I want my bolus insulin to work faster and clear from my system faster! and I am looking for ideas/recommendations. How fast does your bolus peak and when does it clear from your system when you inject in your forearm? Do you switch between your left and right forearm for rotation? I use the Novo Echo pen. I was thinking about injecting into muscles for all boluses because I don’t want the insulin to be active for many hours. Even for a high fat meal, I would prefer to bolus again and for the insulin to clear from my system quickly.
Do you think it will work using the Novo Echo pen and the short needles - without using a syringe with a longer needle (Dr. Bernstein recommends injections into the muscle using a longer needle and syringe for corrections)?
About the comment : Sometimes with basal rates less is more. Did you reduce the basal because you were exercising more?
Once we find a manageable basal rate, should we consider reducing it a little (based on your comment)? I apologize if I’m a little slow and may have missed something. "It appeared to me that the mere act of pulling back on the basal made my basal needs paradoxically decrease even more! This didn’t go on long and in the end I would have to increase some rates from their low point but still at a net reduction from the starting point. "
Keep in mind that the post from @swisschocolate you’re replying to is from January, and I haven’t seen her around here of late so you may not get any response.
That said, given she’s pretty lean I’d suspect she was actually crossing into Intramuscular territory – injecting the insulin into muscle tissue rather than fat tissue, the usual “subcutaneous” target for insulin injections – which absorbs as much as 2-3 times faster in most people.
Yes, when I adopted carb-limited eating, I not only reduced my bolus insulin but I ended up reducing my basal rates significantly, too.
I think it’s always good to consider cutting back on basal insulin if I get a pattern of lows that I can attribute to the basal rate. It was a strange feeling cutting back on basal rates and instead of bringing my BGs up they would go down.
I think that all things held equal, less insulin is better than more insulin. I’ve read some sources that make that also make this hypothesis. In fact I’ve read suggestions that long term complications, especially in the insulin-resistant cohort, that hyperinsulinemia may cause as much damage as hyperglycemia.
Back in 2012 when I changed my eating style to low carb, high fat, I cut my total daily dose of insulin in half. A lot of that cut came from basal + correction boluses.
I’ve found that if I don’t change my pen needle each time I have that problem. Especially with the new super flow pen needles. I’ve had it happen 3 times now and it wouldn’t finish giving me my insulin at all. Screwed up my dose.
Yeah that makes sense… the couple pens I had it with always had new needles they were just weak. I just opened a new one and it’s got a hair trigger again like it should. Hopefully just a temporary glitch
@lh378 I don’t really know the exact action pattern of my NovoRapid, never tested it… I just remember having felt that in comparison to using a pump where you add insulin to an already large insulin-lake at the infusion site, with the pen where you change locations all the time it works faster.
Unfortunately I am not the best at rotating sites, my left forearm is quite the victim as i am a rightie and that is just the most convenient. convenience plays a big role in my injection sites, also the actual reason why i started injecting in my forearm, as its just the easiest to access most of the time. i am trying to rotate more often though…
I would definitely try the forearm thing, start with the 4mm needle and if its not statisfacting maybe increase needle length to 6 or 8mm. I dont see though why you had to use a syringe.
@Dave26 thanks for your concern! i am quite busy at uni, however i get notifications to my email if someone mentions me, and i try to check in and read some posts once a week.
so if you need me you can always find me with @ swisschocolate
have a nice day!!!
[quote=“swisschocolate, post:533, topic:50202, full:true”] @Dave26 thanks for your concern! i am quite busy at uni, however i get notifications to my email if someone mentions me, and i try to check in and read some posts once a week.
so if you need me you can always find me with @ swisschocolate
have a nice day!!!
[/quote]Great to hear from you @swisschocolate! Since we got your ear, give us a quick update on what you’re doing at University!
Tresiba Update. After having read about many positive reports on Tresiba, I decided to give it a try. If I can simply my life and reduce my Levemir injections from twice daily to once daily Tresiba, and maintain decent BG control, I’d say that’s an improvement.
Day #2 on Tresiba once daily at 6 units.
Last night went to bed at midnight at 139.
This morning fasting BG 88.
The morning fasting is lower than I’ve ever had with my Levemir dosage (usual morning fastings between 100-135). My Levemir dosage was 5 in the morning and 6 at night.
I’m not going to make any changes because of the 3-4 days steady state Tresiba guidelines.
It may seem like my basal is set too high because of the drop from 139 to 88. However, my personal experience has been that whether my bedtime is near 140 or near 200, my next day fasting BG had been between ~ 100-135. Is my liver compensating the sugar dump? If the liver senses bedtime BG near 200, it dumps out less sugar? My endo speculated that perhaps my body liked been between 100-135 for fasting. I was hoping to get between 90-100 for fasting. It looks like 6 units of Tresiba achieved it. To be on the safe side, I will target bedtime around 140 and see what happens… Even if it’s higher, I won’t bolus correct because it would introduce additional variables… It has been said diabetes management is a marathon.
