Novarapid or levermir

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Lindiloo

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Type 1
Hello I need some advice - ratio of novarapid is 1 unit per 10 gms carbs - I’m having meals and my bg is rising and not coming down and I’m not in target at next meal - so I need more basal or do I need to up ratio of novarapid - still
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Probably change the Novorapid ratio. Check the Basal balance first. Don't eat for few hours and see if your BS goes up or down and tweak the Basal to keep the level flat when fasting for a few hours.
 
I think you probably need to do some basal testing to establish whether your Levemir is holding you reasonably level in the absence of food by skipping a meal each day in rotation, so that you can see what your levels do when you are not eating. Once you have your Levemir reasonably sorted, then you will be able to see whether your NR doses/ratios are right or if it may be a timing issue.
I assume you are splitting your Levemir doses morning and evening? Have to ask because some people seem to get started on a single dose and are never told to split it.
 
I’d alter the Novorapid ratio first. Try 1 to 9g just to be cautious, then if that doesn’t help after a few days, try 1:8g. Stick to meals that you know the carbs for so as to remove one variable.
 
Oops, we posted at the same time @rebrascora and it looked like I was contradicting you - I wasn’t. It might be a basal issue but personally I’d experiment with the ratio first. Just the way I do things unless there’s an obvious basal issue.
 
How to test basal might be helpful to you @Lindiloo Until basals are steady you can't really see what your boluses are doing. Personally I have only rarely found my ratios out and not for years now. But basal needed changing when I lost weight.
 

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I always see basal insulin as a foundation. If it's not level everything else becomes unstable, so to me, checking that my basal is right is key and my basal needs change a lot, so it is a regular adjustment. I have yet to need to change my bolus ratio.... I am still on 1:10. I do however add a couple of units for DP/FOTF or reduce my evening bolus by 1 or 2 units if I have been particularly active, but I don't see these as ratio changes, just extra tweaks.
 
Inka said:
Oops, we posted at the same time @rebrascora and it looked like I was contradicting you - I wasn’t. It might be a basal issue but personally I’d experiment with the ratio first. Just the way I do things unless there’s an obvious basal issue.
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Think I will try upping novarapid as when I out of my 4 hours for rapid my levels are holding - going up and down slightly- so if I was in range after my 4 hours I think I would be holding in target. Can I ask (so many questions) should your bg rise but come down after 2 hrs into a near normal level (obviously depending on what you have eaten) I eat really well and don’t really eat anything sugary
 
Pattidevans said:
How to test basal might be helpful to you @Lindiloo Until basals are steady you can't really see what your boluses are doing. Personally I have only rarely found my ratios out and not for years now. But basal needed changing when I lost weight.
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Thankyou will take a look
 
rebrascora said:
I always see basal insulin as a foundation. If it's not level everything else becomes unstable, so to me, checking that my basal is right is key and my basal needs change a lot, so it is a regular adjustment. I have yet to need to change my bolus ratio.... I am still on 1:10. I do however add a couple of units for DP/FOTF or reduce my evening bolus by 1 or 2 units if I have been particularly active, but I don't see these as ratio changes, just extra tweaks.
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Ok. I I’m in target through night and wake up and bg is around 6/7. It then starts to rise (I’m told study normal) I have breakfast and it’s spiking up to 14/17 and slowly coming down but after 4 hrs it’s still not in range but when I get to lunch time - so I’m having 12 units levermir in morning - if I up this to 14 should my levels come down quicker after I have eaten ?
 
rebrascora said:
I think you probably need to do some basal testing to establish whether your Levemir is holding you reasonably level in the absence of food by skipping a meal each day in rotation, so that you can see what your levels do when you are not eating. Once you have your Levemir reasonably sorted, then you will be able to see whether your NR doses/ratios are right or if it may be a timing issue.
I assume you are splitting your Levemir doses morning and evening? Have to ask because some people seem to get started on a single dose and are never told to split it.
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So I was told to single dose my Levemir (which I’ve adjusted from 18 units to 14 units a while ago) but I also haven’t been told to split the dosage. What’s the benefit of this?
 
