Insulin newbie question

Type 1 and LADA
1

Hi, all! Firstly, thanks for the warm welcome upon signing up :) I was diagnosed with T1 almost two years ago, and I wish I'd found and joined TuDiabetes sooner.

I've been honeymooning since diagnosis, and just started taking Humalog with meals a little over a month ago. I was transitioning pretty well until about a week ago . . . Since then, I have been having lows (~40s - 50s) maybe 30 minutes after taking the recommended amount of insulin/carb. So, I consume 15 - 20 carbs and within 30 minutes my BG is up to ~110 or so. Then, a couple of hours later, I'm up to 200 - 215. Any idea what I'm doing wrong here? I understand Humalog isn't supposed to peak for a couple of hours after injection, so I'm confused as to why I get low and then correcting causes a high. It seems that when I take less insulin/carb I go high . . .

A few notes: I'm exercise only 4 - 5 days/week. On the days I don't exercise, I imagine my sensitivity is lower. Also, since I started using Humalog I've increased my carb intake from ~40 carbs/day to probably ~120. I'm making up for all the carbs I haven't eaten in the last two years :/ . Low carb was working well for me before, and I'm confident cutting back to 40 - 60/day would allow me better control for both lows and highs.

Anyway, again, ideas? Suggestions?

Thanks :)

2

If I run low 30 minutes after eating, I would think I would need less insulin. The highs might also reflect a bit too much carb to treat the lows with. I would suspect that the way to fix it might be to adjust your carb insulin ratio up a bit (more carbs/ unit...) maybe try .3-4 as lows that quickly seems pretty zippy to me. Most of the time, I will try maybe .1 or .2 but sometimes more, to see if the "experiment" produces the expected result.

I agree that exercising can result in zippier "action" on the insulin sometimes too. There's a chart in Gary Scheiner's "Think Like a Pancreas" that has adjustments, on a %age basis, for exercise. I use it to adjust basal with a pump but you can also use it to adjust bolusing for shots, something like 67% for an hour of moderate exercise so the food fuels the exercise instead of the insulin, as it were.

I know that the AMA recommendation is to take 15G of carbs but sometimes, particularly with food "on board", maybe try 8-10G to treat it and see if that produces less of a spike. You want some spike but, if it's too much, less carbs can be a solution there too.

3

Something to consider is the types of food that you're eating. If I'm having something that digests slowly (high in fiber, fat, or protein), sometimes I will dip low after eating but then it rises naturally. Perhaps your highs are the normal peak of your food made higher by the correcting. What I often do when I have one of those meals is take the bolus either with the meal or right after eating, so that the food and insulin peak together. Might be worth a try.

4

Thank you so much for your thorough reply. I had though of buying "Think Like a Pancreas" before I used insulin, and will probably order it now. Sounds like it could be very helpful. I'll first try adjusting my insulin/carb ratio toward a little less insulin and see how that does. Then, if needed, lower my corrector carbs.

Thanks again!

5

That's a great idea--those are definitely the types of meals this is happening with. Thanks so much!

6

I would also think you may be using a little to much insulin, you may be getting a little help from a phase 2 pancreatic response.

You also may have some timing issues, try giving your bolus insulin as soon as you eat, or even after you eat. You must have bolus insulin for all of the food you consume so when your correction carbs are not covered by insulin your BG eventually spikes. Low carb high protein meals can also be a problem, protein will eventually turn into sugar but it happens after your fast acting insulin has ran it's coarse, so hours later you may have high BG. You can also have problems with high fat and oils delaying your carb absorption causing timing issues. Many of us find that our insulin is to slow to react so we add fat to our diet and this slows down digestion.

You need to keep a log book and track your insulin, food, BG, and activity. Try to figure out how much a carb will raise your BG in two hours and how much a Unit of insulin lowers your BG in two hours. Try eating 6 oz of high quality protein (alone) like chicken or beef and see how much it impacts your BG, at 1hr, at 2hrs, at 3 hrs, at 4hrs. You may/will find that protein has a significant impact on your BG.

