Trurapi insulin

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Wendums60

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Type 1.5 LADA
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Hi all
I’m currently on eight units of Lantus early morning and late evening and eight units Trurapi before lunch and dinner. I’m still in a honeymoon period so still producing some residual insulin of my own.
However I’ve noticed since I’ve increased Trurapi . I’m still spiking yet my blood glucose plummets after I’ve eaten almost to hypo levels. I’m told to take trurapi immediately I start eating. But isn’t it supposed to stop the spike? It seems like it’s kicking in too late by causing the levels to just drop later . I’m talking a brunch at around 1.00pm and my levels now at 5.00pm are 3.4 , yet I still spiked immediately after eating at almost 15 , surely the insulin is supposed to stop that unless my own is kicking in as well .
Any thoughts , speaking to the nurse beginning of December, but this is the 4th time now
 
Try moving your injection time a little earlier @Wendums60 That way the insulin should reduce the spike a little. Be cautious and move it in 5 min increments, trying the new time for two or three days, then changing again if needed. You might also find that once you find the best time to inject, you’ll also be able to reduce your dose a little and thus avoid going too low later.

If your own insulin is kicking in later too, then experiment with a small carby snack prior to your usual ‘drop time’.
 
We use the term "prebolus" to describe injecting an amount of time before a meal, the injection of meal time insulin being the "bolus". The amount of prebolus time varies from person to person and at different times of the day and is different for different insulins. Ideally you are looking to time the insulin so that it's peak of activity hits your blood stream at the same time as your body digests the carbs in your meal and releases the glucose from them into your blood stream. If you are slow to absorb the insulin or quick to digest the carbs you ate then those things will impact how far in advance of eating your meal you need to inject. If you inject too far in advance of eating you will hypo before the food digests, so like everything with diabetes, it is about finding the balance for your body and the insulin you are using and the food you are eating and the time of day.

I am a bit of an extreme example, but when I was using NovoRapid which I believe is similar to Trurapi, I needed to inject my breakfast insulin more than an hour before I ate breakfast, but at lunch and in the evening, I just needed to inject 20-30 mins before I ate to prevent my levels spiking and then crashing back down. As I said this is extreme but I was slow to absorb that insulin and my digestive system is pretty fast. The important thing is to find what works for you at different meal times and as @Inka has mentioned, you start by increasing the time between injecting and eating by a few mins every few days until the spike starts to lower to an acceptable level. I used to spike up to about 15 every morning after breakfast and then come crashing down again a couple of hours later and it made me feel pretty rough, but now I can mostly keep it under 10 and that is loads better. Today I got it absolutely spot on and you can barely see where I ate breakfast on my Libre graph, but those are very occasional triumphs, so don't expect that to happen very often at all. Even people who are not diabetic spike after eating but mostly don't go above 10, so don't expect perfection but if you can experiment with carefully increasing your probolus timing you should manage to prevent levels going as high as 15 most of the time.

Work on just one meal at a time and it may help if you keep that meal roughly the same each day, so maybe a sandwich with 2 slices of bread and a bowl of soup for lunch each day as it doesn't sound like you eat breakfast and work on the timing for that particular meal although you can vary the variety of sandwich filler and soup, but keep the carb content and type of carbs about the same.

Out of curiosity, what do you typically have for lunch and evening meal because 8units sound quite a lot and if you are going low before your next meal, that suggests it might be too much.
 
rebrascora said:
We use the term "prebolus" to describe injecting an amount of time before a meal, the injection of meal time insulin being the "bolus". The amount of prebolus time varies from person to person and at different times of the day and is different for different insulins. Ideally you are looking to time the insulin so that it's peak of activity hits your blood stream at the same time as your body digests the carbs in your meal and releases the glucose from them into your blood stream. If you are slow to absorb the insulin or quick to digest the carbs you ate then those things will impact how far in advance of eating your meal you need to inject. If you inject too far in advance of eating you will hypo before the food digests, so like everything with diabetes, it is about finding the balance for your body and the insulin you are using and the food you are eating and the time of day.

I am a bit of an extreme example, but when I was using NovoRapid which I believe is similar to Trurapi, I needed to inject my breakfast insulin more than an hour before I ate breakfast, but at lunch and in the evening, I just needed to inject 20-30 mins before I ate to prevent my levels spiking and then crashing back down. As I said this is extreme but I was slow to absorb that insulin and my digestive system is pretty fast. The important thing is to find what works for you at different meal times and as @Inka has mentioned, you start by increasing the time between injecting and eating by a few mins every few days until the spike starts to lower to an acceptable level. I used to spike up to about 15 every morning after breakfast and then come crashing down again a couple of hours later and it made me feel pretty rough, but now I can mostly keep it under 10 and that is loads better. Today I got it absolutely spot on and you can barely see where I ate breakfast on my Libre graph, but those are very occasional triumphs, so don't expect that to happen very often at all. Even people who are not diabetic spike after eating but mostly don't go above 10, so don't expect perfection but if you can experiment with carefully increasing your probolus timing you should manage to prevent levels going as high as 15 most of the time.

Work on just one meal at a time and it may help if you keep that meal roughly the same each day, so maybe a sandwich with 2 slices of bread and a bowl of soup for lunch each day as it doesn't sound like you eat breakfast and work on the timing for that particular meal although you can vary the variety of sandwich filler and soup, but keep the carb content and type of carbs about the same.