I saw some old posts about re using old pen needles. How many of you currently re use pen needles, especially for the bolus injection? I figure change the needle once a day. I always prime before every injection. I do see the small air bubble. I think the bubble is an issue towards the end of the cartridge. When there is still a lot of insulin in the cartridge, one can inject such that the bubble is far away from the needle so that the quantity of insulin is not affected. Therefore, I believe that re-using the needle at the beginning of the cartridge or while there is still alot of insulin in the cartridge is probably not going to cause inaccuracies in dosing.
I reuse pen needles for my Humalog. I always prime before each injection and don’t worry about any error since priming makes sure that the isn’t any air in the needle. I just keep the needle on my pen during the day and replace it at night when I take my last bolus and then take my basal. So I basically get by many days with 2 pen needles.
Thank you both about the answers to reusing pen needles.
@Brian_BSC I, too, always prime before every injection.
I want to make sure that I understand correctly: If there is air bubble in the cartridge, I need not be concerned, as long as I prime before each injection? (I try to get the air bubble away from the needle - towards the opposite end of the pen.)
Day #3 on Tresiba:
Bedtime BG 138
Fasting BG 92
skipped breakfast and checked BG 2 hours later :102
Looks not bad to me. The fasting BG are lower than when I was using Levemir. Tresiba seems to give me decent fasting BG. As for the slight rise after fasting - skipping breakfast, the numbers could be within the error of the glucometer. I think it is keeping me reasonably "flat"
I have not awaken in the middle of the night to check BG. In the past when I used the Dexcom, I did not notice that I went low or high overnight. So I assume that there has been no major change.
I always hold my pen vertically, needle up. Then flick it to release bubbles to the top where the needle is. Then I prime, still hold the pen vertically. This should squirt any air bubble out during the priming operation.
The pen needle extends into the vial a bit-- this is what makes it so tricky to get the bubble out… but it also makes it essentially impossible to inject a bubble mid-dose in such a way that would affect the dosing.
Two tips I’ve learned to minimize/ reduce bubbles
prime one unit of insulin BEFORE you attach a needle— so that the vial is pressurized a bit before you attach needle. Hold pressure on plunger. Hold pen upright with needle end upward. Slowly screw on a pen needle while pressure is on the vial and the pen is strait up and down. More often than not the introcution of the needle in this fashion breaks the surface tension of the air bubble which is right underneath it and discharges most of it.
leaving pen tip needles on allows the contents of the vial and vial itself to expand and contract with temperature and pressure changes, frequently drawing more air into vial I’m not sure this is actually a problem, but it’s annoying to me, so I always take the needle off even if I’m in a situation to have to reuse the needle-- I used to reuse a lot but have gotten away from it just bc it seems kinda gross in my mind, no legit reason. I also hold a little pressure on the vial when taking the needle off which I think minimizes air induction.
Spring loaded pens like tresiba seem to have less bubble issues than manual ones like novolog
I just started Tresiba this morning. 18 units. I just received Novolog for a mealtime insulin. I am new to all of this. The Lantus for less than 3 weeks caused 12 pounds of weight gain!! OMG so sad. I worked so hard to have a good body weight. Doctor said maybe wrong amount of basal. I also learned on this site about priming needle and insulin. did not know.
I hope Tresiba is going to be better and not cause weight gain. Then I woke up last nigh bg 69! My hand was numb and I could barely move it. Went to kitchen and had snack of plain full fat yogurt with a piece of a banana and a few seed snacks from Costco. Went back to sleep this morning fasting was 236. Took 18 units of Tresiba. ’
Hoping to get feedback from all the knowledgable folks here. thanks
One key thing with insulin is learning to not overtreat. A blood sugar of 69 mg/dl is a mild hypo, I would treat it with just a few grams of carbs. I used little sweet tarts and smarties, but sometime I’ll just mix a teaspoon of sugar (4.2g carbs) in some water. 4 g of carbs might raise your blood sugar 20-40 mg/dl. The yogurt might have been 15g carbs, a half a banana another 30g, so not including the seeds, you might expect your blood sugar to rise 225 - 450 mg/dl.
An overnight low being driven by a basal is typically a slow moving creature that can be managed with just a little nudge here and there.
And as to weight gain. I have to be honest, part of this is likely that you experienced weight loss because of your high blood sugars and your weight gain is only your body bringing you back to your starting condition. Insulin doesn’t have to cause weight gain. I am within 5lbs of the weight when I start insulin six years ago. Of course you need to eat right, but you also need to make sure your insulin is properly set, take too much and you will end up eating to cover the insulin. Use too little and your blood sugars will run high and you will preferentially gain weight.
Ok. I am going to eat very strictly and high protein. I am having two fried eggs for breakfast with a little cheddar cheese in top. No need to bolus with Novolog as no carbs. They gave me a chart to check bg prior to eating then depending on carb intake for meal to use novolog. I am going to try very hard for low carb to reduce need for Novolog. Folks seems to like tresiba and I hope it works. I am feeling depressed about this weight. 120-125 is where I should be and now 145 5’3" and I am so worried. Never had the numb hand thing last night I am glad I woke up. Will try the sweet tarts or similar next time. Need to grocery shop this weekend for paleo type diet again.
