Is there anything slower than Humalog?

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I’m not obsessed, I’m worried about what is going on. I’ve gone from having high resistance and needing to bolus well in advance with lyumjev up until beginning of September. Then back to humlog because the lyumjev speed was too much as my resistance had lowered. Then up until last week I was still trying to find my new bolus timings using the humalog and battling with an ever changing basal level due to my sensitivity to weather pressure changes, flu and Covid jabs, and stress. Then out of the blue in just over a week my peaks of 16 - 18 mmol suddenly drop to 11 - 13 mmol . Now if I continued to bolus at the times I was now I’m likely to be be almost if not hypoing because every time my insulin kicks in with not enough peak I just plummet within 20 minutes and it never stops until I’ve had some glucose. Something must have caused a sudden change in resistance and the resistance is still becoming lower every day. I plummet too fast for the libre to keep up with and it misses the alarms. I also take 20 plus minutes for food or glucose to kick in. I can’t get anyone to understand what is happening. I keep being spouted by dbn nurses that the manufacturer says take your insulin 15 minutes or more before food. It isn’t working that way for me by a long shot. Not everything is because of my fear of hypos and that seems to be getting in the way of finding out what’s going on with me.
 
I can vary my prebolus timing by 20 mins give or take 5 mins (there is no way I am counting individual minutes) from one day to the next and back again, depending upon a whole host of things.... like if my levels are rising or falling when I inject, if I have been active before or intend to be active afterwards, what type of meal it is and how high or low my BG levels are when I come to inject. For instance at breakfast I normally need about 45mins if I am mid range 5-7 but if I am 8 or higher I will need longer if I am above 10 I might need well over an hour. If I am in the 4s I might need only 20mins. I tend not to watch the clock or time it but watch my Libre to show when the insulin starts to work. On an evening if my levels are in the 4s I can sometimes inject and eat straight away.

You are trying to be too precise and you are worrying too much about levels dropping. Please remember that whatever insulin you inject will be active over 3 hours or more. It won't all hit at once, so that 5 mins or 15 or 20 mins is only part of the activity profile of the insulin, it doesn't all suddenly become active after 5 or 10 mins or whatever, it is just the start of a gradual release just like your food will gradually release glucose.

My gut feeling is that you see a downward arrow on CGM and panic. I had a 4.1 with a vertical downward arrow today when I was up at the stables working and 2 well chewed JBs stopped it, even though I continued to work. Panic is your biggest enemy. If you can't cope with seeing the arrow coming down, do away with your CGM, because it is causing you unnecessary anxiety and just prebolus about 10 mins before meals or whatever the suggested guidance is. People survived for years with just finger pricking, so whilst CGM is fab for fine tuning things, it is not essential to living well with diabetes and I don't think it is doing you any favours, just scaring you!
 
Like you, I have to change my basal doses regularly both up and down, sometimes on an almost daily basis and other times it will be nice and stable on the same doses for
a month or two. I just accept that it needs changing and do it. I have just had 2 nights of high BG levels after weeks of hypos despite reducing my evening Levemir dose down to zero weeks ago. Last night I decided to stick with no evening Levemir (I was tempted to inject a unit of two but resisted) but went to bed with my levels a bit lower on 5.6 instead of 6-7 where I usually try to have it at bedtime, thinking that at least I might end up under 10 instead of 13 when I wake up, but I ended up hypo all night and despite treating the hypos it kept dropping until it leveled out about 3 (according to Libre which might well have been near enough 4 if I had been bothered to finger prick, even though there was no active insulin in my system other than perhaps the very tail end of my morning dose.
Diabetes is tricky. No matter how precise you try to be it will throw your best efforts in your face sometimes. You have to learn to be more relaxed with it, shrug your shoulders and try again the next day or night.
 
I’m not trying to be precise. I was trying to illustrate the huge difference in bolus timing from last week to this week. Like I said I think my fear of hypos is being used as an excuse not to find out why there is such a sudden big change for me. Resistance doesnt just dissappear over night. Im no more active than.usual. nothing has changed other than not quite as stressed as i was a couple of weeks ago but my stress is rebuilding. My meals are the same although my evening meal does change but nothing new. Im now thinking that my digestion has slowed down especially as i seem to be full of wind and have been since this started which i guess could be causing it. It has nothing to do with my fear of hypos. I had a few weeks of getting somewhere to get lower and gained a bit of confidence and have found that its not because of what I'm doing but my body changing quickly for what ever reason.
 
gillrogers said:
Resistance doesnt just dissappear over night.
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Mine does. I’ll have days where I could do loads of corrections and stay high, and days where I can have perfect bgs on tiny doses. Thats just how diabetes works, it’s not something you’ll get drs to investigate.
 
Thanks Lucy. Im still very new to all this and i do think it would help if the nurses would say things your experiences instead of spouting off how it should be as per the manufacturers of the insulin because clearly its not working like that for me. I ring or email them.because something new is happening with a pattern and it's not over one or two days. Comments like that from them to a relative newbie to the game is so unhelpful especially when you're having to learn a new you that worked normally of most you your 50 odd years. Ypu need to know wether something like this has been experienced by others and if so how did they deal with it
 
Just been told theres no mental health help for mr in Gloucestershire NHS .
 
