Think my Novorapid is too slow!

Hi, I did a DAFNE course in 2005, and have been 'doing DAFNE' ever since, except I've been lapsing for the past few years and my HBA1c has been steadily increasing. Obviously this has to do with my non-adherence to DAFNE principles (which are great in theory, but most of the time it's difficult to keep motivated and, to be honest, thinking about avoiding horrible complications is not really such a great motivator as it tends to just leave me feeling a bit depressed). However, there is another issue that I have, and that I've had since I was first diagnosed with Type 1 (I was 30 at the time). This is that I think I digest food quickly, and that the rapid acting insulin that I take (Novorapid) is too slow and doesn't match my digestive process. My blood sugar seems to rise to very high levels for about an hour after taking the Novorapid, and I've always been told that my blood sugar will rise and that this is unavoidable. I'm pretty sensitive to insulin and hypos and am on 1:1 ratios - I think that if I increased my ratios I'd get more hypos. I've been trying to find literature about this, but the closest I got was an article about the timing of the injections. Is there any information out there about the timings of digestion and rapid acting insulin? And how high should blood sugar rise after eating, even after taking rapid acting insulin?

Thank you.

Hello Sheila. I'm a brand-new graduate, so don't feel particularly qualified to advise you (yet) as I'm still just getting my head around the principles involved, but we were told that Novorapid starts to work within 5 minutes and carries on working for 2 to 3 hours. I too notice a high level about an hour after a dose of Novorapid at breakfast (reading taken pre-driving) but it's always down again before lunch, so I haven't worried about it. Hope that's helpful?
Regards, Anne.

Although not a HCP please consider my perspective:
If you were not Diabetic and had a full set of fully functioning Islets of Langerhans containing their insulin secreting Beta cells...your blood sugar would still rise after eating. These cells need sense the rising blood sugar for them to secrete insulin.
So don't worry about it. High BGs after eating are normal and we need focus on getting the levels right prior to our next meal.
We are all individuals. We all have different digestion rates for particular types of foods. Some people find they don't need count some types of carbohydrate...and others of us find it absolutely necessary to tot up all carbohydrate.
I'm afraid that over the years I have regularly seen 14s, 15s and 16s after meals. I take Humalog QA and cope with my uptake rate by taking this insulin 15 to 40 minutes before eating. Bit of a pain when you guess the CHO wrong...but easily coped with by a second, compensation dose immediately after the meal.
If you made detailed notes and can recover sufficient data from the diary figures of your 8 years since DAFNE you may be able to pick out some of the meals that have a marked effect on your BGs. Some of them may surprise you.
I always find eating out a problem. Many a Chef adds sugar to his main course sauce to give it a shine...how do we know that and compensate with the requisite amount of insulin? I now always tell restaurant staff that I am Diabetic and ask them to let the Chef know no added sugar when ordering any meal now.
After 34 years I still muck it up though. Lots of things get in the way of our understanding the complicated thing that is the human body. Don't worry...just do your best.
Regards
Garry

Something I have had great success with recently after hearing about it from Gary Scheiner (author of Think Like a Pancreas) is injecting insulin directly into muscle rather than fat. It gets absorbed twice as quickly. I'm on Humalog which takes about 3 hours to fully absorb, and 90 minutes to peak, but injecting into muscle means it is all used within 90 minutes with a peak at about 45 minutes.

I have only used it so far for when I am high and want to get back down into the normal range quickly, but my HbA1c has gone from 7.2 last year, to 6.1 6 months ago, and 6.2 last week. I inject into my bicep, but I was told that quads and calf muscle could also be used. I haven't had such a good result from either of those (and it can be difficult to inject there if wearing trousers, so I've stuck exclusively to the bicep muscle.

It is also good when I know I am high, but will be exercising within two hours, as I can inject into muscle to bring my down to a good range, and know that all QA will be consumed before I exercise reducing the risk of a hypo during the exercise.

In your case, you could proceed cautiously, and split your dose into two equal injections - one in your normal area of injection, and one into the muscle. Then based on your results, you could increase one and decrease the other depending on what works for you.

Cheers,
Warwick.

Experimenting with the timing as Garry suggested would be my personal choice. Allowing the insulin to get in and going strong would be advantageous to your quick digestion. I injected, and still do bolus with pump, 30 minutes before I eat, in order to get the mid meal spike down as low as possible, so 1.5 to 2 hours later. It works a treat. So definitely worth experimenting with.

Warwick suggestion is good too, if your up for that....

How much of a rise in BG have you observed.....?

Hi everyone - thank you so much for your interest and speedy replies! The injecting into muscle sounds intriguing, but isn't it a bit sore? And wouldn't I need longer needles (I have 6mm at the moment)? It definitely sounds like something I'd look into, though, thanks for the suggestion. My BG seems to rise to as high as 19 or 20 an hour after I've eaten, and that's when it's at between 6 and 7 before I eat. This can't be right, surely? I wondered whether I should change my ratios, but it seems to be more to do with when it's rising rather than the amounts? I'm now also seriously considering taking my bolus dose early, though this might not be achievable each time I eat, as sometimes it's more spontaneous than others! Thanks for all your suggestions.

Hello,

I don't find it sore at all injecting into my bicep. I think it may have hurt a bit injecting into my calf, but I stopped doing that. Everyone is different though, so it would be a case of experimentation.

I use 4 mm needles whether injecting into fat or muscle, but I have very little fat between the skin and muscle of the bicep. An 8 mm needle may be required if more body fat is carried.

If your BGLs are back in a normal zone 3-4 hours after eating, then increasing your QA dose would be a bad idea as it will likely lead to hypos. You would want to look at injecting earlier before meals so that the peak action of the QA matches the peaking of the BGs after eating, or trying the muscle injections.

sheila said:
Hi everyone - thank you so much for your interest and speedy replies! The injecting into muscle sounds intriguing, but isn't it a bit sore? And wouldn't I need longer needles (I have 6mm at the moment)? It definitely sounds like something I'd look into, though, thanks for the suggestion. My BG seems to rise to as high as 19 or 20 an hour after I've eaten, and that's when it's at between 6 and 7 before I eat. This can't be right, surely? I wondered whether I should change my ratios, but it seems to be more to do with when it's rising rather than the amounts? I'm now also seriously considering taking my bolus dose early, though this might not be achievable ea fi
time I eat, as sometimes it's more spontaneous than others! Thanks for all your suggestions.

When our dose adjusting, then the pre meal test is the most important one, but once that's all done its good to go after the mid meal numbers.....

for me these were causing problems, really tired in the afternoons and also pushing up my HbA1c.....

In Sheilas case its definitely worth tackling with numbers that high.....

If your on target by the next meal even when your getting the highs 1 hour to 2 hours after injecting then its all about timing...........you need to get the peak effectiveness of the insulin, which is quoted to be 1-2 hours after injecting, to match up with the peak of the digestion, everyone digests at different speeds, same with the insulin action........so you need to get the insulin in a lot quicker than 'at the time of eating' or 'just before you eat', you need to experiment with it, get it in 15 minutes, 20 minutes, 30 minutes, sometimes more before eating...

the results will e good......

When you inject before having a meal you risk putting yourself in a position where for what ever reason you can't complete your meal.
This is 1 topic I disagreed with Dafne since Dafne teaches us to inject after eating.
My view changed when I injected before I had started to eat my lunch, when the fire alarm went off, for real, complete get your self out the building quick.
I had injected 6 units of AQ humolog.
I can tell you the next 15 mins looking for and explaining to the fire marshal that I needed carbs is something that reminds me to eat then inject.