• Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.

Stubborn High levels Insulin not working as well

D

digihat

Well-Known Member
Relationship to Diabetes
Type 1
Good Afternoon Everyone

Hope the below makes sense

One thing I've been struggling to know how to deal with is when rapid insulin is not being as an effective a trend I have been noticing for me is that when sat down more being sedentary levels are rising more. I make sure to get up and move around every 20/30 minutes keep hydrated with water etc. Now I understand being more sedentary and having put a little weight on over Christmas this would affect my insulin sensitivity. If I’m not sitting down after lets say lying down afterwards the insulin works pretty well and I subsequently don't have as bigger spikes

Instinctively I want to chuck a correction in if I can see via libre that it doesn’t appear to be coming down enough but I know that If I don’t wait till near the end of the 4 hourish the rest of the insulin will kick in with the correction sending me low. Eventually it seems to kick in towards the end bringing my levels down enough back in to range more on the top side of my range. I set my target for 6mmol after meals if possible


I've been engaging more with some of my hobbies interest me that require being sat for longer periods which will be contributing to this just wondering what people might do in this situation described above?

Just feeling a little exhausted with it recently as I've been trending a lot higher than I usually do and I've hopefully finally got the right combo of basal and carb ratio for now baring the above mentioned

As i'm out of ideas making sure I'm moving keeping hydrated I could take more insulin but I find that tends to back fire as mentioned above I know spikes will happen which is fine it’s just for how long its staying raised and not coming down as much
 
Sorry to read about your current spikes.
If your BG comes back down to your target level after 4 hours, the spikes suggest to me that the dose is correct but your timing is off.
How far in advance of eating, do you pre-bolus?
Our bolus insulin has a fixed profile - the activity goes up after about 20 to 30 minutes and flattens off after 4 hours. However, food is not all digested at the same rate. For example, hypo treatments are fast acting but pizza is slow acting. In an ideal world we would time our insulin so the spike in the insulin profile matches the spike in digestion (and converting carbs to BG). This is near impossible so we will see a spike (or a drop if we bolus too early).
You may find the spike is reduced if you bolus a bit earlier before your meal.

The other thing I find is how much easier it is to fixate on spikes when I am sitting down with my phone directly in front of me. If I am busy and not looking at my phone, the spikes just pass me by.

And the last thing to remember (for now) is that CGMs have a tendency to exaggerate highs. If you finger pricked, you may find your spikes are not as high as Libre is telling you.
 
helli said:
Sorry to read about your current spikes.
If your BG comes back down to your target level after 4 hours, the spikes suggest to me that the dose is correct but your timing is off.
How far in advance of eating, do you pre-bolus?
Our bolus insulin has a fixed profile - the activity goes up after about 20 to 30 minutes and flattens off after 4 hours. However, food is not all digested at the same rate. For example, hypo treatments are fast acting but pizza is slow acting. In an ideal world we would time our insulin so the spike in the insulin profile matches the spike in digestion (and converting carbs to BG). This is near impossible so we will see a spike (or a drop if we bolus too early).
You may find the spike is reduced if you bolus a bit earlier before your meal.

The other thing I find is how much easier it is to fixate on spikes when I am sitting down with my phone directly in front of me. If I am busy and not looking at my phone, the spikes just pass me by.

And the last thing to remember (for now) is that CGMs have a tendency to exaggerate highs. If you finger pricked, you may find your spikes are not as high as Libre is telling you.
Click to expand...
@helli I generally aim to do about 25 minutes of prebolusing before most meals sometimes 30 at a push anymore levels will start to come down especially if I'm trending abit lower happened at the weekend went low while eating. Yeah I'm still working on getting the right formula for high fat meals and things like pizza lots of trial and error. As you say I know the spikes will come which is fine its more when they stay high for a long period of time and don't seem to be budging is when it starts to bother me.

Oh dont worry I know libre likes to exaggerate highs I've taken steps to stop me seeing my levels as much which hopefully should help, I finger prick for my doses for the above reasons unless when I'm in range as then its pretty close.

Thanks for replying 🙂
 
What bolus insulin you using, found fiasp works slightly faster than novorapid ever did.
 
digihat said:
Currently using novarapid which in general has worked okay for me
Click to expand...

Novo is fine, was on it more years than care to remember. Switched over to fiasp probably about 5 years back & it does get to work slightly faster, cuts prebolus time down by about 5 -10mins from own experience.

Also like it as it doesn't hang around for as long as novorapid, find by 3 1/2 hours it's finished & no longer active.
 
Sometimes spikes just last longer @digihat I had one that did that at the weekend for no reason at all. I resisted the temptation to correct it as I was going out and it dropped fine - just that bit later than usual. Some areas have slower or faster absorption.

