Curious which insulin is popular for BOLUS? I am using Novolog. Seems to work fine. I usually have to take 2-4 units in morning and with meals 1-3 units.
Wondering if there is a more modern BOLUS Insulin or superior one I don’t know about?
There are a few depending on what is considered a bolus insulin.
First, let me say Novolog is a well-recognized insulin in this category. Two others are Humalog and Apidra. They have different actions but each do roughly the same thing in different ways.
There are short term insulins Humulin R, Novolin R, Actrapid. These insulins have a little longer peak time and as such it takes more time for it to pass out of your system.
I suggest you ask your doctor for options.
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There is Fiasp now, which is made by the same company, but it isn’t approved in the United States yet. Are you type 1? Were you recently diagnosed? When I was first diagnosed I could just take a fixed amount of Novo (2-3 units) like you are talking about and have near-perfect blood sugars after every meal. If you’re type 1 and recently diagnosed you will see that taking a fixed amount for every meal will stop working after your beta cells are depleted. After that it’s carb counting which is tricky and not always effective depending on the type of sugar/carbs. Novolog is fast but not fast enough to match the profile of many carbs in my experience. Fiasp works faster and seems much better so far, so I hope it is approved in the States soon so more people can benefit from it!
Novolog and Humalog are the most common ultra-rapid acting insulins. Afrezza is an inhaled insulin that works a bit faster, but it isn’t very ubiquitous in the US.
Afrezza works A LOT faster than injected, if that’s what you are looking for. Many other benefits that make it an awesome insulin for bolus and corrections (fast in, peaks at 15 minutes vs 45-60min of injected so you can eat any type of carbs really and without much planning, sends signal to liver to stop producing glucose which doesn’t happen with injected, its mostly gone at 90 minutes so a lot less IOB than injected). Its completely different than injected though, so feel free to ask and learn from the mistakes many afrezza users went through.
Good luck!
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I’ve used Novolog, Humalog and Apidra as “fast” acting insulin. While I wouldn’t consider any of them really fast, Apidra had the shortest time to get started and the shortest time to finish acting for me. When I wanted to go to bed three hours after dinner, I could at least get a fair idea of where my BG would end for the night by testing at the three-hour point. But four hours would be safer. With Humalog I can get a fair idea at four hours from bolus, but I can still expect my BG to drop more. With Novolog I really needed to wait five hours! In fact one time my BG dropped another 59 points after the 4.5 hour point.
While I’d still be on Apidra if I could, I’ve been unable to find a Medicare part D supplement insurance in my area that covered it for the past two years. In fact, I even had to change insurance companies twice just to be able to get Humalog, as the companies I was with previously had switched to covering only Novolog, which is for me the slowest.
My experience is similar. Novolog and Apidra seem to have about the same BG-lowering efficacy for me, but Apidra is substantially faster with a shorter tail. And there are ways of speeding it up some, but they involve procedures some people aren’t willing to do.
@David_dns When I have highs over 16 I IV humalog. It starts working in 5 mins and brings it down from 16-20mmol to 5 in 30 mins and is gone completely in 1hr I even have a picture of it somewhere on my carelink CGM. I only do it for highs I don’t want to wait hours for.1
Um, actually I don’t think that is what @David_dns was suggesting. Using an insulin intravenous is particularly risky. If you make an error of as little as 10-20% it could drop you to the floor like a rock and result in your coming around to the faces of little men in white coats. It further runs the risk of not dispersing well and it might have a pocket of concentrated insulin go right where you don’t want it, such as your brain or heart. When given under medical direction IV insulin is dripped in so it is well disperse. Just some words of caution.
What I do to bring down highs fast is to use an Intramuscular (IM) injection. Your muscle is much more vascularized than subcutaneous fat. This is quicker (duration of action more like 1-3 hours) than a subcutaneous injection but is much, much safer than doing in IV injection. I inject in my quadriceps but Dr. Bernstein suggests using your deltoid muscle as shown below.
