Novorapid fixed dose - questions!

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pawprint91

pawprint91

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I am on a fixed dose of novorapid (DSN advised 2-3 units with my evening meal, depending on the carb content). However, I out for lunch with a friend later this week - we are only going to a local Harvester, so nothing fancy! However, chances are I will probably order a main meal, much carbier than the usual 40 odd grams I'd usually have for lunch, and then have something lighter like some toast or a sandwich when it comes to my evening meal. So, my first question is would you have novorapid with the main meal at lunch to avoid some crazy sugar levels, or would you have it with the lighter evening meal and up the dose by a unit to correct the crazy sugar levels if necessary? I've got some errands to run after lunch and the food shop to do, so will be active.

These next two questions might be ones for my diabetes team, but it'd be interesting to get people's take on it. If my lunch seems to go above 40g carb and I test for any reason in the afternoon (before driving or a long walk, for instance), I can still see a spike into the low teen numbers for my levels. Do we think I should be asking if I can inject a fixed dose before lunch, too? I was told by my DSN originally to only worry about pre-meal readings, and my levels are usually okay by then, I guess showing that my honeymoon phased pancreas can still chuck something out in the end to deal with it. This does make me think that maybe I don't need an extra lunchtime dose of nr as obviously generally I'm more active in the afternoon too (even if just housework) so want to avoid hypos, but interesting to hear what people think. Do you spike after meals even when you're not in the honeymoon phase anymore?

Second question: if I'm eating a meal out that is ~ a lot carbier than I have at home, would you add an extra unit on to the fixed dose for good measure, or just maybe advise I leave some of the chips whilst I'm at this stage? :rofl:
 
pawprint91 said:
So, my first question is would you have novorapid with the main meal at lunch to avoid some crazy sugar levels,
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Yes, when you're adjusting your own doses you'd adjust the lunchtime dose to suit that meal. (You might also add a correction dose for the evening meal if testing suggests you got the lunchtime dose a bit wrong, but the goal is to inject the right dose for lunch just before you eat lunch.)

I don't know what you should do while you're on fixed doses.
 
If I was having my main meal at lunch, I’d move the Novorapid to before lunch. If you’re more active in the afternoon than the evening, I’d either eat more carbs for your fixed dose or take slightly less insulin.

And yes, I do think you could try tiny boluses with your lunch as well as evening meal. I think I told you before, but I could eat breakfast without a bolus and be back in range by lunch soon after diagnosis, but I still took a breakfast bolus to reduce the spike. That was the advice of my consultant.
 
Inka said:
If I was having my main meal at lunch, I’d move the Novorapid to before lunch. If you’re more active in the afternoon than the evening, I’d either eat more carbs for your fixed dose or take slightly less insulin.

And yes, I do think you could try tiny boluses with your lunch as well as evening meal. I think I told you before, but I could eat breakfast without a bolus and be back in range by lunch soon after diagnosis, but I still took a breakfast bolus to reduce the spike. That was the advice of my consultant.
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Thank you 🙂 breakfast is the one meal of the day where I don't actually know what I do. It's usually less than 20g of carb though, so I'll leave that one (for now!).

I've kind of been left to my own devices by the hospital it would seem unless I am constantly calling them - do you think they'll be annoyed if I've started doing tiny boluses off my own back? (I'm guessing perhaps only 1 unit, given that 2-3 is generally my evening one?).
 
pawprint91 said:
do you think they'll be annoyed if I've started doing tiny boluses off my own back? (I'm guessing perhaps only 1 unit, given that 2-3 is generally my evening one?).
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If they get cross with you then it is their own fault for not giving you more support. They should be applauding your initiative. To me good diabetes management is about experimenting on yourself to see what works. As long as you are very careful and always be aware of the possibility of a hypo and test regularly and be prepared to change back if your experiment doesn't work, then I can't see how they can criticize. You are an adult not a child (I say that as someone who had similar concerns about my HCPs reaction to me going off-piste with my diabetes care, rather than being critical of your concerns) and these decisions will fall to you sooner or later. If you feel you want to take up more control now and do it carefully and have done your homework by asking questions here, then good on you!
 
It sounds like you have a cautious and analytical approach @pawprint91

And that you are looking ahead and trying to avoid future problems. In your shoes I think I just started doing my own thing (is it Banksy who says it is easier to ask for forgiveness than permission?)