If you know certain times or situations cause these longer spikes, you can always try taking a tiny amount of bolus before your main bolus. This tiny amount can then get working that bit earlier and reduce the spike.
 
digihat said:
I generally aim to do about 25 minutes of prebolusing before most meals sometimes 30 at a push anymore levels will start to come down especially if I'm trending abit lower happened at the weekend went low while eating.
Click to expand...
My point was that there is not one standard pre-bolus time. It depends upon what you are eating. Some carbs are slow acting so need little or no pre-bolus time whereas other carbs are fast acting so need a longer pre-bolus time and some carbs give less BG rollercoaster if you split your bolus.
It may be worth looking at what you are eating that spikes earlier and need earlier pre-bolus.

The other thing to consider is insulin resistance which takes the bolus longer tro start working. We are more resistant in the morning so may need to pre-bolus earlier. We are more insulin resistant when our BG is higher so again may need to bolus earlier.
 
helli said:
My point was that there is not one standard pre-bolus time. It depends upon what you are eating. Some carbs are slow acting so need little or no pre-bolus time whereas other carbs are fast acting so need a longer pre-bolus time and some carbs give less BG rollercoaster if you split your bolus.
It may be worth looking at what you are eating that spikes earlier and need earlier pre-bolus.

The other thing to consider is insulin resistance which takes the bolus longer tro start working. We are more resistant in the morning so may need to pre-bolus earlier. We are more insulin resistant when our BG is higher so again may need to bolus earlier.
Click to expand...
Thanks @helli yeah think I've pushed how far I can prebolus for the moment maybe I do need to split bolus more for some foods still working on the right formula for that. I do suspect my insulin resistance has crept up overall of late which is probably playing a factor in all this 🙂
 
Inka said:
Sometimes spikes just last longer @digihat I had one that did that at the weekend for no reason at all. I resisted the temptation to correct it as I was going out and it dropped fine - just that bit later than usual. Some areas have slower or faster absorption.

If you know certain times or situations cause these longer spikes, you can always try taking a tiny amount of bolus before your main bolus. This tiny amount can then get working that bit earlier and reduce the spike.
Click to expand...
Yeah that's what I'm finding is happening more now will come down eventually not necessarily to number I want but back in to range on the higher side which I will bring down at next meal. Oh that's a interesting suggestion thanks @Inka 🙂
 
If you want to try it @digihat i really do mean a small fraction of your bolus - half a unit or similar. Just enough to push down the rise, then deduct that amount from your bolus when you inject later. You’ll have to experiment with timings.
 
If you are more sedentary at the moment, it could just be that you need a bit more basal. Many of us find that basal need tweaking quite regularly, depending upon which basal you use, so it isn't something that is set for life or the year even. Many people need more basal in the winter when the days are shorter and they are less active than in the warmer months. With Levemir I have to adjust my evening dose on a night by night basis depending on what activity or exercise I have done or not done during the day. Everyone is different, but if you are finding your levels are trending upwards and you are needing corrections at each meal to bring them down, then most likely your basal dose needs slight adjustment.
 
digihat said:
I've pushed how far I can prebolus for the moment
Click to expand...
If you feel you need to take NovoRapid too early to avoid highs, perhaps Fiasp could be an option as suggested above.
It has its own quirks which take a while to get used to but I found it better with regard to prebolus times.
 
rebrascora said:
If you are more sedentary at the moment, it could just be that you need a bit more basal. Many of us find that basal need tweaking quite regularly, depending upon which basal you use, so it isn't something that is set for life or the year even. Many people need more basal in the winter when the days are shorter and they are less active than in the warmer months. With Levemir I have to adjust my evening dose on a night by night basis depending on what activity or exercise I have done or not done during the day. Everyone is different, but if you are finding your levels are trending upwards and you are needing corrections at each meal to bring them down, then most likely your basal dose needs slight adjustment.
Click to expand...
@rebrascora my basal needs have been creeping up last few months only by a 1 unit every so often. At the moment I'm floating in between two different amounts 31 which keeps more in the 7/8/9 with a 1:8 but avoids the lowes more often. 32 with 1:9 staying more in 4/5/6 but has habit of trending down more requiring a little sugar hit. I use Tresiba currently trying to keep those pesky night rises in check!

I find it doesn't tend to rise much after the bolus has finished baring the initial spike from the food. Its mainly not getting back down to the target I want and flattening out higher, then requiring a correction at the next meal which is not necessarily a bad thing. I have started getting to the point of doing different carb ratios for different time of days
 
helli said:
If you feel you need to take NovoRapid too early to avoid highs, perhaps Fiasp could be an option as suggested above.
It has its own quirks which take a while to get used to but I found it better with regard to prebolus times.
Click to expand...
Thanks for the suggestion I have wondered about asking to try it out! I have my last scheduled DSN appointment next week before they stop going down to twice yearly consultant calls ill float it then see what they say 🙂
 
You must log in or register to reply here.
Back
Top