Low dose Insulin challenges and low carb diets

I would like to eat low carb because the laws of small numbers make sense. (Although, the dietitian, and even the CDE would both like for me to eat more carbs. If I eat the way I like to, I would use 1/2 unit to 1.5 unit Novolog for about 10 to about 25 g carbs/meal or snack. In my case, if I lose some insulin from the needle of the insulin pen because a drop dribbled out, it could be a quarter of the dose if I only use 1 unit. I've experimented with syringes and pulling the insulin out of the pen - this isn't easy. Measuring the half unit is especially not easy both visually, and manual dexterity wise. When I'm able to measure 1.5 units of insulin and count my carbs accurately, the control is very good. the portability and convenience of the insulin pen is a terrific benefit. I hesitate to bring a glass vial with me when I'm out of the house.

Has anyone had these issues and experience (really small insulin dose)? How did you resolve it?

I don't have this challenge of using very low doses. Some people, like TuD member, 2hobbit1, dilute their insulin so that's it's easier to deliver an accurate dose. Parents of small children T1Ds sometimes use this tactic.

It takes a little more planning and attention to the dilution math but it can be done. I'm sure 2hobbit1 would be happy to share her routine. She seems to think it's not that hard. She uses a pump, I think.

You'll need some sterile saline for dilution. In effect you'll be diluting U100 concentration insulin into U50 concentration insulin. If you use a 1:10 insulin to carb ratio with U100 then you'll change that ratio to 1:5 for the U50 concentration insulin. If you feel at all leery about the math, perhaps doing this with a CDE for the first batch will help pave the way.

Other than diluting, always drawing up your dose in a well-lit environment and pausing long enough before withdrawing the syringe, I can't think of anything else.

By the way, most CDEs and dietitians look askance at low-carb eating. But, most of them do not have to live with T1D! It's an eminently practical way to control BGs without undue risk of hypos. I've lived with low-carb eating for two years now. It is a sustainable way to eat. Small numbers when dosing insulin is a sound concept. You have the right idea.

Novo Nordisk has one or two reusable pens with half a unit increment. They claim that if the injection is administered correctly (per user manual), the leftover drop from the needle doesn't affect the dose taken.

Thanks Terry for sharing the information with me. When I mentioned to my endo about diluting insulin, the response is, "No, you don't want to do that". She did not provide a reason. Mathematically and logically dilution makes sense too. Whatever the dilution ratio, at least I could draw a reasonable quantity in a syringe. Perhaps the doctor is concerned with liability? Should I make a mistake...I thought that there would be insulin that is sold diluted. How are babies and small children dosed?

I read that manual too. If I'm using 1 unit, and it's approximately 4 drops, and there is a leftover of one drop, that would be 1/4 of my dose. I've noticed that most of the time, my post meal numbers are better with a syringe. However, the pens are convenient.

I found the instructions that 2hobbit1 posted on another section of this site.

Here's her instructions:

Making U50 is simple - one vial of U100, one vial of diluent, two 5cc syringes, use the 2 syringes to take 5cc from each vial, then swap syringes and return to vials. It makes 2 vials of U50, they will keep in fridge for about a month and a half before starting to deteriorate.

I'm sure the doctor is concerned with liability and someone making a mistake. If I needed to do this, I have no doubt that I could do it safely. This is, of course, your decision. Whatever you choose, good luck.

I faced the same challenge early into my honeymoon phase while I was still producing more of my own insulin and I only needed 1-2 units to cover a meal. I've found that even with the pens that dose in 1/2 unit increments, I needed a minimum of a 1.5 unit dose for the pen to be accurate, so I relied on syringes for a 1/2 or 1 unit dose. BD makes syringes in 1/2 unit increments. In fact, you can load these up and if you put the cap back on them it will push the plunger down to where the syringe is holding exactly 1.5 units. I would load up three or four syringes and keep them in my pocket, giving me a readily available 1.5 unit dose, or push out what I didn't need to give me a 1 or 1/2 unit dose.

I use the cartridges, but with syringes for levemir and Novorapid. I carry just the pen and the needle in a 'glasses case'. I use the cartridges because I could not finish a vial before it expires.

I dose novorapid by 1 unit increments, and rarely need more than 1 unit of novorapid at any time (unless I've overeaten or done something out of the ordinary).