But you might be happier keeping your team in the loop and letting them know what you are planning to do to get their input. Probably the better option!
 
I prefer to test changes to my dosing in a controlled environment: at home.

Would you be able to have a lunch at home, similar to what you'll have later this week with your friend, and have it with insulin to see what happens?

Obviously every day is different with diabetes and just because something works one way one day doesn't mean it'll work the same way another day, but if it was my first time doing something new I'd feel more comfortable trying it out at home first.

I'm not shy with making changes on my own, but when they're big changes (new dosing, new insulin, etc), I try it out at home before taking it out 'in the wild'.
 
pawprint91 said:
Thank you 🙂 breakfast is the one meal of the day where I don't actually know what I do. It's usually less than 20g of carb though, so I'll leave that one (for now!).

I've kind of been left to my own devices by the hospital it would seem unless I am constantly calling them - do you think they'll be annoyed if I've started doing tiny boluses off my own back? (I'm guessing perhaps only 1 unit, given that 2-3 is generally my evening one?).
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It’s your diabetes not theirs. However, if it was me, I’d start on the tiniest possible dose, choose a day when I could monitor things closely, and test, test, test. I’d also keep careful records of what I ate, what time, how much insulin, my blood sugar at regular intervals. If you were to need a top-up snack in the afternoon that’s ok too. Better to avoid a big spike and simply have a biscuit or whatever if you feel you need a boost later in the afternoon.
 
I've asked so many questions on here that I've probably asked this before and forgotten - can you inject novorapid on any injection site? I've only used it at home so have only done stomach, but thinking leg might be easier when out and about in a summer dress.
 
pawprint91 said:
I've asked so many questions on here that I've probably asked this before and forgotten - can you inject novorapid on any injection site? I've only used it at home so have only done stomach, but thinking leg might be easier when out and about in a summer dress.
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Yes.

Different sites are likely to respond at different speeds (stomach tends to be faster than buttocks, for example). But given where you are that's probably not going to be that significant so use whatever site is convenient and don't worry about it.
 
Hi. I wonder why you are on fixed doses of the Bolus? Normally DNs start you on a fixed dose and then move you onto to 'carb-counting' after a few weeks or so. Carb-counting is where you adjust the dose to the carbs in the meal using a certain ratio. My DN started me on carb-counting from Day One. The principle is that you adjust the insulin to suit the food and not the other way round. I suggest a discussion with your DN about carb-counting.
 
DaveB said:
Hi. I wonder why you are on fixed doses of the Bolus? Normally DNs start you on a fixed dose and then move you onto to 'carb-counting' after a few weeks or so. Carb-counting is where you adjust the dose to the carbs in the meal using a certain ratio. My DN started me on carb-counting from Day One. The principle is that you adjust the insulin to suit the food and not the other way round. I suggest a discussion with your DN about carb-counting.
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Hello, thanks for your reply. I wasn't on any novorapid until about a month after my diagnosis (and that was only because I was a bit pushy for it) because I am honeymooning hard. :rofl: I have learnt how to carb count and had an appt and a course based around that, but last night for example I had 3 units (fixed dose) for 60g of carb and hovered around 4 all evening. (I understand other factors may have come into play with that). I've found that at the moment I have to carb count for the dose - my body can cope with 20-30g of carb on its own, - but between 30-50g I need 1/2 units and for over 50g of carb I need 2/3. For anything more, I would have 4 (as I did today with a pub lunch), but rarely do I have something that high carb. Personal advice from DSN seems few and far between, attitude is very much manage it yourself unless you have a real problem - so I'm just going with it, surely some insulin and a close eye with scanning and testing is better than none at all.
 
Have you got a half unit pen? I’d go with 2 or 2.5 units for that 60g meal. To be fair, the heat might be making things harder too. As I’ve probably said a million times, always err on the side of caution. Better a little high than hypo.
 
Sounds to me like you have a great take on things @pawprint91 Your assessment above sounds like you are really getting your head around it.
It is frustrating when you feel like you are ready to take the next step but the DSN isn't giving you the go ahead, but it seems to me you are gently and carefully taking the reins little by little and learning from what you do, which is just the way it should be.
It must be difficult for DSNs to assess when people are ready for the next step or perhaps overly confident or would be overwhelmed with more info and responsibility based on the very limited time they have to spend with an individual, particularly in the current climate, so I think things are probably going as well as you could hope, whilst still playing it safe. There is plenty of time to start carb counting but you are clearly working towards it.
 
