Rivaroxaban & xarelto and poor insulin responses.

[Vamppir8]

Anyone else on the above anticoagulants find insulin takes an age to work? Just starting researching.

 

[rebrascora]

Anyone else on the above anticoagulants find insulin takes an age to work? Just starting researching.

It's probably not the anticoagulants but just the insulin. We are lulled into false expectation by it being referred to as Quick Acting Insulin or the brand names like NovoRapid when in reality it is more like Novo(not so)Rapid and if your BG levels are high it will take much longer to work than it's usual sluggishness because high BG levels cause you to be more insulin resistant. You can help it along sometimes by doing some exercise after you inject, but you gradually learn that you need to inject well in advance of when you want to eat.... particularly at breakfast time.

 

[Lucyr]

Anyone else on the above anticoagulants find insulin takes an age to work? Just starting researching.

Insulin normally takes an age to work, it’s just how it works. What kinds of insulin are you taking and when?

 

[Vamppir8]

Insulin normally takes an age to work, it’s just how it works. What kinds of insulin are you taking and when?

Now switched to fiasp from novoslow. Not made a jot of difference...

 

[rebrascora]

Yes, Fiasp was a disappointment to me to. I only need 45 mins prebolus time instead of 75 for breakfast with NovoRapid and 20 mins at other times of day, but if my levels are high (above 10) it can take hours and stacked corrections 😱 for them to come down, even with Fiasp. I have learned that for me I have to be much more proactive with it and correct at 8 and be more heavy handed with the doses and corrections. Would love an insulin that was actually "fast" but limited by our bodies absorption rate and the insulins currently on the market. You just need to persevere and find a way to make it work for you as best you can. It took me 3 months of trialing Fiasp (twice) to make it work for me but it is by no means ideal.

 

[Vamppir8]

I cannot correct, it's taking 4 hrs to get back down to normal. Corrected after 2 hrs and it just added it on end and hypo.

 

[rebrascora]

I cannot correct, it's taking 4 hrs to get back down to normal. Corrected after 2 hrs and it just added it on end and hypo.

If you didn't have Libre then you wouldn't know it was taking 4 hours to come back down.... and most people prior to the development of Libre and other CGM would have this going on and never be ay the wiser and still live well with diabetes, so I think sometimes CGM can be a blessing and a curse.
If your levels are coming back down to normal at 4 hours afterwards then you don't need a correction, you just need to inject further in advance of your meal... ie make the prebolus time longer..... but you have to take into consideration the time of day, the food you are about to eat and your pre meal BG in working out that timing.... or use your L:ibre to see when the insulin is kicking in and wait until you see that before eating. It is just a question of trial and error and getting into a routine of it, particularly at breakfast time when a longer prebolus time is often necessary. I find, injecting before I get out of bed really helps in the morning to overcome this issue.

 

[Proud to be erratic]

I cannot correct, it's taking 4 hrs to get back down to normal. Corrected after 2 hrs and it just added it on end and hypo.

Hello @Vamppir8,
Apologies if there is some repeating in my response; I know you are T3c, but from panc'y damage and not from a total panc'y - I can't remember the fine details and our Internet is misbehaving; so scrolling and searching is not fun today.

I fully agree with @rebrascora, sometimes having that extra CGM visibility can be less helpful and it sounds as if you reacted too promptly. There is a basic principle of avoiding stacking a 2nd load of corrective insulin on top of corrections you already have on board. I have no experience with Fiasp, but the principle will apply.

Dr Bernstein in his book Diabetes Solutions (which I'm only 20% through) talks about the greater any one insulin dose then the less reliable the outcome. He suggests no one dose should be more than 7 units and if it is then administer that split into 2, or more, parts. The observation is that a large shot of insulin doesn't release into one's blood the way we assume - all or only a small part could move into the blood and the rest may or may not subsequently get there. So dosing technique can be a factor of confusion.

Also, the food that you are bolusing for has both a carb content and a glycaemic release speed (often referred to as Glycaemic Index (GI). So timing of pre-bolus is intrinsically related to the Glycaemic Load (carbs & GI). This is barely a mathematical based science, but more of an abstract art! Yet is real enough and needs trial and error to establish what works for you with any one meal type.

Then there is a certain amount of further vulnerability from your Creon capsules- did you take sufficient for that particular meal? Did all the carbs you bolused for get digested and turned into the anticipated glucose.

