15-20 minutes is working okay so far. My I:C ratio is around 1:20 but seems to be creeping up towards 1:30 now that I’ve been using the Novolog for awhile. Maybe my pancreas is doing better since I’m “resting” it with the insulin. So far no bad lows which is a relief, although I’m not using quite enough yet for some higher carb meals. I think I need to ask for the junior flexpens so I can use half doses. Still waiting on the Dexcom, too bad Santa doesn’t have any!
Hi Lilli. I use 2 pens, Apidra and Levemir. I remove the insulin from the pens using 1/2 unit BD syringes. Once you start using the syringe, though, you can't go back to the pen needles.
Oh thanks for the info Trudy. I did that once but then did go back to the pen needles, oops! I tried to google whether you could do that but couldn’t find any answer. So I guess I would need to keep and maybe mark one pen for half dosing with the syringes and another for pen needles.
Lilli, that does sound like a lot of trouble, but whatever works. My doctor prescribes the syringes, and I use a gazillion, even though I use each one twice. I can't say that the syringes are any more bothersome than pen needles, just bulkier.
I take novorapid about the time I start going towards the dining room at work or before I start the final prep for dinner at home. 15 minutes?
I started off bolus'ing 5-10 minutes before as well. Reality is 15-20 minutes works a lot better. I would suggest that in a controlled environment you figure out how long the bolus takes to start "hitting" you. Bolus as normal but instead of eating take your pre-bolus BS reading. Take one 10 minutes after you bolus. Take one again 10 minutes later. When you see your BS starting to dip you know the time it takes to hit.
The only caveat to this is NEVER bolus at a restaurant until you see your food. Too many variables on the timing of when you get your food. You can very easily drive yourself to an extreme low if you shoot too early.
Mike
Yes I’ll try that Mike, I don’t know why Novolog says 5-10, nobody seems to use that timeframe. I’m going to try afrezza when it comes out too, I think for restaurant meals being able to use a super rapid acting insulin right when the meal is set in front of you would be great, no worries of delays and nasty lows.
I'll take exception to the never bolus early eating out -- while your caution is totally justified, this can be managed as well. I don't like to have to, but I will start popping skittles if the food is substantially delayed, eat some bread, etc (usually the latter, since I was going to have some with the meal anyway).
I don't like to have to take in these extra carbs, and usually don't have to. I hit this problem maybe 1 in 4 times eating out, and haven't had a really serious delay that had me basically covering most of the insulin with sugar.
Of course this is just another angle of Tight Control Obsession :-)
The 5-10 minute metric is simply a lowest-common-denominator cover-their-■■■ specification... I doubt any of the fast-acting analogs starts to truly start any real efficacy for 20-30 minutes at a minimum. I see actual effects on BG after 35-45 minutes, peaking around 90 for sub-q administration.
I TAG. I try to stay under 100g carb a day, not very low carb, but pretty low.
I have a pump (Omnipod) which makes this much easier. I program a bolus to deliver an immediate dose that covers the carbs, an an extended "square wave" to deliver the protien/fat portion of the insulin over 4 hours.
With this approach I can stay pretty flat, well below 140 and still out of hypo territory, eating a big burger and fries. If I just bolus for the carbs, 15 minutes early as advised by Eli Lilly, I'll spike over 200 easily for the same food, and 5 hours later be down somewhere between 130-140 having started in the 80s.
There's quite a bit of art in the whole thing, Lilli, and the kind of fine-tuning necessary to really be tight almost requires a pump -- there are insulin delivery "profiles" that simply can't be achieved with injections.
Why can’t we stay tight with injections? Does the insulin work faster with a pump or are you just giving lots of little boluses?
It's a matter of practicality.
A pump can deliver an amount of insulin in a variety of ways that are not possible with injections, chief among them a continuous infusion over a period of time. This mimics the actual behavior of the pancreas much more closely than injections.
Carbs are generally not the problem, per se. Slowly digesting food -- usually fat and protien, but carbs can be slowed too -- make it impossible to match the action profile of an injection to the demand profile resulting from slow carb digestion and gluconeogenesis in the liver.
It will be near impossible to achieve the same results with injections that can be achieved with a pump. Does this mean excellent results are not possible with injections? No! but it's quite a bit more work.
For example, the reasonably simulate a 4 hour square wave injection, the minimum is probably 4 injections, once and hour. While certainly can be done, it's just not practical on a regular basis.
