I have been trying to time when I take Novolog to avoid spikes. I usually try to take it 30 min before eating. Still often I get a large spike before the insulin starts bringing down my bs. And, sometimes it seems to take a few hours before the insulin works to bring down my bs----seems that there is no regular interval before the insulin has an effect on my bs. My doctor said to take half of what I would take for that meal 30 minutes before eating and the other half when start eating---this makes no sense---that would even take longer for the insulin to work it would seem. And yes, I inject but do use a CGM.
What is a huge spike for you (just to get your perspective)?
I have been using Novolog for about four years or so. My experience has been that if I bolus'ed thirty minutes before I started eating I would probably be on the deck from a low. I know it varies person-to-person by a bit but typically fifteen minutes has been the key for me (in restaurants I don't do it until the food is in front of me). Have you ever taken a dose and then check your BG every couple of minutes until you see the insulin starting to have an effect. In my mind that would set the time that you should be bolus'ing too.
Is it possible your insuling:carb ratio is off? Also, on those times where you see a spike after a couple of hours, what are you eating? Sounds like the pizza effect (doesn't have to be pizza that you are eating but a meal with higher than normal fat which serves to slow down the whole process).
Just a thought.
from somewhere in the 100s to somewhere in the 200s
I do have a continuous glucose monitor and so I could watch it closely.
I don't think that it is the pizza effect---it does seem to be when eat a larger amount of carbs, but not sure.
The only thing I think I am sure of is that the Novologs effect varies and sometimes is still having an effect several hours after I took it---it seems?????
I think you may be trying to do the impossible.
What types of foods are you eating ? If mostly carbs, then it's hard to avoid a spike.
I agree with MegaMinxX. You may or may not be aware of the philosophy of "eat to your meter." It simply says that you eat what you want and then test your BGs at mealtime and a few hours later to see what the effect is. If certain meals/foods consistently run your BGs too high then stop eating those meals/foods!
I can tell you right now that if I wanted to dose insulin successfully for a bowl of breakfast cereal with milk and fruit, I could try six ways to Sunday and not be able to do it. I could employ prebolus, superbolus, extended bolus, or creative splitting of boluses. I know that I would not be able to prevent subsequent multi-hour hyperglycemia. And I don't care if I'm eating whole grains, it's still an impossible feat for this diabetic.
Diabetes is a disease of carbohydrate intolerance. The only open question is where your level of tolerance lies. It's a shame that the diabetes advocate agencies and the medical professional associations are in deep denial about what carbs do to diabetics. They seem to want to try their hardest to give us permission to eat copious carbs to our detriment. Don't buy into their seeming empathy. Diabetics must carefully consider their consumption of carbohydrates.
I eat about 50 grams/day. It wasn't until I reduced my daily carb consumption to < 100 grams was I able to maintain reasonable control over my BGs. Your carb threshold may be different but you do have a level of carb consumption where BGs are more easily controlled and your BG variability is reduced from mountain peaks to rolling hills. I feel that BG variability is the single most important factor in BG measurements, way more important than A1c or average BG.
Trying to get that perfect insulin delivery profile to metabolize a 50-100 crab gram meal is wishful thinking for me and many other diabetics.
Lots of valid points made here, so I won't repeat any of them. Just a comment regarding your doctor's advice.
The reason he suggested splitting the dose is so you have some insulin taking effect when you eat, and some more later to cover that delayed spike you talked about. In other words, as the first batch is starting to fade, the second should be kicking in. I'm pretty certain that's what he had in mind.