New Insulin doesn't seem to work.

[tomcamish]

Morning All,

Yesterday I had a review and another HBA1C test (77), and was put onto Apidra fast acting and Lantus slow acting.

My dietitian told me that 1 unit of fast acting insulin brings BG down by 3. I've also been told to calculate at 1 unit of Apidra per 10g Carbs at mealtimes.

Last night my before-meal BG was 13.5, and I was about to eat 50g carbs, so I took 5 units for the food and another 2 units to bring my blood down = 7 units.

2 hours after my food i did another test and was on 15.6!

So I did an experiment this morning. Waking BG was 12.0 (doesn't look like the slow acting Lantus has done much either) and I was going to have 30g carbs for breakfast, so again I did 2 units for my BG and 3 for the food = 5 units. I then didn't eat anything - armed with some jelly babies just in case, I showered, got ready for work and got my son dressed, this all took 45 minutes. I then did another blood test and my BG was 11.3.

Am i calculating this all wrong, or is the insulin not doing a thing? Does it take a while for my body to react to the Apidra and I'm expecting miracle results?

I've left a message for my nurse to call me but theres no guarantee it'll be today.

 

[Northerner]

Hi Tom, the ratio that your nurse has suggested is just a starting point really - most people are told to start at 1 unit per 10g. However, like many things to do with diabetes, this may need to be refined as you gain experience and more information of how you react at this level. So, don't expect it to be right straight away, it rarely is. See what your nurse says, but I expect she will suggest keeping at the current levels for now until you have more data, then adjustments can be made. It's also worth noting that ratios can change throughout the day - many people become more sensitive to the insulin as the day progresses, so you may need less insulin per 10g by the evening than you need in the mornings (when we are generally most insulin-resistant).

Actually, the rise after two hours is pretty good - only a couple of mmol, and remember that the Apidra will still be working in your body to lower it further. I think Apidra can last at least 3 hours for most people. Also, your morning reading - if you don't eat then your liver may continue to release extra glucose and raise your levels for you, as it thinks you are starving! Insulin can also take some time to peak, especially in the mornings, so it looks like your small drop after 45 mins was probably a combination of these factors.

All sounds very complicated I know, but it does become easier as you begin to recognise your reactions, particularly to regular and familiar meals 🙂

 

[Robin]

When I first started Lantus, I was told it would take three days before it was up and running as it should be, so see what happens over the next couple of days.
Also, a rise of only 2 at the two hour point, even with a correction dose on board, isn't at all bad. mealtime insulin does take a while to get going, and peaks around 2 hours, so you'd still got probably half of it still on board. What was the reading after 4 hours when all the Apidra had been used up? Depending on what form your meal took, carb can get into the system faster than the insulin can mop it up, or slower, depending on what you eat with it, ie, look at the Glygaemic Load of the whole meal.
It is a case of having to do an awful lot of experimenting at first, til you find what doses work. Keep in touch with your DSN and keep asking questions.

Edit. Northerner types faster than I do!

 

[trophywench]

And I wanted to say a mixture of what both of you have already said. Any change in Lantus up or down changing the timing, whatever you do to it/with it - takes a full 3 days to see the total effect of. However Apidra is supposed to be the quickest of all the 'fast' insulins.

Finally - but you have a long way to go yet before you know you've reached this stage, if you ever do! - some people just don't do well on certain types of insulin. It ain't the end of the world cos nowadays there is plenty of choice of alternatives.

 

[DaveB]

Hi. You also need to check that your Lantus dose is right. If it's too low then your BS will gradually rise in the 24 hrs afterwards (or 12 hours if injecting twice a day).