Insulin is Too Slow

I use Humalog insulin and Dexcom CGM and an Omnipod pump. And yes there’s some Automation happening with this system too, but not enough. I find insulin lasts in my body for 6 hours plus. Do any of you have this problem? I have proven this over and over by seeing my blood sugar drop after 6 hours have passed since my last bonus. I keep asking the doctor if there is something that will work really fast and then be out of your system really fast. He doesn’t really seem to want me to change anything. I am wondering if the inhaler insulin might do the trick. Since my insulin seems so slow it’s very difficult to control my blood sugar as much as I’d like. When I go high and need a correction it takes too long to come down and I have lows later due to the leftover insulin. So I often take more insulin than I ultimately need and then have a snack once it’s under control again.
Is the inhaler the insulin I’m looking for or something else?

You should consider Afrezza. It is an inhalable insulin with a fast onset and a short duration. I found this recent interview of Ginger Viera informative.

I have been using Afrezza for corrections since it was introduced in the US in 2015. I otherwise use the DIY Loop with a Dexcom G6 CGM. Afrezza is a strong tool that I would not want to be without.

2 Likes

I mean, you’re not wrong. Every single one of us has that “problem” because the insulin we inject does indeed last that long. We’ve made some great leaps forward with technology in recent years, but not really the insulin itself. Even the really fast ones like Lyumjev, Fiasp, and Apidra last that long, they just peak faster. The tail end is nearly identical, though.This is why it’s so important to pay attention to stacking insulin, because it stays with you for so long.

If you were to unfold that little paper that’s stuck in the box with your insulin, you’d see this picture:

That chart shows how much insulin was detected in the body as time goes by. As our bodies use the insulin up, the chart goes down. You can clearly see that at the 6 hour mark (360 minutes), there is still insulin being taken up by the body to lower BG. Granted, it’s WAYYY less than was there in earlier hours, but it is indeed still kicking at 6 hours.

This is what you’re working with when you pick a DIA setting. You have to choose how much of that long tapering bit of insulin action you feel comfortable ignoring. A lot of pump users try to trick the systems into being more aggressive by shortening the DIA setting to just 2 hours, but you see how much insulin action they’re ignoring from every dose. We’re not even past the most intense bit of action at 2 hours. You can’t really make the insulin work any faster, but you can change the DIA setting so the pump knows you’ve still got slow insulin kicking.

And yes. Afrezza is way faster. It’s in and out in short order. Often not ideal as the only bolus insulin because it doesn’t cover slower absorbing foods, but it’s pretty awesome for corrections if you need to come down quick. Assuming you can get it. My insurance won’t cover it for people on an insulin pump.

6 Likes

Thank you for sharing. It sounds like Afrezza is what I’m looking for. Now I just need to get my doctor to prescribe it and my insurance to pay.

1 Like

Well said. People who set their duration of insulin action or DIA for a short time do so for a good reason but often fail to appreciate what that trade-off means in terms of unexpected and sometimes dangerous hypoglycemia.

DIY Loop fixes DIA at six hours for a sound reason. The program also lets me inform Loop about the Afrezza correction doses.

My insurance (Medicare) does not pay for both my pump insulin and Afrezza. Afrezza is so valuable to me that I pay out of pocket for it.

Ginger Viera, in the above video, explains how she uses simple follow-up Afrezza doses to effectively cover slower absorbing foods.

1 Like

The problem with the inhaled version is you can only use 4 unit increments. I take only 1/2 unit or a full unit at a time. My doctors office stopped using it all together. Anytime I drop long after the bolus I am told its the basel rate that is too high.
But speaking from someone who was on a pod and had to come off it I was on considerably more insulin than on any other pump. My control was so terrible it would take hours for the insulin to absorb.

1 Like

If the amount of drop after 5 hours is significant -enough to cause you problems, then It could be that the sites that you use have sub-dermal scarring from frequent use or there’s too thin a subcutaneous layer, and the insulin is delayed getting to capillaries. If so, then using a different rapid insulin analog won’t help much.

You can confirm or rule that out using a frequent meal whose response curve you’ve recorded. Eat it another time, but using a syringe in a different part of your body.

Time the peak, how high it is above preprandial, and the time it takes to drop to within 60mg/dL of the pre-bolus level after the bolus. If those are much better/faster with syringe than pump, the sites you’re using are the issue.

btw, Tandem pump’s Control IQ algorithm uses a duration setting of 5 hours, the same as that John Walsh was using in his book Pumping Insulin 20 years ago, based on being a pump user and working in a clinic where he taught and studied many others.

Many doctors don’t trust users to be able to make informed decisions regarding their insulin therapy. imo, That is a self-fulfilling prophesy. People who aren’t encouraged to learn, to make small, safe changes in behavior stop learning and evolving toward more productive behaviors.

Your question indicated that you are still trying to learn. That’s great. But while forums are ok for getting specific answers, they’re inefficient for gaining an education. Two places that provide compendiums to help you rapidly learn what took others decades to learn about pumps are the books Pumping Insulin and Think Like a Pancreas.

True, but I was aware of that possibility. In my case though changing sites doesn’t fix the problem. Thank you though, good suggestion.

Have you tried Fiasp insuline instead of Humalog? When I was still working and had a medical plan, it covered Fiasp and I found it to be faster acting than Humalog. (Unfortunately, since I retired, the plan I am now on will not cover it.)

Thank you. No, I haven’t been able to get that.

