Need advice on insulin choice for bolus

Hi Folks: let me first say, that although I don’t often post, I find that all of the advice I read on this forum is so helpful! I am a LADA diabetic and although I have been injecting Levemir as my basal insulin for the last year, I just started bolusing with Humalog during the last month or so. Because I eat a low carb keto diet, it appears that the Humalog boluses don’t last long enough to cover the glucose spikes. Dr. Bernstein suggests using Regular insulin for boluses because of the slower peaks from low carb meals. Does anyone have experience with this? He also recommends not using insulin containing protamine (ie novolin H or Humalog H). So I am thinking of asking my endo to try Humalin R. Suggestions? One other thing - I have been using the Humalog past the 28 day expiration once opened. Since I’m using so little it just seems like such a waste, but maybe that plays a part in my results?

So the only advice I can offer is that insulin will usually last longer than 28 days once opened. Yes, it is possible that it might lose its effectiveness, but my suggestion is to not be overly concerned until around day 60.

Now having said that keep it out o sunlight, keep it cool, use an alcohol pad to wipe it down each time, and do not reuse needles. Tiny blood deposits can ruin the sterile nature of the solution.

I know others will disagree so do what you wish, (there are no terrible answers), but I keep my opened vials in the refrigerator.

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I’m on a pump now but was on injections for 18 years before that. When I was diagnosed we only had NPH (basal) and Regular (bolus). When Humalog came out I started using that but found it worked too fast if I was eating something like pizza or fast food. Anything with a lot of fat that took awhile to digest. So I also kept Regular on hand and would use that for any meals I didn’t make at home. Regular has a slower onset and takes longer to get out of your system so it might be a better choice for you.

For years I have routinely used my Humulin R past the 28 day mark. Can’t stand just throwing it out. I use it in an Omnipod pump and my A1C stays in the lower 5 to 6 range. Best wishes.

I’m a T1 like you (so I eat a low carb diet as a requirement) but I don’t have endogenous insulin production at all (it sort of disappeared when I was 11 - I’m 62 now).

The best approach is to use a CGM; I had problems with them a few years ago but I’m firmly adducted now and they are the only thing that will answer questions about what happens immediately after a meal.

If you can’t get a CGM, and, damn it, you should be allowed one as a T1 (in fact IMO everyone should be allowed one and no one forced to use one), you can do BG tests every, at the very least, 15 minutes after a meal to see what is happening. In fact the BG tests are more accurate; it’s just a pain in the finger doing one every 5 minutes.

Buy the strips on Amazon or eBay; you’ve done keto so you’re already buying ketone strips, the Abbott FreeStyle meter tends to read over on BG in my experience but in this case that won’t matter because it is the relative measurements that matter.

The tests allow you to map what the particular insulin does with regard to your diet. You can see the spikes and the lows. A given insulin bolus covers an amount of carbs; the amount may vary depending on your current insulin sensitivity (which varies with exercise and other factors maybe even over a 24 hour period) however the relative matching of “Carbs on Board” vs “Insulin on Board” means that we see both highs and lows. In fact everyone sees the same; some non-Ds see a massive high after eating then are shaking with low blood sugar 2-3 hours later.

Given the LADA diagnosis (I think “admission” might be a more appropriate term) your endo shouldn’t have a problem giving you a CGM for a week to see what is going on, but you can do it with a test meter and an Amazon or eBay supply of strips (no way will an insurance company pay for all the strips…)

All that said, bear in mind that your endogenous insulin production will change and that will change everything. Talk to your endo about serial C-peptide tests - this allows you (well, your endo) to track what your insulin production is.

R can in my experience be used just like Humalog except for Humalog has a faster onset and taper off. If you don’t have a CGM then please get one ASAP. It will tell you much more about how R or Humalog works for you than anything/one can. While I do admire Dr. Bernstein’s dedication and research his program didn’t work well for me long term. R is $25 at Walmart and you don’t need a prescription for it. You can of course get one from your endo if your copay is less and/or you don’t have a Walmart close by.

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I used humulin R for many years.
It works great for low carb diets for sure. I was also using NPH, which has a peak at about 4 hours.
I didn’t like the low carb diet.
I switched to high carb low fat less than a year ago and I use the same maybe a bit less insulin even with higher carbs.
Using log insulins work better for me because the carbs come on faster and drop off faster. When I say carb, I mean high carb Whole Food like corn and potatoes. I still avoid processed carb and I almost never eat carbs with fat.

I have a pump and it works pretty well keeping me in range about 95%.

There is more than one way to skin a cat.

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We are all different. I use Novolog and it covers me well. I use MDI and have no endogenous insulin. After following the Bernstein diet for 11 yrs, I finally realized the diet was causing much more harm than good. I switched to the Mastering Diabetes plan for eating and am much healthier.

I eat about 10% fat and plant based carbs. Doing away with most fat is great for heart health, and greatly reduces insulin resistance. I eat almost 9 times the amount of carbs I did on 30 carbs a day

I eat approx 265 healthy carbs daily. Now I can use 1 unit of Novolog to cover 30 carbs, with my glucose level very quickly returning to normal. I ride my exercise bike after breakfast for 30 minutes. If I don’t feel like exercising I add a unit of Novolog to my morning injection. I sure wish I had been pointed to the Mastering Diabetes website years ago.

Marilyn
Type 1
Dx 1959

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You could try doing 2 boluses, maybe 15-30 minutes later. Experiment with how to split, but possibly 60/40 or 70/30.

When I low carb, I pre-bolus Humalog, 15-20 minutes prior to eating (It takes 26 minutes for my Humalog to kick in) to keep my BG pretty much flat line rather than climbing, and then take an additional dose 90 minutes after the meal to keep the BG flat line flat rather than climb. I gave up Levemir/Lantus years ago and only MDI exclusively with Humalog.

I also frequently use Humalog beyond 28 days with no issues at all.

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I was diagnosed a t2 28 years ago, but when my c-peptide results came in at < 0.01 I went on a pump using NovoLog. I subsequently switched to Fiasp which is effective up-to 3 hours which significantly reduced my A1c.

I use small amount both long term insulin, and mealtime insulin., Pens. I find little difference in humalog, novalog. The novalin, or R version, as from walmart for $25/30 vial is bargin, but its quite slow, old style insulin. Almost have to give shot 25/30 min. Before a meal. 28 days is from the maker, It may be a bit too wasteful.

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What do you use for the basal? That’s what always caused me problems when I was on MDI.

How do you deal with sleep?

I have used Tresiba for several years and love it.

I now sleep like a baby. No more being awakened from low BG alarms at night. I flatline between 85-90 during the night and by eating OMAD at noon, do not get any DP as long as I don’t snack in the late afternoon or evening.

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Sorry, my question wasn’t clear; how many units do you use for basal?

Right, but are you bolusing for sleep? You do OMAD so, traditionally, you do one-bolus-a-day, but a T1 needs extra insulin which is normally most obvious overnight, so I’m wondering how you deal with that using Humalog.

I bolus based on my CGM. I want to be at a BG of 85 when I go to bed so if my CGM reads 100 at bedtime, I will take 1 unit of Humalog to bring me back down to my 85 range. If I sin at all during lunch and have a small piece of bread or other long-acting carb, I pay the price at night as my Dexcom is set to the lowest allowable alarm for high BG at 120 and it will go off sometime between midnight and 4 AM, I then need to take a bolus of 1 unit per 10 points of BG to drop back to 85. I dose in 0.1 unit increments, but Humalog dose is not totally linear as I need 1 unit for 15 points of BG when under 100 but 1 unit per 10 points of BG when over 100.

I use 9 units of Tresiba.