everything was humming along fine with humalog and lantus for me, until one morning the thing i ate every morning spiked me to 180 at the 2 hour mark (i’m usually at 100-120 with the same meal). things came back down really fast though - down to 65-70 at the 4-hour post meal mark. after it happened twice in a row, i figured maybe my honeymoon period is coming to an end and i need more insulin. i upped my dose by one unit, then by two. my 2 hour test was still 180 - how could more insulin not have any impact for the same meal? i tested again at 3 hours each time i upped the dose so i would be able to spot the drop earlier, eat something, and not go low at 4 hours.
after a week of testing, i determined the only explanation was that my humalog’s action was occurring between hours 2-4, and not between 0-2 like it had been. I tried changing the injection site to another part of my body, and i tried a new pen. nothing worked. called up my endo, can’t see him for a few weeks. i asked my brother, who has t1 for 13 years, and he told me my honeymoon period was over, there may be hormonal changes that are impacting when the humalog started working, and suggested that i try taking it a half hour before eating. in my earlier experiments, i tried taking it 15 minutes before eating and things still spiked just the same.
fortunately, i have 2 apidra sample pens sitting in my fridge. i tried one this morning, and my 2-hour post-breakfast bg, for the same meal that was spiking me all week, was only 94 (i woke up at 68 - which is another story). i breathed a sigh of relief that i could take apidra and avoid spiking again.
has anyone experienced this before?
i’m a little worried, because in my short history as a diabetic, i’ve had things work for a while and then stop working. i was doing great on levemir a month, until it decided to form welts under my skin. i was doing fine on humalog for two months, until it started working 2 hours late. considering there are only a few choices out there, i’m worried about them all being eliminated one-by-one.
I have only used Apidra so I can’t compare it to the other two; I know it is the most rapid acting of the three, but I don’t believe the difference is extreme. However, it sounds like, for you, it is significant and that Apidra works much better which is great!
Yes, it does sound frustrating and anxiety producing to have things go along fine for just so long, then run into obstacles. And I can understand your anxiety about “running through” the limited options. A couple thoughts: If you had problems with both the two long acting basal insulins, you have the option of going to a pump and not using long acting at all. True there are only two basals and three rapid acting. But considering each of those was introduced relatively recently, it is safe to assume new ones will pop up as well. Also, while most people do better with the newer insulins I have heard of people whose individual diabetic picture was such that one of the older regimens such as NPH, regular and animal insulins worked better for them, so there are other possibilities. I hope though that your current regimen continues working well. Hang in there.
From this site http://diabetesupdate.blogspot.com/2008/04/four-fast-acting-insulins-have.html
- Humalog. This is Lilly’s fast acting insulin and it is the one that most people seem to start out using when their doctors prescribe fast acting insulin. Many people find that Humalog works well if they inject no more than 15 minutes before eating. Some can inject it right before eating.
Humalog should peak about 1 hour after injection and it is supposed to stay active for about three hours. Dr. Bernstein says that you should use 1/3 less of a dose of Humalog than you would use for R. Though many people find this the ideal insulin to use, a few report that it causes a pattern of highs at one hour followed by lows at three hours when they inject it as directed
I was having the same issues before going on a pump
Humalog & Novalog have always had a second peak for me, usually around 3-4 hours after I use it. So, I’d start to drop a little bit after I take it, and two hours after I eat I’d be in a range I wanted to be, but then between 3 & 4 hours afterward I’d always go low. If I adjusted the dosage to where I wouldn’t go low, I’d be too high at the 2 hour after eating mark.
I switched to Apidra, and never had that problem. 
So, you’re not alone in what’s happening, and my advice is to stick with Apidra.
It could also be your honeymoon messing with you. Sometimes people lose their phase I insulin response (meaning your blood sugar goes up), but then your body kicks out some insulin to bring it down. In addition to the insulin you injected, that can be pushing you down quickly.
I found with Humalog that I needed to wait 25-30 minutes before it started dropping me at all. If you want to do a CAREFULLY controlled experiment: sometime when your blood sugar is above 140 mg/dl, then take your insulin and wait 10 minutes, then test every 5 minutes and eat when your blood sugar fell by more than 5 mg/dl. For me that point was 30 minutes after injection. My doctor HATES that I wait that long, but it works for me. I don’t wait if I am under 100, but if I’m 100-140, I wait 10-15 minutes, if I’m over 140, I wait 30-40 minutes.
