Pumping Humalog, I used to have best results when I waited 30 minutes before first bite--but I say better results at 2-hr post-prandial reading and next pre-meal reading. With only fingersticks, could never be sure I had caught the peak.
I switched to Apidra a few years ago on advice of nurse practitioner, who said that for some people, long-time use of one rapid-acting could lead to it not working as well. Sounded fine to me at the time, but not really sure it's about the insulin--perhaps more an issue of insertion site scar tissue?
Anyway, Apidra doesn't seem to be out of my system as quickly as your chart states. Now that I have a cgm, I hope to be able to get a better handle on it.
For now, I bolus and wait 30 if: I'm above 120 or planning to eat some fairly simple carbs. If I'm above 180, I correct the high and try to wait longer before meal bolusing.
I wait about 15 minutes otherwise (unless I'm under 70). That does mean I'll start to plunge a bit, before the glucose from the carbs hits my blood stream, but seems to help keep my peaks more Ozark Mountains (less steep) than Rocky Mountains!
My endo just this Tuesday was surprised I wait so long. She said the Apidra starts working in 5 or 10 minutes. Well, it probably does but in my real life there's no such thing as a tidy chart!
The other thing I want to work on: how long it takes me to eat. I tend to eat too fast.
What stands out in this discussion is that medical people and the insulin websites can only give us a guideline. We have to fine-tune and adjust our own doses. I make a guess with every meal depending on my BG, the food I'll (probably) eat and whether or not I'm expecting it to spike, the time of day; also taking into consideration that for dinner, I'm going to have very slow digestion.
On MDI, I use three insulins--Apidra, Regular, and Levemir. I choose whether or not to us the Apidra or Regular, or both, depending on the meal. For dinner, I usually take half my bolus in Apidra just before eating, the other half in Regular right after eating.
When I'm lucky enough to use my pump (Apidra), in the evening, I take half my bolus before dinner, the other half a while after dinner, depending... I never could figure out how to get the dual wave right!
Back when I first started using insulin in 1984, I was told to take it 30 minutes before eating. When Humalog came out, I was told that I could inject that right before eating. Then I learned that did not necessarily work and I would pre-bolus by about 15 minutes.
When I first switched to Apidra, both my doctor and I were concerned that it would be too fast for me because of gastroparesis, but he was willing to let me try it. I guess he did not think that it would work because he gave me a sample without a script and I had to call and ask for the script when I decided I wanted to continue using it. Apidra takes 20 minutes for it to kick in for me and that is confirmed by using a CGMS.
Even if my BS is in the 70s or 80s, I will prebolus by 20 minutes, but if my BS is low, I won’t do that. In the mornings, it takes 22 minutes from the time I inject my insulin until I take my first sip of coffee. If I am in the 60s when I wake up, I wait until I actually drink my coffee. I do find that I end up going high if I wait until I actually take that first sip of coffee to take my insulin.
I (like many) was origninally told to sit down at table with plate + food, count carbs, bolus (I was on MDI: Novolog), and eat. When I began to see wacky 2hr #s, my Endo recommended that I bolus about 15min before eating if 80< BG >150. It helped a bit with those numbers.
I have been on a pump (now oPod w/ Novolog) since Sept 2009 and have since had an issue with breakfast specifically. I was able to bolus about 2-2.5u right when I woke up ( BG< 120), shower, get ready, etc for 1.5+ hours and not move a single iota in terms of mg/dL. Frustrating for sure. I have since added Symlin specifically to breakfast when I eat high(er) carb (>30g) and will bolus right before eating. I have not had wonderful success with Symlin in general (NO decrease in I:C, TDD, nausea, appetite, etc) but it does seem to slow the rise post-bfast.
My doctor about 1.5yrs ago gave me pretty free-reign of my management (college student, biology major, etc), and I have found that bolusing about 30-45min prior to a meal (any meal) works wonders for my post-prandials.
Anywho, not really an answer to your question, but it's how I do things.
Wow this is good. Cheaper and faster action. I will see what hoops I have to jump to get some. I will ask new GP for a prescription hope he is not chicken ■■■■ and refuses. Maybe I will ask pharmacist to write him a note or even better is pharmacist is allowed to prescribe.
Thanks all for the advice. The pharmacist prescribed the apidra with no hassle. It is about $4 per vial cheaper. Will start ASAP when the novo rapid vial is finished (soon). Our province does not cover anything.
Very interesting reading. I am always super amazed at people that can give such precise numbers (in minutes, ratios, etc.). I can do the same thing day in and day out and get such different results that I don’t think I can ever narrow numbers done like that. I just watch the BG and act accordingly.
For breakfast I will bolus Apidra:
15 minutes before breakfast if I am between 75 and 90,
30 minutes if I am between 90 and 125,
an hour or more prior to breakfast if I am above 125.
I have dropped too low sometimes, but then take that as my opportunity to eat a bowl of cereal (which I never eat otherwise because I spikes no matter what I do).
For the rest of the day, I normally eat while there is still IOB, so I need not usually wait. Of course if BG is high then I try to wait till it is below 125 to eat. I must say though that all insulins seem to go on forever in me. I tested the tail on Apidra and I was still seeing flat BG 6 hours after the last insulin was injected ( No basal, meaning I still had IOB keeping the numbers flat)… I also seem to peak at 31/2-41/2 hours. And of course all those other various factors play into all that. Sheesh…I am amazed any of us survive even a day lol
I started following that method b/c I had lots of lows about an hour after I ate, especially if I worked out shortly before a meal.
I actually said "I don’t inject much insulin…"
I do occationally do the 2nd phase insulin, but I don’t typically eat enough protein to have to account for it. I historically have only used the 2nd phase, kind of what Rick Kowalczyk described, on Thanksgiving, and when I ate something like pizza or chinese food.
I recently tried to start doing the Bernstein diet (I am working on it, but the lows have me breaking the 30g limit), but I have had such trouble with unexpected highs and lows. They are only unexpected because everything is os much different than when I was not on low carb. I need to start using those glucographs that Bernstein created so I can look at what is going on with me. I think once I start eating enough protein and My body gets use to the gluconeogenesis, then I will probably start having to do the 2nd phase shots. Injections don’t bother me, though.
Typically I don’t bolus before a meal. I suspect I have some gastropareses with anything but a small snack. The other issue is that whenever I’ve bolused well before a meal, I almost always end up eating something different to what I’d planned. Less because I’m not as hungry, more because I had seconds, or at a restaurant and the meal isn’t want I expected, and so on.
I do TAG and I do extended boluses for dinner (and lunch if it’s more than a cracker and a salad). Lately (without a fundamental change in diet) I’m finding BGs going up 3 and 4 hours after a meal. Not sure how to manage that without going low first. I do an average of 70/30 for most dinners, which is great for the first 3 hours. What works better is if I have some more insulin at the 2 to 2.5 hour mark. I can’t seem to figure that in with the initial bolus without going high or low at some other point. Still getting my head around that one.
A CGM would be really helpful. Sadly, only the Medtronic ones are available here - not my first purchase-choice. Am still trying to borrow one from a DE. I see a new DE (I moved states last month) soon.