Jimmy2202 said:
So I was told to single dose my Levemir (which I’ve adjusted from 18 units to 14 units a while ago) but I also haven’t been told to split the dosage. What’s the benefit of this?
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I’ve always been told by diabetic hospital team to take levermir morning and night - you can adjust nighttime if you are in target but rising you can adjust so you stay in range through night - it’s the daytime that I get confused on
 
Spiking up to 14-17 after breakfast is likely a timing issue, so you might want to experiment with bolusing for breakfast a bit earlier. It is extreme but I needed 75 mins prebolus time for NovoRapid and I now need 45 mins prebolus time for Fiasp at breakfast time. I also add a couple of units to my breakfast bolus to account for "Foot on the Floor" syndrome because my liver is pumping out glucose to give me energy for the day on top of my breakfast carbs. If I don't have any breakfast or I have a very low carb breakfast like an omelette, I still need to inject 2 units of bolus insulin to prevent my levels rising too much and the sooner I get those into my system the quicker it helps to control that rise. I don't see that as a ratio change because if I don't have breakfast, I still need it, so to me it is an add on to help my Levemir.
 
rebrascora said:
Spiking up to 14-17 after breakfast is likely a timing issue, so you might want to experiment with bolusing for breakfast a bit earlier. It is extreme but I needed 75 mins prebolus time for NovoRapid and I now need 45 mins prebolus time for Fiasp at breakfast time. I also add a couple of units to my breakfast bolus to account for "Foot on the Floor" syndrome because my liver is pumping out glucose to give me energy for the day on top of my breakfast carbs. If I don't have any breakfast or I have a very low carb breakfast like an omelette, I still need to inject 2 units of bolus insulin to prevent my levels rising too much and the sooner I get those into my system the quicker it helps to control that rise. I don't see that as a ratio change because if I don't have breakfast, I still need it, so to me it is an add on to help my Levemir.
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I think you have hit nail on the head because I wake up about 7.30 and I’m in target by the time I came down and have a cuppa it’s rising so before I have breakfast I’m heading up to 9/10 so if I injected a couple of units on waking I would probably be in target at breakfast and then knock on effect I would be in target. Will try this tomorrow and see what happens - Thankyou so much xxxx
 
Do you have Libre?
I inject that 2 units plus my breakfast bolus and my Levemir before I get out of bed. Then I get myself a coffee and make my breakfast and get washed and dressed etc and keep scanning my Libre watching for my levels to start dropping and then I eat my breakfast. Pretty well 45 mins every day for me between injecting and eating breakfast gets me a very small hillock on my graph. That is excessive and it might just be 20 or 30 or 40 mins for you, so you need to keep a close eye on your Libre to get the timing right otherwise you will obviously hypo.

I really hope this strategy helps to sort it for you as I know how unpleasant it is spiking up to mid teens every morning and I have to say, I found it worse still plummeting back down into range. Getting the timing right so that you stay below 10 as much as possible makes a huge difference.
 
rebrascora said:
Do you have Libre?
I inject that 2 units plus my breakfast bolus and my Levemir before I get out of bed. Then I get myself a coffee and make my breakfast and get washed and dressed etc and keep scanning my Libre watching for my levels to start dropping and then I eat my breakfast. Pretty well 45 mins every day for me between injecting and eating breakfast gets me a very small hillock on my graph. That is excessive and it might just be 20 or 30 or 40 mins for you, so you need to keep a close eye on your Libre to get the timing right otherwise you will obviously hypo.

I really hope this strategy helps to sort it for you as I know how unpleasant it is spiking up to mid teens every morning and I have to say, I found it worse still plummeting back down into range. Getting the timing right so that you stay below 10 as much as possible makes a huge difference.
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Thankyou I will try this tomorrow and yes I’ve got Libre - I know because when I’m spiking up to 17/18 I’m so tired - I also find any different routine also throws me out of normal pattern. But will start with this tomorrow xxx will let you know how I do
 
Good luck!
 
Jimmy2202 said:
So I was told to single dose my Levemir (which I’ve adjusted from 18 units to 14 units a while ago) but I also haven’t been told to split the dosage. What’s the benefit of this?
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Levemir doesn't last 24 hrs despite Novo saying it does. It lasts something like 12-15 hours depending on the dose hence the need to split it.
 
It certainly does last 24 hours if you are taking a large enough dose of it per kilo of your body weight - as per the helpful 3d graph.

Since most of us only take lesser amounts we overlap them however we need to in order to achieve as flat a BG profile as poss when we basal test. Play with the timings and doseage amounts to your heart's desire.

When you get fed up with that all the while for a couple of years - ask to swap to a PUMP!
 
trophywench said:
Since most of us only take lesser amounts we overlap them however we need to in order to achieve as flat a BG profile as poss when we basal test. Play with the timings and doseage amounts to your heart's desire.

When you get fed up with that all the while for a couple of years - ask to swap to a PUMP!
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But to be fair @trophywench, even on a pump I have to bolus ahead using Apidra which is supposedly faster than most of the other so called fast acting insulins in order not to spike. I can however get a very flat basal profile.
 
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