrong place!

 

[Kaylz]

Also Apidea (which doesn’t get mentioned so much these days) always had a bit of a reputation for faster action and shorter tail than NovoRapid or Humalog

Do you mean Apidra Mike? If so I think @Bloden uses Apidra so may be able to offer an insight into that particular insulin xx

 

[everydayupsanddowns]

Do you mean Apidra Mike? If so I think @Bloden uses Apidra so may be able to offer an insight into that particular insulin xx

Doh! Darned autocorrect 😡

 

[Bloden]

Hello @Gareth Davis.😛 Apidra-user here. 🙂 I’ve been using Apidra from diagnosis, never used anything else, so can’t say if it’s faster than other insulins.

Breakfast is a nightmare for most people/insulins, it seems. I remember spiking like a fool until I found the right breakfast for me - 15g carb only, ratio 1:15, and a 1-hour walk with my dogs. This flattens out the spike. If I really wanted to have a flat profile, I could skip my breakfast coffee - I discovered it’s behind the small spike I do experience - but, no, coffee’s essential first thing!

I don’t have to pre-bolus for lunch. At my evening meal, I actually post-bolus - I jab after eating - otherwise I go hypo immediately after food.

My question: what type of carb do you eat? I try to eat low-GI and low carb at breakfast (15g) and lunch (45-60g) and medium-GI at dinner (35-50g carb). High-GI foods are a no-no.

Good luck!