So it's all pretty tricky trying to accurately 2nd guess what is going on and thus how to respond - correction or more carbs; and if more carbs fast JBs or slower biscuits?

I saw earlier today you'd found Diabox. Did you install that? When I had it working it was even more helpful than LibreLink. One reason was the dual alarms for both lows and highs, along with the option of personalised alarm sounds. For low you can have it set at an upper "alert" level, as high as 6.8, with a less urgent sound to let you know your BG is falling. Then a further alarm (or alert) nearer to a hypo threshold, with a more strident sound (eg a siren). Also the Diabox trend arrows have numerical calibration - so you know just how quickly change is happening. The Libre trends are a really good thing, but feel clumsy and basic once you've got that trend quantified as with Diabox. All of this means that you have continuous and quantified visibility of change. My own T3c is considered as very brittle (none of the normal panc'y hormones) and I found I had much better management when Diabox was available to me.

I personally think having any low alarm at or near 4 is too low, too late. I prefer to think of the alarm as an ALERT, allowing me to see, take stock and then respond - all quite quickly. I now have very, very few hypos and just the odd 'almost' hypo - invariably because I've misjudged something; but really easily caught and salvaged before it even becomes a mild hypo. I've stopped counting accurately, but no deep hypos and some 5 or 6 mild hypos throughout 2022. I am in no doubt that managing my D is intrusive to my lifestyle; but it was less intrusive and produced better HbA1c outcome when I had Diabox working. Monitoring and responding was so much simpler.

 

[everydayupsanddowns]

I cannot correct, it's taking 4 hrs to get back down to normal. Corrected after 2 hrs and it just added it on end and hypo.

4-5 hour insulin action is pretty much exactly what you’d expect I’m afraid.

If you were mid-range from a correction after 2hrs the chances are the remaining half dose would push you hypo.

Can you see a pattern in your high readings? Is there a way to work from the other end and try to reduce your glucose variation before it gets too high? Maybe leaving some time between dosing and eating?

 

[Vamppir8]

4-5 hour insulin action is pretty much exactly what you’d expect I’m afraid.

If you were mid-range from a correction after 2hrs the chances are the remaining half dose would push you hypo.

Can you see a pattern in your high readings? Is there a way to work from the other end and try to reduce your glucose variation before it gets too high? Maybe leaving some time between dosing and eating?

Unfortunatly not, I don't get in bed till 1am getting up at 7am don't do it for me. Plus got chronic memory problems from epilepsy drugs, I will forget, or do it twice. I'm still putting peanut butter in fridge and milk in cupboard and we moved them a year ago. It's so ingrained now I'd do it after I ate again I know it.

 

[everydayupsanddowns]

Unfortunatly not, I don't get in bed till 1am getting up at 7am don't do it for me. Plus got chronic memory problems from epilepsy drugs, I will forget, or do it twice. I'm still putting peanut butter in fridge and milk in cupboard and we moved them a year ago. It's so ingrained now I'd do it after I ate again I know it.

Do you mean you are dosing after you have already eaten?

That could well be a fairly significant factor in your high levels after meals? It usually takes NovoRapid a good 15-30 minutes to get up to peak activity.

If you can get hold of a NovoPen Echo and use penfill cartridges rather than disposable pens you’d have a record of when you last injected - you are quite right, it can be so automatic it’s very hard to remember!

Maybe setting an alarm and/or timer on your phone could work?

 

[Vamppir8]

Do you mean you are dosing after you have already eaten?

That could well be a fairly significant factor in your high levels after meals? It usually takes NovoRapid a good 15-30 minutes to get up to peak activity.

If you can get hold of a NovoPen Echo and use penfill cartridges rather than disposable pens you’d have a record of when you last injected - you are quite right, it can be so automatic it’s very hard to remember!

Maybe setting an alarm and/or timer on your phone could work?

Plus I dont know my tea time its random whenever I can get it in, changes daily depending on hour of work. Im home alone all day if I double jabbed well....

 

[Lucyr]

Plus I dont know my tea time its random whenever I can get it in, changes daily depending on hour of work. Im home alone all day if I double jabbed well....

You could inject when you are cooking rather than when you’re eating it, to give the standard 15 minute prebolus time. Novorapid can be used in memory pens so you can check if you’ve already injected or not.