My fast acting insulin takes a long time to work. I inject in my abdomen, but my reading always spike It doesn't seem to work until 4-5 hours. Any suggestions?
As you probably know, Humalog onset is about 15 minutes, peaks at about 90 minutes, and endures 4-6 hours. So your experience is not typical.
How many carbohydrates do you eat with a meal? Do you take your meal insulin dose in advance, like 15-30 minutes? How long have you been injecting in your abdomen? Do you rotate your sites? How many sites do you use? Do you have any scar tissue? Do you think you've developed insulin resistance?
Have you been slowly adding body weight over time? Has your insulin to carb ratio changed much over time? Has your insulin supply been exposed to high heat (>98.6 F) or freezing? Do you use a pen or a vial and syringe? All the insulin in a pen or vial must be used by a certain time after first use. With vials it's 28 days.
As you can see, there are lot of things to consider.
Oh, yeah, what's your basal regimen? Lantus or Levemir? How much and when? When's the last time you tested your basal rates?
I take 6 units of Lantus at 9pm. I take 1 unit of Humalog for every 15 grams of carbs. I am newly diagnosed in December 2014. I initially went low quite a bit and the CDE had me at a 1/20 ratio, but now always seem to be high even though I am counting carbs and taking insulin accordingly. I usually take the short acting 15 minutes before the meal. I rotate the sights and haven't developed scar tissue. I haven't gained any weight since I lost weight when diagnosed ketoacidosis/type 1 or 1.5 in December. I'm wondering if I should go back to a vial and syringe, since I question whether I am getting the right dose out of the pen. My pens are not expired, hot or cold.
At 8pm I was at 183, ate 45 grams of carbs (max) and took 3 units of Humalog. It is now 2 hours later and I am at 255 (according to my worthless CGM). It is very unreliable in my opinion. This morning it was 70 points off on my 3rd day of 7!!! I will prick my finger before going to bed. This all is so frustrating.
It takes a long time to get your doses dialed in just right and your carb counting skills mastered, though they can never be perfect we’re only human. The conclusion is inescapable though that if you’re having fasting levels at 180 and 2 hours after eating at 250… You need more insulin, and should work with your cde to get it dialed in. Things are weird for a while when newly diagnosed, sensitivity varies more, etc. It’ll settle out. Just take a lot of notes and keep track of what works and what doesn’t before you know it you’ll have it mastered.
I sometimes experience this, my BG will shoot up to a seemingly intolerable number @ 2 hours and won't begin to drop until I reach 4 hours. I have to be careful with my CGM, because I sometimes (too frequently!) overreact @ 2 - 3 hours and give a correction only to find myself going low afterwards.
With regard to your example, if you started @ 183 and went to 255 2 hours after a 45 carb meal, that's only about a 70 point rise from your starting point. That's not bad. What was your BG @ 3 and 4 hours? If it eventually dropped to near 183, then your 3 unit dose was just about perfect.
Starting at 183 then eating 45g of carb, bolusing 15min before and then being 255 at 2v hours postprandial isn't an odd profile at all. I'd be in the same shoes under the same conditions.
Several comments:
- You need to pre-bolus earlier for meal carbs. Try 30 minutes.
- If your hunger can handle it, you should correct your BG down to normal before eating. It is going to go up after you eat, no matter how well you manage insulin administration, and with 45g of carbs, it's going to go up 40 pts at least for most people. So, if you're starting that high, you should administer a bolus that includes both your correction and meal insulin together, but don't eat. Then, watch your BG on your CGM. When it starts dropping (say 183->170) eat you meal/snack. With this technique, you probably won't peak over 200 from the meal, and land back down in the normal range within 3-5 hours.
- CGMs are most accurate at low BGs, and become increasingly inaccurate at higher BGs. Although off by 70mg/dl is an unusually large error -- perhaps you are on a sensor near the end of life, and it was within a few hours of calibration? In any case, CGMs are 100% accurate for indicating changes and trends, which is all you need for the technique described above.
- As Terry points out, your IC may need adjustment. Some careful, controlled experimentation over the weekend with measured carbs (ideally, use glucose tablets) can get a very good measure of IC (assuming you're not sick).
- Insulin pens have no different requirements than vial insulin. They are good in the fridge until their expiration date. They do not need to be refrigerated after first use. They are good for 30 days after first use, and should be kept at room temp.