@Brian_BSC Lol from a type 2 of all people. I have had type 1 for over 40 years and never had an issue with IV or IM and I sure you mean well but l am just answering in a forum about my experiences so please make it a little more welcoming and forgo me the lecture as I’m not prescribing people to change their medicines etc. If you want to know how to do IV ‘Safely’ it’s over in an hour and literally will stop dead in it’s tracks at 1 hour flat lining on the CGM ( in my body ) because of the IV half life is very short ( in my body ) I find it to be safer aand more predictable than SC and would use it all the time of it didnt wreck my veins.
People come here often looking for advice. And people like you who have 4 decades of experience are looked at as venerable sources of knowledge. We should expect that someone may read something here and just go do it, which is why I posted this. I have never seen IV injections of insulin ever recommended by a healthcare professional, instead they tend to say NO, NO, NO. That is why I posted this, not to criticize something that works for you.
ps. I have been on insulin for 7 years and treat myself with the exactly the same MDI regime that someone with T1 uses.
Sorry Brian I probably went off without thinking and was very rude to you and I apologise. I really do need a warning caveat for things I say like please don’t do this at home, but it is nice to have an environment to talk about this stuff that I mostly keep to myself due to no one else having it around me. I don’t really do healthcare professionals although that said I have a good endo and a CDE for my pump but they acknowledge that I look after my T1D. Helthcare professionals will IV insulin only when in hospital into an already established drip. I would love to keep talking but thia is amounting to thread hijacking.
I apologize as well if my post came off as a lecture. I just worry about our community and I want us all to feel safe.
Look, I’m all about not following medical directives when I think they’re nonsense. I only refill my pump once a week at most instead of every 2-3 days, reuse tubes, keep insulin out of the fridge longer than I should and still use it, and never change lancets until I’m in pain (which could be 6+ months). However, IVing insulin is extremely dangerous and could kill someone. Superbolusing is a much safer idea if you have a pump - you can suspend your basal for 1 - 3 hours and take the same amount up front as a bolus. It works great for foods with rapid-acting carbs and for corrections if you do it along with a correction bolus to bring BG down way faster.
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You people are sensitive. When I was 10 yrs old I had type 1 for 7 years and I ended up in hospital twice for hypoglycemia from SC insulin unconscious. I have IVd insulin and never even reached hypo levels so YMMV and lets face it insulin is dangerous stuff and can kill you stone dead no matter how safe you are with it. I dont recommend IVing it to anyone but I have actual experience with it this isn’t out of a book I read and seeing as you guys want to talk about it IV insulin wears of very quickly and I mean stops working in under an hour when I have it IV it’s got brakes on it, so much so if you don’t also have some SC as well in say a site failure it will rebound back up just as quick as it came down. I do have a picture of it on my CGM from a pump failure once. Again do what your medical healthcare team say not what somone says on the internet they do. I mean gee.
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It’s not a matter of being sensitive. Again, I do lots of things that probably wouldn’t make many doctors happy. I think stacking insulin can be done safely and I’m willing to endure some mild hypoglycemia now and then for better control. I understand what you’re saying, but insulin is made to be injected under the skin and even if it starts dropping you, it will still be far slower than if taking it in the bloodstream and far less likely to knock you out or kill you before you can get help. If you’re doing it and it works for you great, I just think it crosses a very big safety line and is too dangerous for most people to even try.
I am a fan of trying unconventional things though and my A1C would be crap if I just listened to and did what my medical team told me, so happy this method works for you! I would just be afraid to try it myself or for anyone else to outside of a hospital.
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Insulin IV has about a 10 minute tail. That’s it. I’ve seen the half-life listed as between 5-8 minutes. When it hits the blood stream it circulates once and is pretty much gone. A massive dose IV will indeed have serious repercussions but length of action isn’t one of them. When administered IV it needs to be given with a continuous drip for just this reason.
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Thats right well said.
I was reading these while at work today. First is IV intravenous and is someone injecting insulin into their vein? I won’t be doing this. i am still trying to figure this all out! What is IMD? What is the tail? The end of the insulin working? If I inject Novolog 2 units at 6 pm, doesn’t; it wear off in about 90 minutes? What is the tail? I usually inject in my stomach or thighs, but see Tresiba shows the tops of thighs and also arms, I seem to have plenty of fat locations to inject.
Thanks!