Okay guys need help with fast acting insulin

Okay My endo(due to my readings) has decided to keep me on NPH and now is starting my on Novolog. Along with Metformin dropped glipizide. Now I need your guys help. She said for meals dose 1:10 I know that means 1 unit of novolog per 10 grams of carbs. Then she put correction factor 1:35 above 100 as directed <------ this is what I don’t understand help me out all, yet again!

The correction factor means that you take one unit for every 35 mg/dl that your blood sugar is over 100.

So if you are 135, you need to take one extra unit for correction. If you are 170, you need to take two extra units for correction.

Your endo should have explained this much more clearly. Is there a CDE (certified diabetes educator) who you can see in addition to your endo?

Ahh that helps. I do have 2 books Have to read on this subject! also I see that NPH and Novolog can be mixed. I also know that you have to put novolog in first then draw NPH…any thoughts?

I don’t know about mixing insulins, but hopefully someone else will!

You are exactly right Stardust. You want to put the Novolog in the needle first. Otherwise there is not much more to worry about. When I was on NPH I found I would have to add a little air to the vial towards the end to make it easier to pull the insulin out as I did not inject air in since it was the second insulin you draw out (or you could inject air in as you go along)

You can mix NPH and Novolog in the same injection, but it takes a number of properly ordered steps to make sure you don’t cross contaiminate. You always do the R (clear) first. I like to remember that cloudy messes up clear, but clear won’t change cloudy. Here is the steps that I use for a mixed injection (with NPH/R).

  1. Inject air dose into R vial
  2. Draw R dose into syringe
  3. Draw NPH dose into syringe
  4. Inject
  5. Inject air dose into NPH

This ordering assures that there is no change of NPH messing up your R. A single spec of NPH could mess up the whole vial of R. You don’t have to inject air until you see the end dimple, but I do it all the time to equalize the pressure.

I never liked mixing insulins. I used R/N but just did two shots. When I mixed them, it always seemed like the R would get “tired” faster?

Not sure about the mixing have not done it yet. Now I have to ask. Do I take the rapid acting every time I eat? Also how long after I eat do you take it again? Last but not least, If you take your blood sugar after 2 hours and it is over and you have to take a correction dose do you take that dose right after you see that your BS is high at 2 hours?

I can’t really judge that. I don’t really need much R at this point and only take it at dinner. I have heard that mixing can just end up smearing the responses. But of course, that is exactly the mixtard 70/30 type of response.

Yes, you take the rapid acting everytime you eat. You may take it right before you start but I personally try to wait 15-20 minutes for my insulin to kick in before digging in. Do not take another correction dose for 3.5 hours at LEAST especially in the beginning until you know your correction factor and learn how to estimate how much insulin you have left on board. You do not want to start overlapping your boluses which can lead to a severe hypo. It’s best to figure out your correct insulin to carb ratio and not have highs rather than trying to correct them after. You may have an insulin to carb ratio of 10:1 or it may be 12:1 8:1 etc everyone is very different and even different insulin to carb ratios at different times of the day. For instance when your NPH is peaking you may need more carbs per unit of insulin to avoid a low. You should keep a food log writing down everything you ate, what your starting blood sugar was, how many carbs and units of insulin you took and what your 2 hour blood sugars were. Do you have the book “Using Insulin”? It is amazing at explaining all of these things, I still refer to it almost daily.

You generally take some fast acting to eat? “Theoretically”, you can calculate a carb ratio, like if it 's 15-1 you have one unit for each 15g of carbs so say a 30G sandwich would be 2U and a 90U burrito would be 6U? I think that you are sort of suppsoed to wait until the insulin has run it’s course, like 3 or 4 hours but that would also depend how high it is? If it’s 300 though, I would hit it w/ a couple of units. It’s much more challenging if you are trying to guess the ratio but can be done? i did ok with it for a few years but gained some weight and have done a bit better with a pump and now a CGM.

I have the book think like a pancreas and using insulin, still reading using insulin. I’m glad you referred that book to me. I just figured out you are supposed to do your correction dose with your carb coverage before the meal. Didn’t know that.

In short, corrections are done with your preprandial number (before a meal) and then afterwards. 3 hrs after a meal is probably a safer time to see if you need to correct.

If you preprandial number is > 100, then subtract your number from 100 and divide by 35 (your correction factor). That is the insulin correction dose. Add that to the bolus required by the meal, which is the number of grams of carbs divided by your 10 (your I:C). You can be conservative and if you are way high 3 hrs after meal, you can correct, but right now I only correct if I am > 180 mg/dl.

Over time, you will make adjustments to all these numbers to fit your unique characteristics. It is best to just keep things simple. Correcting before a meal is best, it avoid so called “stacking” where insulin lasts a long time and multiple injections overlap in their effect.

. Do you know what your range of numbers ? Can you be 130 and be ok? I do not count carbs etc (SOME DO,NOT ME OK?). If you are doing all of these calculations etc, diabetes is in the forefront of your life If you need a book to read (also ref by my endo and my doctor)–Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin [Kindle Edition]
Gary Scheiner M.S. (Author), Ph.D. Barry Goldstein M.D. M.D. (Foreword) THE KINDLE EDITION CAN BE DOWNLOADED TO YOUR PC without having a kindle. Its $10 , and worth it… your question is answered with no doublespeak.

If you have a kindle btw, you can take the kindle with you (or your apple ipad or…) and use it to look up in search box what he is talking about and maybe you will walk about feeling better about the info

good luck

I do have that book, I have not read it yet. I also have a kindle and I might download that to it si it can travel with me. I think I might have to adjust my Basil dose now. I just ate my 30 carbs=3units of novolog, and my blood glucose was 63. This is going to be so much fun…not!

My endo wants my readings down to 140 or below after meals, and 130 or below before meals.

How was your BG down the road apiece after the 30G of carbs/ 3U of insulin?

it went down to 63 got to play with all of this now!

Ah, I thought it was 63 when you had the insulin and ate! I would look at that as a pretty good result, very close to where you want to be then? If 3U for 30U gets you to 63 (assuming, of course, that everything else is flat, which may not be the case, which is where it can get tricky…), maybe like 2.5 or 2.75 would be perfect? Or look at it as 10C/unit and try maybe 11C/U and eat 22G of carbs w/ 2 units and see what happens?

I have been playing around with some of my #s as I think I was in the (25 year…) habit of not bothering to calculate and running low and catching up w/ snacks. I think I hit the crossover point and am turning it back up. I will give it 3 days and see how it goes. Unfortunately, this weekend appears as if it will be full of junk food, which may make the results a bit questionable?

Good luck with your experiments!

I will try that. I am in the process of resetting my Basal dose. What I was taking I think was way too much we will see. I will give the new dose time to set in and see if it is working okay.