Split injections

[Fe 82]

Due to abnormally and frustratingly high levels last night, causing the usual increased dehydration and tiredness (which I am still suffering from - I am not feeling the diabetic love today 😡), I asked my dietician what I had done SO wrong that had caused my wholegrain pasta to send me nauseatingly through the roof for about 18 hours. She advised one solution - when eating a low GI meal with a pre-consumption reading of above 10, one can take a corrective injection before the meal, and a carb counted injection afterwards. Does anyone do this? This is the first time I have been told about this, but theoretically makes sense as you are matching the bg pattern more closely...
x

 

[Northerner]

It's a new one on me Fe - did the dietician say how long after eating to take the carb-counted dose? I know there are some reports here of people who do split their injections for some foods that have a longer time converting to glucose, so that there are two insulin 'peaks' of fast-acting. On pumps I believe a lot of people 'dual-wave' the bolus insulin - a proprtion taken with the meal and then the remainder trickled in over a period of a few hours.

 

[Becca]

It's a new one on me Fe - did the dietician say how long after eating to take the carb-counted dose? I know there are some reports here of people who do split their injections for some foods that have a longer time converting to glucose, so that there are two insulin 'peaks' of fast-acting. On pumps I believe a lot of people 'dual-wave' the bolus insulin - a proprtion taken with the meal and then the remainder trickled in over a period of a few hours.

Yep, on the pump for pasta we would do the bolus for the pasta and any correction and make sure it was on a dual wave over 3 hours (at the moment.) Another thought is to bolus for food 15 mins or more before if BMs are high so it will start to match the food peaking. Although, you'll need to know the carbs going to be eaten beforehand etc....we used to do this for breakfast with R to try and combat the breakfast spike.

 

[Fe 82]

No time instruction was given, merely to inject within the 15 mins usual guideline. I have to say Im not jumping for joy at the thought of injecting more times in a day than the 4 I am now. However if it means getting the levels better then anything is worth a try.
Similarly my DSN said that if people want a carb snack half way through the afternoon, then as long as it is 2 hours after the last basal bolus injection, then it is fine to take another injection to match the food. Another new one, but again I think I would rather have the basic 3 meals a day and only inject that many times, than increase the amount of needles going in me...

 

[Northerner]

I'm the same as you there Fe, I'd rather not do any more injections than necessary. I've found that I only snack now if I've gone low. I think in the early days I used to deliberately inject more with my meals than I needed, so I would go low later and need a snack! The porblem with injecting two hours after your last bolus is that it's very difficult to know how much circulating insulin you have (easier on a pump, of course!). Two hours can only every be a very rough guesstimate of your last bolus peak - it might be 1 hour or 3 hours, and it may still be influencing you up to 5 hours later!😱

 

[Patricia]

Hi Fe

My son is now on the pump (and he dual waves all pasta, rice, pizza, chips on it, etc) BUT when he was on MDI we found that we simply *had* to split his bolus for pasta and rice in particular (this was originally because he would hypo like nobody's business with a full bolus up front; later we discovered the long spike). He appears to spike and stay that way for about 10 hours...We never got on top of it completely on MDI (and still haven't for the pump!), but what we did worked pretty well:

30 or 40% of bolus up front, including correction.
Remaining bolus 1.5 or 2 hours after. He worked best on two hours split, but as we have to test the tail end of the bolus before we go to sleep (to check he doesn't drop from it), we sometimes only did 1.5 hours just so we could go to bed before 1 in the morning!

The 'danger' point of this regime of course is when the first bolus is at its peak, which is why the two hour split worked best...one was wearing off a bit and then the second dose would come in. We did have a couple of relatively spectacular mis-doses, when he gave the second dose and then immediately realised he felt low: was 2. something and had a whole dose to get through...But then of course the pasta eventually hit and it all settled.

We once accidentally had to give him a smaller proportion of the bolus a whole hour after eating pasta -- so like 70% of the overall dose all at once. Which was a complete guess. It showed just how slow pasta is with him: in that hour, he had not gone up one jot!

My son has always but always wakes up high in the morning after eating pasta even at 6pm or 7pm the night before. This is getting better with the pump, but is still problematic. Another suggestion that our consultant thought might work is actually to increase the evening long-acting dose by 1 unit to account for this. We got the pump before we could try this, but it might work for you?

Finally, we did actually do extra injections as long as there were two hours before and two hours after a meal. With a growing child, it is almost impossible to consistently make it so many hours between meals. It was nerve-wracking though because as Northerner says, we could never be sure of the amount of active insulin -- and more than once he did come down too low from our 'stacking'. It's all guess work...

Hope this helps?

Patricia

 

[randomange]

Hi Fe

I split my injection for certain foods, like pizza, or rice. It's pretty much trial and error to find out what works for you, but I generally do 50% before the meal and 50% two hours later.

With snacking, on DAFNE we were told that we can either take an injection to cover it, or take extra insulin at the next meal (as long as the next meal is less than two hours away). They said that as long as you were injecting to cover carbs that you were eating, and you knew your carb ratio, then it's fine to inject, because the insulin is covering the food.

I have to say, this is very much my attitude. The only times I have problems is if I have miscounted the carbs I'm eating, but that's a risk you'd be taking whether it's a snack or a main meal. I don't mind taking the extra injection, but I can certainly understand why other people do! 🙂

 

[Fe 82]

Hmm thanks for your responses guys - really interesting that the second of the split injection you give circa 2 hours later...I guess that would make sense, because if you gave one soon after you eat, are you really going to react differently than to having it all at once before the meal? Surely the time difference is too minute to qualify for said split.
Saying this, and I know its all about trial and error, I have just tried a split dosage with a sweet potato meal, with a pre-meal injection to cope with an abnormally high level and a post-one straight afterwards for the food...we'll see what happens!
The doctor today also supports this dual method, so that's doubly reassuring.
Thanks again everyone.
Fe x