Insulin types and doses - Basel/Bolus doses - Novapen 5

Hi All

New to the forum so I hope the following question is OK - Been a T1 for just over a year having had serious necrotic pancreatitis at Xmas 2014.

I am on Innolet Insultard, one jab in the morning and one at night if my BG is high. I have done a lot of reading, the latest on basel/bolus dose
insulin. One thing I suffer with is post meal, BG spikes. I eat the best 'diabetic' meals I can (Shredded wheat, Livlife bread, no mash or chips
or pizza but the odd gingernut) but I still spike from 6.0 to 11.0, typically, and it takes a few hours or a good 2 mile, post meal walk to get it
back down below 7.0. I am committed to 'doing my best' and walk 5 to 7 miles a day, kayak, swim, ride a bike, have lost 7.5 stone in 2015
(I was VERY overweight) and have even purchased a Freestyle Libre to monitor my numbers.

The question: Should I be using a bolas dose 'pen' before meals to combat the spikes or should the Innolet be enough?

I have been reading about Novapen 4 or 5 and NovaRapid cartridges and I have an appointment with my GP next week to discuss getting
one. Thoughts?

Thanks

I had never heard of Insulatard InnoLet, I had to look it up. It's a long-acting insulin that starts acting after about 1.5 hours, peaks between 3-12 hours, and lasts up to 24 hours.

When I was diagnosed 5 years ago, I was put on a long-acting insulin twice a day for the first 14 months. The reason for this is that at the time of diagnosis, we are usually still in the honeymoon period where our pancreas is still making insulin, so to avoid lots of hypos, basal insulin is prescribed, and that can work well. I was getting HbA1Cs below 7 while I did this with a very careful diet, avoiding anything sugary, and foods like white rice which would send my BGLs into orbit. Like you, I also saw lots of spikes after the meals, but before each meal time, I was usually in a good range, so my endo was quite happy.

Once your honeymoon period is over, you are much more likely to be prescribed basal and bolus together. That certainly helps with the post-meal spikes, but also can lead to more hypos.

Do you know if your honeymoon period is over? As the beta cells slowly die, you go from needing a small amount of insulin to needing more to get the same BGL levels as previously. Once the honeymoon period ends, your need to make changes stops as you'll reach a state where because all of the beta cells are now dead, the amount of insulin you need to inject stays largely the same from day to day. If it is over, then it could be worth looking at quick acting insulin. If it isn't, then you may be fine to stay as you are for now. That will be a decision for your endo, but it would be worth asking them.

It sounds like you are doing fabulously well though, so don't stress about it too much. While quick acting insulin certainly helps, especially when you want to get down from high levels quickly, it can still be frustrating to manage BGLs and hypos tend to occur more often and more rapidly than with just basal insulin.

While most T1Ds will use a mixture of short and long acting insulin if injecting (and just short-acting if on a pump), there is a growing number of T1Ds who are successfully switching to a low-carb diet to avoid the need to worry about large shifts in BGLs due to lower insulin doses. There are articles about this such as http://www.dietdoctor.com/low-carb-manage-type-1-diabetes and also some books which are helpful are:

The Art and Science of Low Carbohydrate Living by Jeff S. Volek and Stephen D. Phinney. The authors, both doctors, promote cutting carbohydrates down to a minimum and using fat in place of carbohydrate as a fuel source. Both authors have implemented this diet for several decades with no ill effects.

The second book is Dr Bernstein’s Diabetes Solution. Dr Bernstein promotes a low carbohydrate diet for diabetics and is type 1 himself. His reasoning is that lowering the intake of carbohydrate requires much less insulin and therefore errors in the amount injected are much smaller leading to much less serious consequences.

Hope that helps.

Hi

Thanks for the input - I was suffering from quite a few exercise induced, medium hypo's in a week however the Libre has been a great help
to spotting them coming and doing something about them before they happen. I would say that around 50% of the time, I am able to do some
kind of post meal exercise to combat the spike however 50% of the time I can't and the down side of the Libre is that I can now see how high
my BGL gets and for how long in these cases.

I shall push for a Novapen + Novarapid and see if this has any effect - If it does, gerat - If not, I will stop using it.

Thanks again

JD

Well thanks for that Vic , this new word of Spike has only recently crossed my path in diabetic control , but now i am on the Forum i hope to address that .

I have been a T1 for 43 years and like most old hands are a little annoyed at the BSL / HbA1c goal post migration .
When first diagnosed in 1974 I was told that an HbA1c of 8 would put them all out of a job , but despite leading an active life until very recently where Arthritis of the spine is slowing me down my HbA1c has remained there or there about .
With less mobility now I am being persuaded to lower it , which I take on board , but i am finding it difficult to say the least .
My Dietician is trying her best , but between us we are not doing to well , but perhaps its me being impatient .

It was suggested to me by another diabetic that perhaps a pump is the answer but from what i have viewed on Forums they are harder to manage than the insulins i am currently on .
I have always done about 8 blood sugar level tests a day [ though some are just checks to see whats going on ] but i have recently been given a Freestyle which i find easy to use but hard to comprehend , as the suggested insulin doses are well below what i would normally have taken and some days i seem to be riding on a spike which i find counter productive short term and insanity on the long term

Hopefully things will improve but the signs so far are sole destroying