Inka said:
Have you got a half unit pen? I’d go with 2 or 2.5 units for that 60g meal. To be fair, the heat might be making things harder too. As I’ve probably said a million times, always err on the side of caution. Better a little high than hypo.
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I only learnt half unit pens exist about 48 hours ago, but I really would like some. Do they make them for Levemir too, do you know? I think the nurse said they do them for novorapid. And can the drs change your prescription or would that have to come from your nurse? (Sorry for the questions, don't expect you to necessarily know the answers, just curious before I ring round everywhere and inevitably ring the wrong people first 🙄 :rofl:).
rebrascora said:
Sounds to me like you have a great take on things @pawprint91 Your assessment above sounds like you are really getting your head around it.
It is frustrating when you feel like you are ready to take the next step but the DSN isn't giving you the go ahead, but it seems to me you are gently and carefully taking the reins little by little and learning from what you do, which is just the way it should be.
It must be difficult for DSNs to assess when people are ready for the next step or perhaps overly confident or would be overwhelmed with more info and responsibility based on the very limited time they have to spend with an individual, particularly in the current climate, so I think things are probably going as well as you could hope, whilst still playing it safe. There is plenty of time to start carb counting but you are clearly working towards it.
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Thank you for your lovely words of encouragement. I don't mean to sound so critical of my diabetes team as I understand they must be pushed beyond limits! However basically being given the green light to try and manage it myself was I think what I needed. My attitude towards food is much better because I know I can just tentatively have some novorapid. Would have just had a salad probably a few weeks ago at the pub for fear of going so high and being unable to yet have the means to come down!
 
pawprint91 said:
I only learnt half unit pens exist about 48 hours ago, but I really would like some. Do they make them for Levemir too, do you know?
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I think you need reusable pens (specifically, probably, Novopen Echo Plus). Those can take both Novorapid and Levemir cartridges. (They come in two different colours so you can have different colours for the two kinds of insulin.)

They also remember when you last injected (and how much), and (eventually, when Novonordisk and Abbott release an update) it should be possible to scan both into Libreview to record the injections.
 
pawprint91 said:
Hello, thanks for your reply. I wasn't on any novorapid until about a month after my diagnosis (and that was only because I was a bit pushy for it) because I am honeymooning hard. :rofl: I have learnt how to carb count and had an appt and a course based around that, but last night for example I had 3 units (fixed dose) for 60g of carb and hovered around 4 all evening. (I understand other factors may have come into play with that). I've found that at the moment I have to carb count for the dose - my body can cope with 20-30g of carb on its own, - but between 30-50g I need 1/2 units and for over 50g of carb I need 2/3. For anything more, I would have 4 (as I did today with a pub lunch), but rarely do I have something that high carb. Personal advice from DSN seems few and far between, attitude is very much manage it yourself unless you have a real problem - so I'm just going with it, surely some insulin and a close eye with scanning and testing is better than none at all.
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Hi again. It sounds like you have good grasp of what your are doing and it's a pity your DN isn't really keeping up. I'm lucky in having a super DN and now an equally good consultant. As Bruce Stephens has said, go for re-useable Novo pens. I have pens for both my Novorapid and Levemir and different colours.
 
pawprint91 said:
I don't mean to sound so critical of my diabetes team as I understand they must be pushed beyond limits!
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You don't sound critical of them at all but I can read an element of frustration in your posts that I can relate to as I was in a similar situation. I think being a regular member of this forum enables you to progress so much more quickly because you gain a lot of extra knowledge that other newly diagnosed people just don't have... I found this on my DAFNE course too.... but I imagine it is hard for DSNs to recognize that level of knowledge in someone newly diagnosed when the majority of people they deal with will have no understanding. My comment about them being stretched was more really justification in response to @DaveB's comment about you not officially carb counting and dose adjusting yet. I think you are easily ready for that but I am guessing they don't have the time. Fixed doses are a stop gap solution and I imagine since the pandemic more people will be on fixed doses for longer simply because they haven't got the time to educate people.
I am pleased you took the remainder of my post for the compliment it was intended to be. :D
 
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