First off, don't use/trust the CGM for treatment decisions, at least not until you have quite a bit more experience.
Also, I would not consider a 183 to 255 w/ 45 grams of carbs too big of a spike.
As a follow on to Terry's questions: How often to your test? What are your fasting numbers? How about before lunch, etc.?
For me I have noticed a significant difference in my spike when eating the same meal when my BG is less than 100 vs when it is over 100. I'm taking about a 30-40 point difference just based on my pre-meal BG. The higher it is before eating, the worse it gets afterwards.
And of course, the timing of the peak and duration of spike differs based on the types of Carbs I eat and the fat/protein ratios.
Maggie - Sorry for my bundle of questions. With so many things in diabetes the answer to many questions is, "It depends."
You've received many good suggestions already. I won't add to the information barrage you've now received. Good luck with your diabetes challenges. Sometimes they are a real pain in the tail! On the positive side, they can often lead to later successes.
Good luck with your efforts to make things better. Like most self-improvement programs, making progress on the margins will add up to dramatic changes over time. Better is better!
It may be an idea to go back to basics. Do you know how to test your basal insulin dose and if it correct? Then also check your carb:insulin ratio. These change over time, unfortunately, as Diabetes can be a progressive disease. It maybe that you need to adjust your basal rate first rather than your bolus.
Do you know how to do corrections. Dave and Terry's advice is good.
have you looked into afrezza? lots of discussions and valuable information and I am exploring it myself before talking it to my endo. I have been following a lot of people here and on twitter
Does this always happen or is it a random thing, if you only inject into your abdomen they you may have developed a lot of scare tissue. Your endocrinologist should be able to provide insight into the potential problem . It could also have something to do with what you eat and when you eat it. I’ve found that if I eat fats and proteins first followed by carbs it tends to delay the spiking aspect of things and vis versa.
This may be an insultingly obvious suggestion, so I will apologize in advance…
Are you “priming” your pen by dialing up 2 units and shooting that into the garbage (or wherever) before dialing up your actual dose and injecting?
Like many have already suggested, best to start out meals/snacks with a BG less than 120.
Hey Maggie.
Dave and Terry give very good advice. I've had Juvenile Diabetes for 20 years and I've learned a ton from those fellas in just the past month.
Also (and I'm sure you have heard this multiple times now) try not to get too frustrated. Since you are recently diagnosed, it will take some time for you to get a handle on the nuances of diabetes. And then once you think you've figured them all out something different will pop up. Living with diabetes is extremely complicated and frustrating to say the least. It will not be perfect and that's ok.
One thing that could be going on is that stress could be playing a role here, especially as it relates to high numbers. Also, CGM is recommended to be used for trending as Dave mentioned. Some expect their CGM's to be right on point with their meters but that most of the time does not happen as CGM measure interstitial fluid and that can lag by 10-15 minutes. Give the CGM some time and calibrate during times when your blood sugar is not fluctuating rapidly (meals, exercise etc). CGM is an amazing tool; it's like a road map for me. Hopefully you will learn the ins and outs and come to love and rely on it as much as many others do.
Anyway, it's going to be trial and error for awhile and it won't be perfect. It isn't perfect for any of us. Just try to do the best you can, work with your CDE on tweaking your treatment and it will all get better. Also, keep posting and reading threads here. This site is comprised of very knowledgeable and caring individuals who are all going through, or have gone through exactly what you are experiencing now.
Good luck and I'd be happy to help in any way I can!!
Good catch!
Also, thighs are another really good site, if you're tummy's getting too scarred.
+1
Good suggestions, everyone. Some may not realize that Maggie is brand new at this, only four months!
I’ve experienced a simalar thing with Novolog. It was keeping me at around 150 for a meal that would have sent me over 200, so helping but not totally stopping the spikes, but then I began having stubborn hypos 3-4 hours later even when I injected 30 mins before eating. I stopped using it and decided I’d wait for Afrezza since post meal spikes is my only problem, my fastings are good and now that I have a CGM I find I actually tend to drift too low at night sometimes (without any insulin on board). Anyway, after using NovoLog for only a month I guess I must be honeymooning now because I can control my spikes easier than before with diet alone. One thing I’ve learned from this site and my own body is that there is a huge variation in how diabetes and the various treatments effect each of us. Perhaps you should ask to try Novolog or apridra or as suggested, maybe Afrezza would be better for you?