I believe most insulin's can be diluted, but you need to proper diluent. So for instance to dilute Humalog, you need Sterile Diluent for HUMALOG. Often diluents are available directly from the manufacturer (some for free), but you have to go through the right channel (like your friend the pharmacist). They may even provide extra sterile vials. And you may find that the pharmacist may wish to prepare the diluted insulin for you.
Should you dilute, you may find that preparing U10 is better than U50 since the math on dosing will be easier. 10 "units" on a standard syringe will be 1 actual unit. With U50, 2 "units" is 1 actual unit.

I believe those pens have a minimum dose of 1 unit. And with small doses consistent priming and making sure there is no backwash are critical.

I use Levemir and Apidra pens, which I much prefer to vials. I use BD 1/2 marking syringes to remove insulin from both pens. I used to use a pump, which of course is accurate in very small doses; the 1/2 unit syringe is as close to that as I can get.

Is Novorapid the same as Novolog Flexpen? Are you eaten low or restricted carb? about or less than 20 g /meal?

novorapid is insulin aspart. Yes i eat low carb, typically < 20g / meal. i dose 1 init og novorapid for about 20 g of carb. I also try not to eat too much protein - 30 50g / meal (5 - 10 oz of protein containing food).

I've used the 1/2 marking syringes to remove insulin from pens too! I find that 0.5, 1.5 are all pretty accurate. When I use the pen needles, there is a small drop that comes out almost always (despite holding it in place for 10 seconds). Trudy, why did you stop using a pump?

Hi all,
Yes I pump U50 Novolog. NovoNordisk is still making diluting fluid for its novolog. Not sure if the diluting solution for Humolog is still available.
The diluting media is the identical solution/preservatives etc that the standard U100 is made in. It is only available to your Endo, from NovoNordisk. You endo must fill out the paperwork to get it shipped to their office. It has a similar shelf life and storage conditions as the novolog does.

Making the dilution is fairly simple, once you get your endo onboard. It simple requires a script for the 5cc syringes and needles required to do the exchange/dilution. Once made it has the same stability any other open but refrigerated vial of insulin.

It takes some thought and initial math to change from U100 to U50.
For every 1 unit of U100 you will need 2 units of U50. Also if your U100 I:C ratio was 1 unit per 10 gm of carbs, then for U50 you will need 1 unit per 5 gm of carbs. Correction factors are also half of your U100 crew so if using U100 your CF is 1 unit drops your BG 100 mg, then 1 unit of U50 will drop you 50mg. Your duration of insulin activity is still the same.

You will need to work with your endo on the math involved with marking the switch, and how to do the dilutions. Once it's set, then there is no additional mental math other than accurate carb counting.
Doing basal and bolus testing will still be the same.

This would require syringes for MDI, since U50 is not available in pens. Depending on the type of syringe your doc writes for you can get unit markings that allow quarter unit approximation. If you add that to U50, you should be able to micro dose.

When you inject with a pen I don't think the drops which come out after you inject are usually from your dose. When you inject with a pen, make you sure prime one unit first, and then keep the pressure on the pen for 6- 10 seconds. I have tested this and all of the insulin from the pen dose comes out in about 6 seconds. I haven't tested what happens with syringes but I also have a harder time measuring the dose with them due to getting confused by all the lines. The novopen junior and the novopen echo both have 1/2 unit dosing. I find syringes are less accurate for me. The novopen echo records your last dose so if you get confused about that you can see what it was. Although the pens claim to not be accurate for 1/2 unit doses I find that 1/2 unit doses with them work for me.

Another thing I noticed recently was that the numbers/lines seem to quickly wear off the syringes if you leave them unprotected in your purse or handbag.

Hi ih378. I stopped using the pump because as I grew older, I lost tissue to the point that I didn't have enough real estate with good absorption left for pump infusions. It's much easier for me to use shots, but of course, not as accurate. Doesn't matter--I'm enjoying life and food at almost 84 y.o.!

Do you use BD pen needles for the novopen echo? I like the BD nanos for the NovologFlexPen that I currently use and I am considering switching to the Novopen Echo.

Hi Trudy, that's terrific, that you're enjoying life and food at almost 84! Do you also eat a low carb diet?

Moderately low diet... Since I have Celiac Disease, I gave up baked goods except for a slice of good GF bread now and then. I eat lots and lots of salad and veggies; some cheese, meat and fish. Carbs I like and eat: reasonable portions of fruit, ice cream, Nut-Thins, and GF beer. Happy to say that my white wine doesn't change my carb count.