Just wondering how long you wait after you give a bolus of humalog to test again, and potentially do a second bolus more to lower your blood sugar?
I;ll bet its one of those things that's different for every person, but I have a bad habit of overshooting the mark and going low
This is becoming less of a problem with my recent change in diet (going medifast) but even then its still happening.
I have a history of problems with stacking insulin so I try to wait 3 hours before I bolus again. I'm on a pump and cgm now, though, so what I do is test somewhere between 1 and 2 hours and if I feel like I'm higher than I want to be, I do an increased temp basal rate of maybe +20% for an hour to try to nip any spikes in the bud so to speak. Many times the increased temp basal will fix the problem. Then I'll test again and bolus again if I need to. It's working pretty well for me.
I too have a history of stacking insulin and am pathologically afraid to be high, so instead of taking humalog - which for me lasted almost 5 hours, I asked my endo for a fast acting insulin with a shorter tail. I started on Apidra for my boluses and have found it makes a huge difference. Where humalog could send me low hours after a meal, apidra seems to do the job and be done with in about 2 to 2.5 hours. So for me it makes it a lot easier not to stack and be able to cover if I do in fact mess up with the carb count at a meal. But as in everything with D, YDMV so what works for me may or may not necessarily work for you.
I am also pathological about high readings. My pump will keep me from stacking if I believe it. I tend to need more insulin to correct if I am 200+.
Anyway, I will test hourly if I have a reading over 200.
I have a plan that works quite well for me. I bolus then zero the dive timer on my watch. When timer reaches 20 minutes I start my meal. When timer reaches 2 hours, which would be 1:40 after I started eating, I test. If it’s higher than I like I’ll test again at 2:20, or a full two hours after I started eating… If it has gone up from the 2:00 test I’ll add additional bolus. Works for me.
I will test two hours after eating and if high I correct. It's true I have a pump which takes into account the Insulin on Board. However, before I got my pump I just did my own calculations. I don't like staying high longer than I need to. I do follow up checks to make sure I'm down and haven't gone low. I rarely go low when I correct as I'm pretty confident in my ISF. If you are going low a lot when you correct true backing off your ISF a bit.
Try to test when your BG peaks. You may need to do this at different times to determine approximately when that is. Of course for different types of meal this may vary. Most insulins aren't working at full strength for at least an hour. So in my mind 1.5 to 2.5 hours is the test window. Only test when you are prepared and willing to do a correction. On MDI a simple technique is to assume that after 2 hours 50% of your meal bolus is still active.
I also try to get back in range as fast as possible. That is even if it means over-bolusing and catching the low with a Dex4. I have this obsession with total hours over 140.
me too! I tend to wait about 2 hours after I eat and will give a small correction. I just switched this weekend to humalog, trying it out,not sure if it lasts longer but maybe works a bit better - faster? I've had some lows correcting too early.
Humalog always lasted about 4-4.5 hours for me, and it had this weird second peak at about 2.5 hrs. So, I used to end up stacking it a lot, too, and had lots of lows. I switched to Apidra, and it still lasts about 4 hrs in my system, but I don't have that weird second peak to deal with. Also, Apidra starts to work faster for me, too.
really, i'm going to ask for Apidra, do you pump? Maybe I'm going low because of the humalog...? One thing's for sure novolog takes so dang long, at least for me.
I do pump. I have an Animas Ping and it has been great. It's action seems a lot more predictable than Novalog or Humalog.
Even better, Apidra has no co-pay for the rest of this year, so it you have insurance, it is completely free of charge.
I have used all three of the rapid acting analogs and for me Apidra is the best. It has -- again, for me -- the fastest onset and the shortest tail, which is exactly what I want for processing carbs.
how does it work if one has to bolus for protein. sometimes i like that the others stay in system longer...i wait 20 minutes after bolus to eat and eat slowly, sometimes it takes me an hour to eat (purposely as I try to get the insulin and food to hit together, easier said then done..ha!) so I wonder if
Aprida would be out of system by then?
