What’s happening? I inject novorapid, and eat exactly 10 mins after the injection. Otherwise I always go into a hypo?? Why does that happen ?

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Upset Racoon

Upset Racoon

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Relationship to Diabetes
Type 1
Thank you for all your great, encouraging answers on my last post, sorry , it takes me a while to .. reply

I don’t officially want to follow a strict low carb diet . I have been managing fruit ( about 30+ grams of carbs plus greek
yogurt ) and that’s sometimes an hour after eating say 40g carbs for dinner . Does that sound risky for a diabetic to do? It did spike to 10 yesterday /. does nearly everyday actually
Can you eat high carb as long as it’s not too close to
your last meal / don’t have a clue !!

This evening I injected 7 units of novorapid for my dinner .( 45g of carbs ) hummus, sausages, mixed vegetables and mashed potatoe . I meant to eat exactly 10 mins but accidentally ate it 12 mins after . Around 20+ mins after ? HYpo . libre says 3.6
I’ve tested properly before and it says 2.8 sometimes . I absolutely hate this . It’s all way too much and I am never going to come close to succeeding with it . and yet the diabetes team? say how well I am doing with it . :(

My lantas basal is 11. I don’t know how to properly do the official test ( I’ve read it , still don’t have a clue sorry .)
 

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So I’ve of course , had two sweets. Which J guess now, will cost me a spike . My blood sugar always seems to go low at around 2 am too
so have to have a biscuit and a sweet (still not the suggested 12 + grams of carbs) I find that’s usually enough to get me to 8 ( usually just a 7g carb biscuit without a sweet : S everything seems odd
 
Upset Racoon said:
and yet the diabetes team? say how well I am doing with it
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Look at the graph! And if that's not obvious enough, it says 95% in range. That's why the diabetes team says you're doing well.

You're going hypo because 7 units is too much for what you're eating. The difference between 10 and 12 minutes makes no odds: the graph's going strongly and obviously down.
 
It looks like you have now adjusted your range down to 8 instead of up to 10 as I suggested in your previous thread. You are causing yourself anxiety by making your range far more narrow than it needs to be. 3.9-10 is the standard range and you only need to keep your BG within that range 70% of the time to be doing really well. You are trying too hard to keep that top level artificially low and that is leading to hypos. Please put your upper target range up to 10 and don't worry if your levels spike above it occasionally....because that is normal.
You will burn yourself out trying to hit some totally unrealistic target that even non diabetic people would struggle to achieve with a functioning pancreas. It is OK to spike above 10 once or twice every day as long as you don't stay there for hours on end. Please cut yourself some slack.... We are all telling you the same thing. You are trying too hard. Make your target range wider and relax.
 
Upset Racoon said:
I don’t officially want to follow a strict low carb diet . ... Can you eat high carb ...
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You don't have to eat low-carb. Type 1s can eat as much carbs as we want, provided we get our insulin right.
Upset Racoon said:
This evening I injected 7 units of novorapid for my dinner .( 45g of carbs ) hummus, sausages, mixed vegetables and mashed potatoe . I meant to eat exactly 10 mins but accidentally ate it 12 mins after . Around 20+ mins after ? HYpo . libre says 3.6
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Bruce is right: 7 units of insulin seems too much for 45g carbs! That's the first obvious explanation for why you went hypo.

I mean, that's an insulin-to-carbohydrate ratio (ICR) of 6.4; I've read that most people have an ICR somewhere in the region of 8 to 12. What ICR have you been using?
Upset Racoon said:
My lantas basal is 11.
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And in your second post you say you're frequently having hypos around 2am. That's the second obvious problem: if you're often going hypo overnight, your basal is too high.

As for the attitude of your diabetes team: Keep in mind that the Libre graphs will only show a hypo lasting for more than 15 minutes. So, if you're often having hypos but correcting them immediately-- your team won't know that unless you tell them. If you tell them, they will tell you to change your ICR and reduce your basal.

PS I really hate that Partha Kar tweet! 70% time in range is not ideal. Higher time in range is better-- BUT ONLY IF it can be achieved without excessive hypos and without harm to your mental health and wellbeing and quality of life. Do talk to your team, try using a little less insulin, see how you get on, and let us know! Wishing you all the best.
 
Spathiphyllum said:
PS I really hate that Partha Kar tweet! 70% time in range is not ideal. Higher time in range is better-- BUT ONLY IF it can be achieved without excessive hypos and without harm to your mental health and wellbeing and quality of life. Do talk to your team, try using a little less insulin, see how you get on, and let us know! Wishing you all the best.
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Yes, but that tweet relates to a range of 3.9-10 and the OP is using a range of 3.9-8.0 by the looks of it, maybe 8.5 and achieving 95% for that narrower range, so 100% TIR for the normal range and the OP is still suffering from anxiety about their achievement even though it is a truely exceptional result. You really have to be careful not to feed people's anxieties and make sure they have realistic targets. There is very minimal risk to long term health from getting 70% TIR and this is a much better measure of diabetes management than HbA1c. Yes. it is nice to get a bit higher and I am consistently about 85% but aiming for 100% TIR all the time is very dangerous mental territory.... which is where the OP seems to be with this.
 
If you’re calculating insulin for fruit but not eating it for an hour then that will send you hypo @Upset Racoon 7 units for 45g carbs seems like a lot to me .

