Struggling with Novorapid

[Quizzical]

Hi.

I'm getting rather depressed trying to find some consistency with using Novorapid. I'm on a basal of Lantus in the mornings, and following the last meeting with my GP, he suggested introducing Novorapid to deal with the spikes in BG at lunchtime and at supper time. Initially, 2 units before the largest of those two meals.

Reducing the basal from 14 to 13 or 12, and starting Novorapid 2 units at 30 minutes before supper still resulted in a spike up to 16. I tried varying the time of the injection before the meal, but haven't yet succeeded in getting it right! Today, I have moved the bolus dose to pre lunchtime.

So far today:

8am BG 7.2 (higher than usual, which is around 5.5)
9.39. Lantus 12 units
9.40 breakfast 8g carb
12 BG 8.8
12.05 Novorapid 2 units
12.35 lunch 38g carb
13.00 BG 7.8
14.20 BG 15.2

The results were recorded on my Freestyle Libre and occasionally checked on with a finger stick test.

I have ibs, and my diet is difficult to predict.

Time in range is 60%. Suggestions on Libreview suggest addressing glucose variability.

Thanks for your help!

 

[Tdm]

Are you type 1? I know nothing about t2, but if t1 i would say you need more novorapid. The typical starting point is 1 unit novo for 10 carbs so typically one unit before breakfast, and 4 before your lunch in the above example.
You are taking 1 unit novo for 18 carb which would only be correct if you are very insulin sensitive and or perhaps still in honeymoon.

Not sure are you reducing your lantis? Thats a basal/ long acting insulin, isn't it. Your basal is there to mop up sugar your liver produces, and once you get it right you pretty much leave it as it is ...basal isn't adjusted for food.

A 15 min prebolus of novo is normally fine for me, no prebolus if particularly low gi or high fat - dunno about ibs.

Would you be able to post your libre chart, would help us advise? Also, your type and when diagnosed would be helpful. Have you done a basal test?

 

[Quizzical]

Hi Tdm

Thanks for your reply

I’m a t2 on steroids and have been both for many years. Started Lantus about a year ago.

If I can manage it I’ll post a graph:

 

[Inka]

I too think you might need a little more Novorapid @Quizzical The other option is to keep the lunch NR the same and slightly reduce your carbs. I would imagine the doctor has started you on conservative doses of NR for safety.

 

[Quizzical]

I think you are right about my GP, Inka. I see in David Cavans book, that if your total insulin dose (including basal) is less than 30 units a day, use a half unit for every 10 gams of carbohydrates. I am now trying to bolus for supper as well as lunch (naughty, but just a one off and I’ll check with GP if it works). I’m not generally eating loads of carbs. My BG sometimes sinks to 3.9 at night so I need to keep an eye on what I do.

 

[Inka]

Absolutely - always err on the side of caution to avoid hypos as much as possible.

 

[Tdm]

I'd also suggest reducing your prebolus time....if that graphs goes with the timings you have previosly given, it looks as if the novorapid kicks in before your meal has started digesting much, so initially it goes down, then right up at about the time when novorapid is running down (about 3 hours). If you increase the amount of novorapid but keep the same timings you may go hypo. Was it a low GI / high fact meal? Cos it seems to have taken a while to peak your sugars. You may not need to prebolus at all for such a meal. Or even split your novo (eg half just before real, half an hour later)

Also if you go low at night, maybe your basal is too high? Bsst to get basal right first, then sort out bolus.

 

[Quizzical]

Thanks for your reply. I see that the graph I sent you was from yesterday, so doesn’t tie in with today’s readings, which are below.