Novarapid

[PhilD1960]

What's the usual amount to inject at meal times, is it based on carb intake or body weight?

 

[Kaylz]

There isn't a straight answer to your question, carb counting is how things are done but then everyone has their own individual ratios for how many grams of carbs 1 unit of insulin will cover which can also vary for that person based on the time of day so there is no "usual" amount xx

 

[Bruce Stephens]

There isn't a straight answer to your question, carb counting is how things are done but then everyone has their own individual ratios for how many grams of carbs 1 unit of insulin will cover which can also vary for that person based on the time of day so there is no "usual" amount

An endocrinologist might well estimate the initial ratios using body weight but nobody would expect those to be accurate (so you'd expect to adjust them later). I'd expect it to be quite different for someone with significant insulin production, too.

 

[trophywench]

Well for established healthy adult Type 1s the starting point is usually 1u per 10g CHO - which you start testing with smallish amounts of carb, eg 20 or 30 grams to begin with. It is only supposed to exactly deal with the carb in that meal, and despite lasting for up to 4.5 hours ish in your body, it isn't supposed to provide help to our background requirement of insulin.

No idea what they tell T2s, sorry.

 

[everydayupsanddowns]

Welcome to the forum @PhilD1960

Have you been using insulin for long? Which types do you use?

I‘ve found it quite frustrating over the years that T2s don’t seem to have an equivalent of DAFNE or BERTIE as a comprehensive course that gives advice for T2s on MDI about matching doses to meals, and taking account of illness, activity, alcohol etc etc.

You could try adapting BERTIE to your own diabetes, but I‘m not sure which bits would apply in T2 and which would need altering.

Bertie Diabetes

www.bertieonline.org.uk

I wonder if @Ljc might have some hints and tips to offer?

 

[Dave W]

In my case as a T2 it varies considerably from meal to meal. At present I take 9u 30 mins before my breakfast of 35gm instant oats and am thinking about upping it to 10u as I'm going a bit above target a couple of hours later. My evening meal is much heavier in cabs but I can usually get away with about 4 or 5u.
Exact requirements are very much an individual equation and even then can vary throughout the year and with physical activity.

 

[PhilD1960]

I am using 70 units every night of Lantus and 4 metformin to try and control my background sugar levels, which are currently running at 10 to 12. I was put on novarapid about 6 weeks ago to try and get things lower, but to be honest it ain't working. For example, for breakfast I have natural yoghurt and some berries with a few chopped nuts . I'm having to take 30 units to keep things at the same level as before eating.

 

[PhilD1960]

There isn't a straight answer to your question, carb counting is how things are done but then everyone has their own individual ratios for how many grams of carbs 1 unit of insulin will cover which can also vary for that person based on the time of day so there is no "usual" amount xx

I thought that might be the case, its just that I'm new to fast acting insulin and just making it up as i go along.

 

[Kaylz]

@PhilD1960 whoever is in charge of your care should be having regular contact with you until things are more controlled and established, Novorapid won't lower you so to speak, you basal should keep you relatively steady over 24 hours in the abscence of food, novorapid at the moment is only being used to cover the carbs in the food which should mean 4-5 hours after injecting it you are close to what your pre meal levels were, to achieve that though the basal has to be as near to perfecr dose as it can be, if that dose isn't correct then other things don't work as they should, it can be a lengthy process but we tend to basal test when things aren't going quite right to see whether than needs adjustment or if its the bolus that needs adjustment, bolus doses vary hugely from person to person and Type 2's do tend to require more, if in need of any advice about your doses please contact whoever is providing you care asap whether that be a diabetes team or GP xx

 

[PhilD1960]

@PhilD1960 whoever is in charge of your care should be having regular contact with you until things are more controlled and established, Novorapid won't lower you so to speak, you basal should keep you relatively steady over 24 hours in the abscence of food, novorapid at the moment is only being used to cover the carbs in the food which should mean 4-5 hours after injecting it you are close to what your pre meal levels were, to achieve that though the basal has to be as near to perfecr dose as it can be, if that dose isn't correct then other things don't work as they should, it can be a lengthy process but we tend to basal test when things aren't going quite right to see whether than needs adjustment or if its the bolus that needs adjustment, bolus doses vary hugely from person to person and Type 2's do tend to require more, if in need of any advice about your doses please contact whoever is providing you care asap whether that be a diabetes team or GP xx

Thanks for that Kaylz, i will try and get in at the docs to see if they can do anything to lower my background levels. When they put me on nova it was done over the phone and i have had no follow up contact since.

 

[everydayupsanddowns]

Thanks for that Kaylz, i will try and get in at the docs to see if they can do anything to lower my background levels. When they put me on nova it was done over the phone and i have had no follow up contact since.

How frustrating for you @PhilD1960

Hope you manage to get some clarity and help from your Docs. I agree with @Kaylz - my experience is that the two doses (lantus and novorapid) need to work together. Lantus providing enough backgroud support so that the doses calculated to cover the carbs can work properly. If the ratios are out meals things don’t work out... but also if the background dose isn’t right then the meal doses won’t work either!

It’s about getting them both in balance, and adjusted for different times of the day.

 

[Kaylz]

Thanks for that Kaylz, i will try and get in at the docs to see if they can do anything to lower my background levels. When they put me on nova it was done over the phone and i have had no follow up contact since.

Sorry to hear that you haven't had contact since you were started on it, that really is lack of the care you deserve, please do contact them ASAP and as it will likely only be a phone consultation make sure you have a note of a good few days worth of readings to hand as this will give them a better idea of what and where adjustments need made, it won't always be a check in need, when you gain confidence you will learn to spot patterns and adjust where needed yourself but it just takes time my lovely, do keep us updated and also feel free to join in on other threads xx

 

[Piglet]

Hi Phil,

Ask you GP/ DSN to refer you to either a DESMOND or EXPERT education course. Do not take no for an answer as it is important for you to better self manage the condition. These are the T2 equivalent to the T1 DAFNE course but it varies around the country as to which one is available. This should explain how both types of insulin work and how the short acting ratios work too.

Having to dose adjust is frustrating when you start out but it does become easier over time, and you will get used to adjusting your dose as and when required.

Good luck and keep us posted.
Piglet

 

[grovesy]

Hi Phil,

Ask you GP/ DSN to refer you to either a DESMOND or EXPERT education course. Do not take no for an answer as it is important for you to better self manage the condition. These are the T2 equivalent to the T1 DAFNE course but it varies around the country as to which one is available. This should explain how both types of insulin work and how the short acting ratios work too.

Having to dose adjust is frustrating when you start out but it does become easier over time, and you will get used to adjusting your dose as and when required.

Good luck and keep us posted.
Piglet

Not all areas do them, many have their own Education courses, and very rare for a Type 2 on Insulin to get one on Insulin use.