This is so individual that I can only tell you what I do. I've worked this out by trial and error and constant testing, and it gives me a pretty flat response:
About an hour before eating, I bolus with Regular. I calculate the bolus based on both carbs AND protein. I use Regular because it has the longest tail, which works best with protein because it digests so much more slowly than carbs.
Even so, the Regular begins to fade at around 3 hours after the bolus, so there is a very modest spike shortly thereafter as the protein is still being processed. So at 3 hours after the initial bolus, I supplement with a very small amount of Apidra (usually about 1 u), to extend the tail just that extra bit longer so that the insulin and the digestion finish pretty much together.
If nothing else unusual is going on, this usually has me back under 100 to stay by the 2 hour mark (2 hours PP, that is).
OK, thanks. sorry scott, don't mean to take over post...but DNS, so...I was 78 before lunch (almost low), i had 4 ounces of grilled pork (had some fat on the bone) veggies and 1/2 c s/free pudding, I bolused for the protein, 3 hours ppl I was 119, now 5.5 hours after lunch I'm 167, so is that my basal not working or not enough bolus for the protein? I can't seem to figure this out? I woke up at 89 this morning so I thought I basal was OK, but I also did a correction before a bed, a small one cuz I was a bit too high. Maybe I need to increase my AM basal dose? thanks!
Wow, Sarah, there are so many possible things going on here it's hard to know where to begin. Here goes, in NO particular order.
Possibility #1: Your bolus calculations are off, either underestimating how much a given amount of food will raise your BG, or how much 1 unit of bolus insulin will lower it, or both. And those numbers are potentially different for each individual. You can't just assume that the ratios in some book are right for you. You have to test to find out what your correct numbers are. And it can vary by time of day, too. Many people have different patterns in the morning or evening than during the rest of the day.
Possibility #2: There could be some gastroparesis happening, so that your food is being digested unusually slowly. In that case, food would still be in the process of being digested when the insulin is wearing off.
Possibility #3: Your bolus needs to be "split" into two doses a couple of hours apart (essentially what I do) to cover the entire time period over which digestion is occurring.
. . . and doubtless there are other possible scenarios. I hope some others comment on this too so you aren't getting just one viewpoint.
General comment #1 -- this doesn't sound like a basal issue. The purpose of basal insulin is to regulate blood sugar in the fasting state, i.e., when you aren't digesting food. Bolus insulin is intended to cover meals. From your description, it's meals that cause your problem.
General comment #2 -- you didn't indicate whether you are on a pump or MDI. Blood sugar management (and troubleshooting) follow different paths depending on which one it is. My description of what I do is specific to MDI since that's what I do. If you are on a pump, then I'm not the right person to answer this; some pump experts need to chime in.
This crazy disease is unbelievably variable. Some days it behaves just the way you expect it to and other days it acts like a spoiled child throwing a tantrum. It isn't always easy (or possible) to know why. But keep working the problem. The more you learn about how your body responds to things, the better your control will get. We've all been there.
David
i think that is what is happening with me, humalog isn't lasting long enough..i don't know. I'm seeing highs in the evenings, way past dinner and before bed so maybe it's a dinner bolus mistake, humalog not lasting long enough or my basal is dying out by my PM dose. I'm on MDI's...gonna try the omnipod. I keep having to give corrections before bed but 3 hours after dinner I'm OK then my blood sugars go up after that. I hate correcting before bed.
DNS, just wanted to share. I increased AM basal - levemir dose yesterday 1 unit, no highs in PM or after dinner, decreased PM dose .5 overnight (I'm pretty insulin sensitive), went to bed at 105 woke up this morning at 105...OK, that's never happened. Hope I'm on a roll! HA! If I could just stay this way on MDI's I feel I wouldn't want to go on a pump, but...we'll see. thanks!