Out of curiosity, what do you typically have for lunch and evening meal because 8units sound quite a lot and if you are going low before your next meal, that suggests it might be too much.
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Thankyou for your quick replies , I think you are spot on with the timing issue , so I will experiment with moving the trurapi forward by a few mins each day .
I typically have low carb bread ( Heylo ) poached eggs , sometimes a crumpet and banana , if I’m at work I have low carb rolls or rivita, with Philly cheese and ham or chicken , fruit and someone’s the low fat walkers crisps . Dinner tends to be chicken , veg , jacket potato which I know is a bit of a no no , sometimes , salmon , and very occasionally a naughty oven chips and chicken dippers , I also have some of the M&S count on us meals , which are great meals for one I eat lots of veg . Plus the low carb surreal breakfast cereal, so really trying to keep the carbs down . I’m on some courses next year so that should really help things . It may be I need to lower the dose slightly and inject earlier to catch the spike as you say . The nurse did say I could tweak I’d need be .
Thankyou so much
 
The recommended diet for Type 1s/LADAs is the same healthy diet recommended for everyone else @Wendums60 There’s no necessity to eat low carb and, in fact, control is usually easier if you don’t.

If you’re not eating many carbs, it could be your insulin meal dose is too high. Have you been shown how to carb count and adjust your own bolus/meal insulin?
 
If you are LADA then you do not need to eat low carb and in some respects this can be more challenging when using insulin. LADA is a slow onset form of Type 1 and a healthy diet for Type 1 is the same as a healthy diet for anyone who isn't diabetic. The trick is to take the correct amount of insulin for the carbs that you eat, not reduce the carbs to manage the diabetes. I think this mindset comes when people are initially misdiagnosed at Type 2 and then found to be Type 1 or LADA but have got into a routine of eating low carb.

Usually when you start on insulin they go with a rough guide of 1unit of meal time insulin to 10g of carbs. This can be too much for some people who are very insulin sensitive or are producing some of their own insulin still but it might not be enough for others who are a bit insulin resistant.
If you are using 8units of Trurapi for your low carb brunch and evening meal, then this may well be too much. Does your nurse know you are following a low carb way of eating? Please don't feel guilty about eating a jacket potatoes or occasional over chips. These are part of a normal healthy diet, you just have to learn to use your insulin to cover them and I am pretty sure that the 8units of Trurapi you have been told to take will be assuming you are eating such things regularly. ie. normal bread and potatoes and pasta and rice etc.
 
rebrascora said:
If you are LADA then you do not need to eat low carb and in some respects this can be more challenging when using insulin. LADA is a slow onset form of Type 1 and a healthy diet for Type 1 is the same as a healthy diet for anyone who isn't diabetic. The trick is to take the correct amount of insulin for the carbs that you eat, not reduce the carbs to manage the diabetes. I think this mindset comes when people are initially misdiagnosed at Type 2 and then found to be Type 1 or LADA but have got into a routine of eating low carb.

Usually when you start on insulin they go with a rough guide of 1unit of meal time insulin to 10g of carbs. This can be too much for some people who are very insulin sensitive or are producing some of their own insulin still but it might not be enough for others who are a bit insulin resistant.
If you are using 8units of Trurapi for your low carb brunch and evening meal, then this may well be too much. Does your nurse know you are following a low carb way of eating? Please don't feel guilty about eating a jacket potatoes or occasional over chips. These are part of a normal healthy diet, you just have to learn to use your insulin to cover them and I am pretty sure that the 8units of Trurapi you have been told to take will be assuming you are eating such things regularly. ie. normal bread and potatoes and pasta and rice etc.
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Yes , I was initially thought to be type 2 , but my HBa1c level was through the roof at 121
So they said defo type 1 it’s now down to 58 . Nurse knows I’m watching my carbs so yes , I’m thinking 8 is a bit too high , as I said she did say I can tweak . It’s just getting the balance right which she did say would take a bit of time , both my dad and grandad died from complications of type 1 so it’s genetic , although I went through an extreme period of stress which they said would have caused the high level antibodies which attacked my pancreas . I’m booked on some courses in January and February which includes carb counting . I will at some point stop producing my own insulin but the consultant said that could be up to a couple of years
 
There’s an online carb-counting course @Wendums60 It’s pretty simple and makes things a lot easier:


Here’s some basic info from Diabetes U.K. too:

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...
www.diabetes.org.uk www.diabetes.org.uk

It’s not carbs that are the issue with Type 1. It’s insulin. Any high sugars are almost always due to wrong insulin not ‘bad’ food.
 
Inka said:
There’s an online carb-counting course @Wendums60 It’s pretty simple and makes things a lot easier:


Here’s some basic info from Diabetes U.K. too:

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...
www.diabetes.org.uk www.diabetes.org.uk
Click to expand...
 
Yes I know about Bertie , my nieces husband is type 1 and has a pump , he recommended it , the nurse said though that it’s more for people who don’t produce any insulin at all ?
 
Wendums60 said:
Yes I know about Bertie , my nieces husband is type 1 and has a pump , he recommended it , the nurse said though that it’s more for people who don’t produce any insulin at all ?
Click to expand...

No, it’s for everyone, I think 🙂 I still produce tiny amounts of insulin decades after diagnosis, and my honeymoon period lasted around 7 years. Throughout all that time I counted carbs (and still do, obviously).
 
Inka said:
No, it’s for everyone, I think 🙂 I still produce tiny amounts of insulin decades after diagnosis, and my honeymoon period lasted around 7 years. Throughout all that time I counted carbs (and still do, obviously).
Click to expand...
Ok , that’s very helpful, I will definitely have a look at that .
Thankyou xx
 
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