Novo-not-so-rapid and the sting in the tail

[Northerner]

As some of you may know, I'm a bit of a weird diabetic. I'm Type 1, but stopped needing a basal insulin about 4 years after diagnosis (now about 4 years without it). As such you would think that I could happily go to bed without any real worry about having night hypos? Not so! 😱 I've had quite a few over the years and they have been a real puzzle. I've come up with various theories, only for them to be disproved by failing to adhere to any sort of predictable pattern.

However, I now have a new theory! I've always thought that novorapid lasts about 5 hours in my system, meaning it would be largely 'spent' before bedtime, usually around 6 or more hours after last injecting. Recently, the hypos seemed to be getting more frequent, and I have noticed that I am going to bed earlier these days, partly due to sleeping better due to quitting alcohol. The fact that I haven't had an alcoholic drink for 50 days has excluded this as a possible cause, which was a previous theory. I've also excluded any exercise effects as a possible cause - recent hypos have not coincided at all with patterns of exercise.

Here's what I think is happening - my novorapid is continuing to drop my levels after bedtime, possibly for up to 7 hours, leading to the hypos. I've sort of added weight to this theory by changing my injection site for my evening meal from my posterior to my belly - the latter tends to absorb much quicker, and sure enough my levels are falling faster, earlier.

So I think that's what it is - before I was going to bed late enough to see the true extent of any drop - I also wonder if , by going to bed and dropping quickly off to sleep, my liver is slowing down sooner and putting out far less glucose than if I was still up and about for an extra hour, so I have that insulin still working and less liver action = hypo.

I'll have to see if the new injection site prevents the hypos in order to firm up on this theory, but at least it seems plausible! 🙂

 

[Annette]

Sounds plausible. Just because 'they' say Novorapid lasts 3-5 hours, doesnt mean thats the case for everyone. (After all, 'they' say lantus is a flat profile with a 24 hour duration, and we all know the truth of that particular statement...)Maybe also, if you always injected into your posterior, it is becoming a little less sensitive to the insulin, thus slowing down its absorption? Like having a very mild case of hyperlipotrophy (sp? lumps caused by injecting in same place) that is indetectable to feel, but still affecting the absorption.

 

[Robin]

Interesting! I agree, just because they say Novorapid lasts 4-5 hours doesn't mean to say it does on everyone. Also, I was advised to inject it in my abdomen because it has a faster response there, and it still takes half an hour to get going, (but with me, is all done and dusted by 3 or so hours.)

 

[KookyCat]

That does sound plausible, novorapid behaves differently in me at nightime btw, during the day it's all over at the two hour mark for me, but at night I continue to tail off for a good five to six hours. I have two hypo special times, the first is midnight that's the sting in the novorapid's tail, the second 3 am which is usually the sting in the basal's tail. If the two collide then it's hypogeddon. the only real way I've found to deal with it is adjusted ratios and a very strict limit on carbs, boring and annoying though it is. I'd be interested to know more about your experiments, and when you come up with a solution I'll steal it 🙂

 

[Austin Mini]

Why not have a little something extra at tea/dinner time? A piece of cake or a few biscuits might help stop those hypos.

 

[Robin]

Why not have a little something extra at tea/dinner time? A piece of cake or a few biscuits might help stop those hypos.

And ruin Northies sylph like figure? Perhaps attack it from the other direction and reduce novorapid at evening meal.

 

[Austin Mini]

A piece of cake beats reduced insulin hands down Robin, well in my book anyway.

 

[khskel]

Sounds logical to me.

 

[Northerner]

Why not have a little something extra at tea/dinner time? A piece of cake or a few biscuits might help stop those hypos.

And ruin Northies sylph like figure? Perhaps attack it from the other direction and reduce novorapid at evening meal.

Well, to be honest, I've been doing both! I've reduced the insulin for my evening meals by about 40% so far this week, but am still having to eat more than I actually want to in order to stave off hypos 😱 It's a bit of a transitional period, I think, whilst I adapt to the different speed of absorption and reduced insulin requirements.

I don't think it's that my injection sites have become compromised at all, since I do stab all over the place, plus I only do three injections a day not the 4, 5 or more that some people have to do. The earlier bedtime is the most likely culprit (combined with the consequent lower liver activity proposition), since the hypos had started increasing in frequency in line with that.

 

[Stitch147]

Don't know much about insulin, but sounds like a good theory to me.

 

[everydayupsanddowns]

Interesting interesting...

Someone, someday will write a book about your case Alan!