Yes, my doctor always wants me to change the basil rate, when it really still has to do with the bolus from hours before. He is learning though that I have me figured out probably better than anyone.

This is why I (myself) would never use Alfrezza. My correction doses need to be pretty conservative b/c (apparently) I’m very sensitive to insulin and Alfrezza would be a nightmare for me.

I will suggest a possibility, take it or leave it. It’s based on my own experience: Perhaps you have set your expectations that insulin should work at a certain rate for a certain amount of time, and that if it doesn’t, something is wrong.

However, it may be one’s expectations that are off. This happened to me. I read a lot of stuff when I got T1D about how insulin “should” work and what “should” happen to blood sugar. These expectations set me up for a lot of frustration and confusion. I finally realized that, no, the reality is, bolus insulin takes some time to work and do its thing, and its effects in the body can extend six, sometimes even seven hours (especially if you took a bit too much or exercise later on), and all this can be entirely independent from basal insulin.

After adjusting my expectations, based on the evidence of, here is what is actually happening over and over again with me and my body, I then realized over time that all of this is ok, and nothing is necessarily wrong.

One trick, but be careful, that I’ve found to get blood sugar down and to get insulin working more quickly is to do some exercise, if you are able to. Keep an eye on things though and always be attuned to how you feel, b/c exercise can have major major effects on the rate that insulin will bring down your glucose.

Anyway, I hope all that helps. I would try not to worry so much and more so focus on just learning from your body and experience, and accepting that that is the best barometer for how things happen, and managing from there. And recognizing that, feeling good physically and mentally each day (or at least not feeling bad) is the most important thing. Again, this is all just my own experience and the advice I tell myself all the time. :slight_smile:

1 Like

I appreciate your input, but everyone is different. It takes a lot of insulin to get my blood sugar down once I lose control of it. Four units is not a problem at all. That was really the answer I was looking for. Next doctor visit, I’ll try to get a prescription for the inhaler.

There are a number of things going on: 1) time to digest the food for which you have bolused for; 2) how fast the insulin bolus enters the blood; 3) amount of insulin on board from the basal insulin delivered via your pump; 4) your insulin sensitivity; 5) various stresses that impact hormonal levels (sleep, exercise, various worries). A low-fat meal will get digested relatively quickly (generally within 2 hours) while a high-fat meal can take 4 or more hours before the carbs hit. Also high-fat meals will make it more difficult for the insulin to work.

If you are experiencing repeated highs, that could be due to insufficient basal level or too low a bolus (i.e. your insulin to carb ratio has to be adjusted).

Pump automation programs are designed to minimize lows as lows can be quickly deadly. Highs are less likely to be deadly and so they treat highs gingerly to avoid flipping you low.

While small doses of Afrezza will reach peak serum concentration about 20’ faster than Humalog, use of Afrezza is associated with decrease in lung function, not serious if you have normal function but could be an issue if you don’t.

1 Like

Yeah I get that! It’s definitely worth a try then. I hope it works out!!

1 Like

I’ll have to look into that lung function thing. I would only use it occasionally though, so maybe it could still be a benefit.

I also use Afrezza (paid out of pocket, insurance wouldn’t cover) when I want a quick, strong correction. If I’m well over 200 mg/dL and I would have taken an 8u rage bolus, I’ll use the 12u Afrezza for the same effect. I start to see the effect in about 15 minutes on the cgm, and it’s pretty much all done in an hour and 15 minutes. For me, the “8u” Afrezza isn’t enough, I only use the 12’s now.

In the pre-approval trial they showed a loss of lung capacity of about 1% compared with people who took the placebo. In my case, after a year my lung capacity actually tested as greater than before I started Afrezza. The bottom line seems to be that if you have lung disease, Afrezza is a bad idea, but if you have healthy lungs you can expect them to remain healthy: post-approval surveillance has not found any adverse safety signals (according to a paper I saw a couple years ago.) That said, I know an elite-level athlete who won’t take Afrezza because any potential reduction of lung capacity would be significant.

1 Like

I am concerned about the side effects as I already have many other health issues including an Autonomic dysfunction which makes me get out of breath if I stand for long. However since this was caused by 48 years of diabetes wear and tear, it also makes me want to control my diabetes even closer than ever. I think if I get this I will use it very sparingly and perhaps that would help prevent the side effects. Still under consideration.

What is a typical 72 hour diet for you?

I set my pump for a 3 1/2 hour “lasting” effect. But that 6 hour mark is sooo irritating. I feel like it’s not working at 4-5 hours and then I get a pretty good kick at 6 hours. But I am unwilling to stay higher to allow for it. I just have something I enjoy if/when I need to. Great time for the dessert cookie, chocolate, grapes or pineapple.

I love Afrezza, the only thing is I end up going higher later easier because it doesn’t stay in my system long enough. So I either have to take more later or take some regular insulin with it.

My insurance does cover Afrezza, but I have a patch pump, Omnipod so that could be why. The only restriction that I know of though is I’m only allowed 2 different insulins in a 3 month fill time period. I don’t think it was ever linked to whether I have a pump. I say that because Optum Rx who administers my Medicare part D called originally and questioned how much I was using and how I was using it and definitely confirmed that it was only my second insulin I was currently using. That seemed to be the only thing they cared about. Only 2 are allowed per quarter fill. The next refills it has never been questioned and just sent to me.

And on their website they have discount cards available if it’s not covered. You also have to be able to pass a simple breathing test to be able to get it.

1 Like