Do you know the profile of the insulin you’re using? Novorapid starts working 20-30 minutes after injecting and peaks an hour later but will still have some impact up to 4 hours after. If you are injecting too much insulin for the food you’re eating at the time then you will go low so if you’re including the carbs in your fruit but not eating it at that time then you’ll go low.


As others have said your basal may well be too high which is causing the night time lows but it also depends if you eat late and have fast insulin before bed as any insulin within that 4 hour window may be bringing you down.
 
rebrascora said:
Yes, but that tweet relates to a range of 3.9-10 and the OP is using a range of 3.9-8.0 by the looks of it, maybe 8.5 and achieving 95% for that narrower range, so 100% TIR for the normal range and the OP is still suffering from anxiety about their achievement even though it is a truely exceptional result. You really have to be careful not to feed people's anxieties and make sure they have realistic targets. There is very minimal risk to long term health from getting 70% TIR and this is a much better measure of diabetes management than HbA1c. Yes. it is nice to get a bit higher and I am consistently about 85% but aiming for 100% TIR all the time is very dangerous mental territory.... which is where the OP seems to be with this.
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The thing is, I don't think there's a necessary correlation between the level of anxiety people feel and the TIR target they're aiming for. Some people will aim for 70 and feel a lot of anxiety about it; other people will aim higher and not feel anxiety about it.

The ideal of course is to aim high but/and not get anxious about it or distressed if you fall short. Same as with everything else in life. We don't tell children 'do not try to do well at school, it will only make you anxious.' We tell them 'try to do your best, and if it doesn't work out, that's ok.'
 
Spathiphyllum said:
PS I really hate that Partha Kar tweet! 70% time in range is not ideal. Higher time in range is better-- BUT ONLY IF it can be achieved without excessive hypos and without harm to your mental health and wellbeing and quality of life.
Click to expand...
I think he's taking that into account: if you're trying for over 80% there's a higher chance you're heading for some kind of burnout. So 70% is fine (it's higher than most people achieve) so once you're there that's good enough.

And 95% on a range of 3.9-8.0 is insanely good, just as the occasional day or two I get of 100% (in 3.9-10.0) is very good. But long term, it's too good to want as a target. (Absent hybrid closed loops or other similar technology.)
 
Totally agree @Bruce Stephens The relief of loosening your targets a little is massive. Torturing yourself about your results is pointless and damaging. Live your life and aim for 70.

@Upset Racoon Others have already answered, but leaving a gap between your main meal and dessert (fruit) means it’s better to split your bolus. Bolus for your main course, then bolus for your dessert when you’re about to eat it.

10 mins? 12 mins? 9 and 1/2 mins? It doesn’t matter. There’s no magic number. I totally get why you’re clinging to things like that because I’m prone to do the same. But it becomes a false talisman. Relax a little. It takes practice to properly relax but once you get the hang of it, then you’ll feel the benefits. It’s so tempting to ‘want to do everything right’ but Type 1 doesn’t work like that. We’re not machines.

As an aside, if you’re going hypo a lot, you’re almost certainly taking too much insulin. Hypos are something to avoid as much as possible. Firstly because they’re potential dangerous, and secondly because they’ll blunt your hypo awareness, which is potentially dangerous too. Better to be a little high, than a little low.
 
Something else that occurred to me..... If you have set that upper limit at 8.5 because you have read that that is the limit for Type 2 diabetics after food..... the critical piece of information is that that is 2 hours after food. Levels will spike higher within that 2 hour period, but the important thing for Type 2 diabetics is that their body is bringing it down again by that 2 hour mark. That is guidance for Type 2 diabetics using finger pricks, not Type 1 diabetics whose insulin response will often be slower because we have to inject it, but also our Libre is showing us what happens before that 2 hour point and people's levels very often are higher before that 2 hour point even non diabetic people. The important thing is that it comes back down into range promptly and not too low if you are injecting insulin.

Anyway, it just hit me that perhaps you had read about 8.5 being an upper level somewhere and that you need to keep below that all the time, but you absolutely don't and it does not do you any harm going above 8.5 as long as you come back down again promptly.
 
Quite right @rebrascora The Type 1 targets are very different from the Type 2s and we don’t even have a 2hr target, just to be back in range by the next meal. That’s so much more do-able and realistic. Trying to avoid all spikes isn’t realistic and just means you’re likely to be fighting hypos or your daily routine is interrupted as you have to top-up with carbs to do simple, basic activities.

@Pumper_Sue made a really good post recently relayed to excessive control/fear. I’ll have to Search for it. I’ve had Type 1 almost 30 years but I found her post reassuring and it’s had a positive affect on the way I think (thanks, Sue 🙂 ) It’s far too easy to get obsessed with perfection and unnecessarily tight control. It’s a horrible path to go down as it takes over your life.
 
Hope you are able to cut yourself some slack, widen your target range, and celebrate your successes @Upset Racoon - you are doing really well. Perfection isn’t really possible with T1, it’s a cantankerous machine, and we only have access to controls on the front fascia - most of the levers and switches are round the back!

Oh, and one other observation - I’ve been prebolusing for breakfast and lunch for years (dosing then leaving a gap before eating). Mostly 10-20 minutes-ish, but sometimes 30 or 45-60 minutes depending on the year and the season. But I have never, in all that time, been able to prebolus for my evening meal. It always makes my hypo. For evening meal I just dose (or split dose) and eat.

It doesn’t make any logical sense why my body should respond differently for that one meal. But after 30 odd years I’m past looking for logic where t1 is concerned. I just spot whatever patterns I can. and work around them 🙂
 
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