 

[trophywench]

God I'm so boringly predictable with my diabetes LOL

Novo lasts 4+ hours no more than 4.5, however after 3.5 it really doesn't do much that makes a noticeable difference (unless there was some exercise a while ago that exacerbates it), my I to Carb ratio is 1u to 10g, my A1c is now always was and as far as I'm concerned around 7% - when I have lousy control it increases and to get it down any more I have to pay if so much attention, constantly that I couldn't have a life, plus I'll have shedloads of hypos. Just at the mo (about 10/12 days on the trot) I seem to have bloody fantastic control day after day after day after day - I have NO idea why it's suddenly decided to do this, it's out of character for it not to fluctuate really (I mean I don't habitually test eg 2 hours after eating so I may indeed spike then, but in that case I always would have but I never have tested then, so I am comparing like with like here.

It seems to have gone on far too long for this to be correct .......

 

[stephknits]

Very interesting stuff, Alan. I have recently been having hypos around bedtime, well after the four hours since injecting NovoRapid. It does seem to last longer in the evenings for me. I have changed my carb / insulin ratio so am now doing less insulin in the evenings and this seems to be working so far. I have Also reduced my basal as I have been sitting about a lot more due to my recovery. I am waking with much higher numbers, but my routine is shot at the minute. Am hoping to get back to work next week, so will see how I go.

 

[TheClockworkDodo]

It sounds quite likely to me, Alan. All sorts of things have a delayed effect on me, and therefore on my bgls - I will often get the hypo in the afternoon, or even in the evening, for the gardening I did in the morning, for instance. And at the moment something is making me hypo every afternoon, for a completely unknown reason (I've just posted about this on another thread), despite massively curtailing my lunchtime insulin dose. It's not gardening this time - am waiting for it to warm up a bit!

 

[KookyCat]

Right so we're all having fun with insulin at the moment then, must be that ruddy fairy, I seem to have a strange issue with basal at the moment, can inject 6-10 units (and every point in between) and get almost exactly the same results....my only explanation is my liver is routinely chucking out sugar to compensate and I need even less, what with my reversey Percy reaction to too much insulin, either that or my meter is broken/I'm now utterly delusional, hope that new meter arrives soon!

Good luck with the changes folks, and Stephknits hope your recovery is moving along nicely 🙂

Incidentally I'm going to suggest to Ladybird that they write an adult book title "Fun with Insulin" 😉

 

[TheClockworkDodo]

Suspect I may have the same problem with basal you do, Kooky 🙄

 

[trophywench]

Apparently if you get an insulin syringe and load it with water, you can have fun with jelly babies by injecting them!

All you weird ones could do that with the green ones until they ... no I'm not going to explain what happens - let it be a surprise!

 

[Anna1]

Hi Northener, Just read this post and fascinated that you don't take any basal but are a type 1 - I've been told we all have to take basal to match liver sectretion but I've been cutting back on mine drastically and am now on 10 units of Tresiba and still going down - on top of that the novo seems to last like you for about 6 hours making evenings and nights difficult - if ok would be interested to hear how you came about not needing basal as I feel I'm heading that way - thanks

 

[pottersusan]

That ties up with what's happening to me - I frequently go low in the middle of the night 4/5 am despite no basal since 10pm and no bolus since then either. And I'm definitely not producing any insulin myself😱. I agree about Novo-not-so-rapid.

 

[Northerner]

Hi Northener, Just read this post and fascinated that you don't take any basal but are a type 1 - I've been told we all have to take basal to match liver sectretion but I've been cutting back on mine drastically and am now on 10 units of Tresiba and still going down - on top of that the novo seems to last like you for about 6 hours making evenings and nights difficult - if ok would be interested to hear how you came about not needing basal as I feel I'm heading that way - thanks

Hi @Anna1 - quite simply I kept having to reduce my lantus and eventually got down to 2 units (from 20 units at diagnosis). I decided that was hardly worth having as I was still waking in the 4s, so I stopped it entirely and haven't needed it since. The only possible explanation is that my beta cells have recovered sufficiently to provide me with enough insulin to cover my basal needs. I suspect it also helps me to keep my levels reasonably good - my HbA1c has been in the 5%/30s most of my 'diabetic life' 🙂

I have encountered about half a dozen others here on the forum over the years who have had similar experiences, so I'm not unique, but unusual. It's nothing special I have done. Using the Freestyle Libre I can see that my levels stay rock steady through the night, usually in the mid to upper 4s with no injected insulin active 🙂 If I don't eat at all during the day, and therefore have no novorapid either, my levels usually go up to upper 8s/low 9s, but then fall back overnight - presumably because my liver is less active in trickling out the glucose while I sleep 🙂