Lucyr said:
Mine does. I’ll have days where I could do loads of corrections and stay high, and days where I can have perfect bgs on tiny doses. Thats just how diabetes works, it’s not something you’ll get drs to investigate.
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Me too.
 
gillrogers said:
Thanks Lucy. Im still very new to all this and i do think it would help if the nurses would say things your experiences instead of spouting off how it should be as per the manufacturers of the insulin because clearly its not working like that for me.
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I totally agree with you there Gill. There is a huge difference between the guidelines and theory and what works in reality but I think a lot of nurses and consultants don't really understand this. My consultant was horrified that I prebolus 45 mins before breakfast with Fiasp (it was 75 mins with NR) as he seemed to think it should just take 10 mins maximum, but he couldn't argue with my Libre graph where I note each morning when I inject and when I eat. Occasionally, I might just need 20 or 30 mins prebolus, but the way I get round that is to inject before I get out of bed and then make my coffee and breakfast so that when my Libre shows the Fiasp kicking in, my breakfast is ready for me to eat it whether that is 20mins or 45mins or somewhere in between. Other meals it is a shorter time, usually 5-20 mins, so less difference, but if levels are dropping too fast before my meal is ready, I just have a JB to slow the drop and then eat my meal when it is ready. Libre will continue to show my levels dropping but experience tells me that the JB will slow it down enough until I eat my food and I might eat the carbs before the protein and veg in that situation.
 
Lucyr said:
I’ll have days where I could do loads of corrections and stay high, and days where I can have perfect bgs on tiny doses. Thats just how diabetes works, it’s not something you’ll get drs to investigate
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Im not asking them to investigate the corrections and staying high. Its the sudden loss of resistance in a week thats still going on but only now seems to be afftecting just lunch and dinner. ‍♀️ If a professional can tell me it happens and how im going to cope with summer as my resistance lessens even more then ill be happy. But none of them will or cant and would rather put it down to my fear. ‍♀️
 
Insulin resistance/sensitivity does change, not just from day to day but morning to lunchtime, let alone summer to winter and of course women have different insulin needs through the phases of their hormonal cycle due to insulin resistance changing and pregnant women experience huge changes and of course it depends on the level your BG is at when you inject..... and of course illness, so if you have a tummy upset, yes that will affect not just yopur rate of digestion but also your insulin resistance. you just have to go with the flow when you can see a trend and be prepared to go back to where you were before when when it shows you things are swinging back the other way.
 
Lucyr said:
Mine does. I’ll have days where I could do loads of corrections and stay high, and days where I can have perfect bgs on tiny doses. Thats just how diabetes works, it’s not something you’ll get drs to investigate.
Click to expand...
Me too. Or to be slightly more accurate I can have periods of 2-4+ hours really low (3.8-4.5), usually after my very standard breakfast and just cautiously have snacks of 5-7 gms carbs trying to nudge myself up a little without getting onto the high low roller coaster; then really quickly I'll go high towards 12+.

Or go high unexpectedly & quickly and then take loads of modest corrections that don't seem to work, keeping me high - then they all decide to arrive and make me fall pretty rapidly.

What I perhaps could also do is be more diligent in mentally noting the prebolus time and thus how much insulin I could possibly have left when I have that final snack that triggers my upward surge ..... then trying to better co-ordinate my activities while keeping better track of my modest corrections. After all the evidence of suddenly going high must be related to too much carbs now in place or of rapid drops must be related to too much insulin on board!!
gillrogers said:
Im not asking them to investigate the corrections and staying high. Its the sudden loss of resistance in a week thats still going on but only now seems to be afftecting just lunch and dinner. ‍♀️ If a professional can tell me it happens and how im going to cope with summer as my resistance lessens even more then ill be happy. But none of them will or cant and would rather put it down to my fear. ‍♀️
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I agree with @Lucyr and @rebrascora it is very much the nature of D that BG behaviour is just not simple. What is soooo much better for me today is that my G7 is very reliable and allows me to see my extended lows or catch sudden falls - which was simply not possible for my 1st yr when I didn't have CGM.

It is still stressful and infuriating. I no longer expect a Professional to fully explain why, we are butall different and there will be loads of other factors that must be causing this - factors that I haven't "twigged" on those days. But, because I still fully record on my G7 app my insulin and meals they can see for themselves that my BG behaviour is erratic from looking at my Dexcom Clarity results (= the equivalent of LibreView).

@gillrogers are you still recording such activities, events and details into your LibreLink notes for onward transmission to the Web based LibreView? That surely would help someone analysing your recorded events to accept its not just your premature fears!

At the end of any one difficult day I take solace from the remarks by Gary Scheiner in his book "Think Like a Pancreas" that Diabetes is "Complicated, Confusing and Contradictory". This alone tells me it is not just my imagination that days can sometimes be troublesome.
 
gillrogers said:
Im not asking them to investigate the corrections and staying high. Its the sudden loss of resistance in a week thats still going on but only now seems to be afftecting just lunch and dinner.
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That’s completely normal though. Diabetes is constantly changing.
 
rebrascora said:
Insulin resistance/sensitivity does change, not just from day to day but morning to lunchtime, let alone summer to winter and of course women have different insulin needs through the phases of their hormonal cycle due to insulin resistance changing and pregnant women experience huge changes and of course it depends on the level your BG is at when you inject..... and of course illness, so if you have a tummy upset, yes that will affect not just yopur rate of digestion but also your insulin resistance. you just have to go with the flow when you can see a trend and be prepared to go back to where you were before when when it shows you things are swinging back the other way.
Click to expand...
Yes i get that. My resistance up until recently has always been more or less the same in thr morning and evening and about half that for lunch time. Ive gone past the mrnopause thing and theres just nothing i know that i csn attribute it to as its not the change i expected. I really expected to be begging for the lyjev back for winter. Even my consultant warned me i probably would need it but its gone completely in the opposite direction and confused me as its not happened like this before. With the lyumjev i knew what it was. It was obvious.

Keep meaning to politely say is not the down arrow. Its the double down arrow that doesnt stop. That was down to the lyumjev straight after injecting when I started becoming sensitive to it.

Anyway @Lucyr and @rebrascora have now settled my mind on whats happening and that its a normal trait of this diabetes. Thank you both.
 
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