Remember your looking for a average BG response , every day is a new opportunity. Test, Test, Test, and you

will get better at this...

7

Hi,

Welcome. You've received some good suggestions here already but here are a few more. If you are ending up at 200-215 after 15-20 additional carbs, your total dose may be OK since one carb may bump you up 5 points and 215-100 is 115....

A few things you might do to smooth things out are:

Taking a portion of your insulin an hour or two later. I eat a high carb breakfast and do well taking about 1.35 units at 2 hours post. Finding the exact balance is a question of trial and error.

Reducing your carb corrections. I eat 2 glucose tabs to correct the 50s and 3 to correct the 40s. You want to use glucose tabs to bring you up as quickly as possible which also allows you to not over correct.

Waiting until you finish (or are half way through with) your meal before taking the insulin. The lag might allow the food to get a good head start.

And finally, as others have said, just cut back on your bolus and see where it leaves you at 2, 3 and 4 hours.

Good luck,

Maurie

8
I have been having lows (~40s - 50s) maybe 30 minutes after taking the recommended amount of insulin/carb. So, I consume 15 - 20 carbs and within 30 minutes my BG is up to ~110 or so. Then, a couple of hours later, I'm up to 200 - 215. Any idea what I'm doing wrong here?

While my good friends here are more experienced with this than I, looking at the quoted passage above leads me to believe they may have misread, to some extent, what the problem is.

You are going low 30 minutes after taking the insulin -- not 30 minutes after eating. This indicates your are pre-bolusing too early. Everyone absorbs and reacts to insulin a bit differently -- you seem to be one of the lucky ones.. absorb and react quickly.

Your understanding of Humalog is incorrect -- it begins activity in as little as 15 minutes, and peaks (on average) 60-90 minutes. It's pretty much done and gone at 3.5-4.5 hours in most people.

So, here's what I think is going on: You are bolusing too early; this causes the low. Try bolusing 15 minutes before eating, or put differently, when you bolus a 15 minute timer starts, for which you must eat by the time it expires.

The post-meal highs: Probably don't have your I:C ratio dialed in. The most "accurate" way to determine your I:C is to check your BG before a meal, then again 3-4 hours after. It should be back down within 10 mg/dl to the pre-meal value. If much higher, you need to adjust your I:C to fewer carbs per unit. Too low, adjust the other way.

Also, basal insulin can further complicate this... you didn't say if you were taking a long-acting for basal (like Lantus or Levemir), so I'm assuming you are not, and the honeymoon is still taking care of that.

Now, a summary of how to attack this:

Use a weekend when you have nothing planned. Plan to hang around home, being relatively sedentary, to eliminate other factors affecting BG. Record BG's before and 3.5 hours after every meal. Fast in between meals. After you've done two meals on saturday completely (all measurements taken), based on the results start tweaking your I:C for subsequent meals if necessary, trying to get to balance -- BG about the same after as before.

Also it's best to eat well measured/quantified carb loading -- this is a good day to eat yummy packaged crap because it's pretty well controlled in terms of the actual carbs as compared to the labeling.

For the lows, adjust your pre-bolus timing in 10 minute increments +/- until the pre-meal lows go away. You may be very very lucky and have such a good response to Humalog that you can simply administer right before you eat.

Anyway, put simply this is first-order about your bolus timing, and your I:C. Once that's really dialed in, second-order, more advanced strategies like splitting the bolus to simulate an extended bolus (like on a pump) can be added to fine-tune your control and better flatten the BG curve.

9

Thank you very much for your suggestions and encouragement :)

10

Thank you! I really appreciate it. I'm going to try taking insulin near the end of my meals. You calculations make sense--without the corrections, it looks like the dosage might be right. I'll keep testing and we'll see.

Thanks again :)

11

Thank you! When I was first diagnosed (before insulin) I was better about tracking how much foods affected my BG. I'm going to use your suggestions in getting back on track to be as educated as possible.

Thanks again. I really appreciate it.