John, this is basically what my brother suggested to me, and it might be worth giving humalog one more shot (hehe) about 45 minutes in advance before breakfast, especially because i have 4 new pens of it sitting in my fridge. the problem is i don’t think anything is happening at all with it until 2 hours later, because my 2 hour test is the same as it would be if i hadn’t taken any insulin at all. i eat about 35 carbs for breakfast, and go up about 3 mg/dL per carb, so that’s ~100. If I wake up at 80 and am at 180 after breakfast, that makes me to think the delay can’t be solved by bolusing a half an hour or even an hour in advance. i’d literally have to bolus 2 hours in advance to get it to work the way it was working 2 weeks ago, or the way apidra worked today - which is a pretty big risk. i’m definitely ok with the idea of trying 30-45 minutes in advance just to see if it keeps things a little lower, but i really think the timing is off by even more.
what you described is exactly what happened with me my first 2 weeks on humalog - good 2 hour numbers, low 3-4 hour #s. then it worked properly for a while. now i have high 2 hour numbers and low 3-4 hour numbers. i think it might be time to switch to apidra too, but that means wasting all that humalog. i’m also skeptical that apidra will stop working properly for me after a month or two and i’ll either have to go to novalog or back to humalog, but i can only try and wait. anyway, good breakfast and lunch #s today on apidra is a good sign - 94 after breakfast, 106 after lunch
ok, so the goal of this is to try to figure out how long it takes for humalog to actually start working? the other variable it seems that needs to be cleared out is insulin on board.
usually when i have spikes i still have some humalog still in me. also, the way things are going now, i think humalog is hanging around well over 4 hours. it’s almost as if it’s peaking by the time i start lunch. for the last week i’ve done a 1:6 ICR at breakfast and still spike, and then a 1:30 ICR at lunch is the only way to avoid an afternoon low, and i still have to snack before dinner. i have nothing bringing glucose down in the morning, and then a non-stop peak from like 11-5, and then i spike again after dinner. i think this is because the peaks from my breakfast and lunch doses have been timed so they’re right after each other, and then they’re both about cleared up by dinner, since the time gap between lunch and dinner is greater (about 4 hours breakfast to lunch, 7 hours lunch to dinner). then the same thing that happens at breakfast happens at dinner - 2 hour spike, 4 hour low.
i guess i’m one of the few, but one of enough that they had to write about it.
yeah, these are my thoughts. since i’ve ruled out levemir, if anything goes wrong with lantus then i either need a pump or just deal with the levemir side effects. fortunately, i’m switching insurance in january and am optimistic that i can get a pump in 2011.
If you are seeing no drop in your blood sugar two hours after taking the insulin, it sounds like you need more basal insulin in the morning (most of us do). Are you taking your basal once or twice per day? For me Lantus had more effect the first 6 hours and wore off before 24 hours. I switched to the pump, but I may have been able to solve the problem by taking two injections of Lantus per day and taking a bigger dose in the morning than in the evening.
Sounds to me like your breakfast insulin is not covering carbs, but also covering your insulin resistance and need for more basal insulin.
Yes, that’s the goal. My doctor thinks its RIDICULOUS that I wait half an hour sometimes. She switched me to NovoRapid (same Novolog) and for me it is a bit better, but not much. I still wait half an hour sometimes. So I’m not sure that switching insulins will solve the problem. People have mixed experience, but many have better experience with Apidra (I haven’t tried that yet).
My ICR for lunch is around 10 now. For breakfast it is around 5. But my basal rate (on my insulin pump) is also higher (almost twice as high) as well. See my basal comment below.
I just saw your comment above that you are using Lantus – how many shots per day?
hi kristin, i’ve considered this, but i think i have no choice to keep it low. my lantus dose is down to 5 units once a day. i think this is too small to split and get good coverage, and too small to not split and get good coverage. however, higher doses make me more prone to lows during fasting times. even at 5 units my bg might drop 40-50 points overnight. the timing might be something to adjust though. right now i take it at 10pm. if i switched to taking it at breakfast i’d probably have enough to cover me through dinner, and then partly through the night without risking drops. just an idea. this is another thing that was working and then changed drastically. i thought i found a happy spot at 10 units of lantus, then i started getting a lot more lows in between meals, and larger drops overnight, so now it’s down to 5 and i think it’s too small for some parts of the day but still too high for others. gotta get a pump
Switching to the morning with the Lantus sounds like a good compromise for now. Ask your doctor about it. The transition can be a bit tricky, but you can just not give the 10pm dose one evening, wake up during the night to check for a high and correct with Humalog if needed, then start on the morning dose cycle.
Diabetes is never predictable, but it will become slightly more predictable once the honeymoon is over. BUT once the honeymoon is over, you will be amazed at how HIGH your blood sugar can go when your doses aren’t right. I hardly ever saw numbers over 200 during my honeymoon. One morning I woke up at 400 and discovered that the honeymoon had officially ended and my insulin needs about doubled.
It’s interesting that your ICRs are so low for that amount of basal insulin – we are all different I suppose!
By the way, you have a pretty awesome level of knowledge about your diabetes given that you are newly diagnosed! I wish I understood that much 7 years ago So congrats on a fast learning curve!