The flexibility in managing boluses was the main reason I pushed hard to get approved for a pump. I'm probably not the best example, because in terms of BG management and tight control, I'm a T2 version of acidrock :-)
I wouldn't either. also, one cannot tell when they're actually peaking with either carbs or insulin with a dexcom or any CGM because it too has tons of variables and has a lag time. this is not linear. any amount of exercise too can change all of this. the peak of insulin and it's duration can also change due to many variables. high carb or low carb, you just count the carbs and bolus for the carbs. Lilli, it says you're on orals, are you a type 2?
Forgot to update my profile Sarah, just started Novolog at mealtime two weeks ago. I may be early & slow onset LADA, or thin T2, not sure. Endo thinks LADA based on genes and family history. I’m kinda type weirdo it seems.
OK. I guess it's sometimes frustrating, as a type 1 anyway, when I read comments like, "I do this and this and achieve this." It doesn't work that way, unfortunately, and especially for a type 1. Exercise (even walking, moderate) can change how insulins work or don't work. Where we inject, the absorption, can effect how it's going to work or not work. If one is thin, has a lot of muscle, they'll absorb insulin differently, too. As I said, none of this is linear. We all know we can do and eat the same meals every day and often have very different results. Weather, lack of sleep, anything can effect any and everything. You have to experiment, every meal time can have a ton a variables too. A CGM is great for trends and it will show you where your BGs are heading (I'd never give up my Dexcom) but it lags and that lag time can depending on many things too. Often times, however, it's spot on. So...go figure? Also, the reality is, we have no clue how our body is going to process and/or digest foods (the timing), converting it into glucose. there's no way to know and there's really no way to accurately determine when the insulin will hit or when it's at it's peak. every body is different, too.
Yes before I started insulin I could see a lot variable in my BG, problem is as you all know when you add insulin to the mix it really gets complicated. I need the CGM to at least know the trend since I don’t feel the lows until they are dangerous. Is an 85 spot on good or going down fast? I was hoping to get my awareness back by avoiding lows but so far that’s not happening. It’s funny, but until you have this health problem it seems a lot simpler, you are T1 or T2, you take insulin or metformin. Now I know the truth and the truth kind of sucks actually.
dave said: "The flexibility in managing boluses was the main reason I pushed hard to get approved for a pump."
i thought type 2's could not get pumps approved by insurance. what were the most important factors leading to you successfully getting a pump?
Lilli, re your question about tight control and MDI, being able to smooth out basal is another advantage of a pump. I'm on MDI and it can be challenging finding the right dose and timing of injections to make sure I don't crash in the middle of the night and that I'm not too high in the morning. That's just one example. I know my basal needs change throughout the day and if I go to a pump, I'm hoping I'll be able to keep a more even line on the CGM. That is, if I can still afford the CGM!
I hope you get a pump and it helps with your basal Shadow Dragon. So far my basal is ok and I just need a small bolus with meals. I still eat very low carb at night though so I don’t have to worry as much about going too low while sleeping. My Dexcom comes next week so I may add back some carbs once I get it up and running. I feel lucky to have my own background insulin still, if I just don’t eat much I stay pretty steady, but of course not eating is not a good option!
Mismatch of bolus timing v mismatch of insulin to carb counts:
- Timing mismatch: If someone boluses “late” or does not pre bolus, would it typically show up as high BG and then the BG ought to retreat with time as the insulin kicks in.
- The mismatch of insulin to carb counts: I would imagine that insufficient insulin would simply manifest itself as high BG and may remain high or retreat only after many many hours or perhaps with a correction insulin injection. Does this seem to make sense both in theory and from your experience?
Thanks.
I would start buy eating the same meals each day and changing my bolus until most of my post meal BG tests where in target range after 5 or 6 hours…I would not snack between meals while testing my meal bolus. After I had some success with my IC: Ratio for each meal time (they can be different for breakfast lunch and dinner) I would start increasing my bolus timing slowly watching for a drop in BG before my food kicks in and this is what would be my max time for that meal ,time of day, and my starting BG…There is no science here I have just adapted to what gives me the best overall success. I’m a Type 1 diabetic and I know my BG is going to end up out of target range when I do certain things, and sometimes it just does it anyways!
Relax…you have the rest of your life to figure out what works best for you…Just the fact that your trying is going to help you. Keep a log book, take notes everyday, take lots of BG test, and eventually your insulin dosing will become routine.
Try not to misinterpret what is being said on the DOC…Even well controlled diabetics have Diabetic blood sugars…