Libre and spikes: is Novorapid knocking on my door?

[Elenka_HM]

Good evening to all.

It's been roughly a year since my type 1 diagnosis. Time flies! As some of you may know, I've been managing on basal insulin only, with the approval of the diabetes team, and my HbA1c was quite good in August. Pre meal readings were generally in range too. I didn't usually test after meals.

This is my first week using Libre. I love the convenience of scanning anywhere, not worry about washing my hands or get blood when out and about, especially in this cold when fingertips don't cooperate! I check a lot more often, and also have information from in between scans, which I didn't get with finger pricks only. And that is great, but also brings questions...

I'm now testing before and 2 hours after every main meal. I'm usually seeing a rise of 2-3 mmols, which I understand is not unreasonable, and I see it keeps coming down after that. If I walk after the meal, there is barely any difference between pre and post meal reading. But the Libre often shows a spike over 10 (from a starting BG of 5 or 6). The nurse said I should contact them to start introducing bolus insulin if I regularly see levels over 10, but I am not sure if the spikes after a meal count, as they come down so quickly. If I was testing only my blood I wouldn't even know they were happening.

I guess my question is, considering levels are coming down on their own, would novorapid cause me to hypo or just help to make the spike a bit lower? Should I expect to go to 12 or 14 even with correct bolus? I'm aware this numbers won't look so high for more seasoned diabetics, I'm trying to figure out if it's the time to move to proper basal-bolus regime (with professional advice, of course) or it is still normal and don't need to change.

 

[everydayupsanddowns]

I think it’s a conversation to have with your hospital DSN or Consultant really.

It’s quite unusual to start on basal-only as a T1 I think… And I wonder if your basal dose is artificially high and is generally making your BGs trend downwards, rather than holding you level?

I’ll be interested to hear what your clinic says 🙂

 

[Elenka_HM]

Thanks @everydayupsanddowns. I agree it is a conversation to have with the diabetes team, I just wanted to get some opinions in here before writing them an email.

I know starting on basal only is not common, my diabetes was caught early and I was still producing a decent amount of my own insulin. I was also very anxious about needles and the doctor suggested this could help, getting used to injections before working in carb counting and doses. They warned me this could work for a while but eventually would have to take bolus as well.

 

[Inka]

It sounds like you might need a bolus insulin @Elenka_HM It’s hard to say because your basal insulin might be masking your true response to food. Even tiny doses might help you. But I’d be asking about reducing the basal insulin alongside introducing bolus insulin. How much Levemir do you take each day and when?

 

[Eternal422]

I do think you need to speak with your DSN about whether/when to add Novorapid bolus to your regime. From what you say, if your pancreas is still producing some insulin then you may be ok for a while but will definitely need a fast acting insulin at some time.

I am on both Levemir as a basal and Novorapid as a bolus and still see spikes with some meals, for example here is today’s chart so far :


and that is with Novorapid before breakfast and lunch (I must have done better with timing and amount for my lunch as the peak was still in range). I believe as a general rule of thumb Levemir tends to be around 0.2 to 0.4 U / kg body weight to give you a rough idea of whether you are on a high basal or not. Basal is typically one third to one half of total daily insulin dose. Obviously there are variations between people and what foods people are eating.

Hope this helps!

 

[Elenka_HM]

It sounds like you might need a bolus insulin @Elenka_HM It’s hard to say because your basal insulin might be masking your true response to food. Even tiny doses might help you. But I’d be asking about reducing the basal insulin alongside introducing bolus insulin. How much Levemir do you take each day and when?

I'm currently taking 6 units of Levemir in the morning. I started on 10 units one year ago, but I've been taking 7 or 8 for the past few months with good results. I walk quite often and I see it really helps keeping me in the lower side, when I stay at home I do notice higher levels.

I have a half unit pen for Novorapid so I could do smaller doses if I need to.