# Novorapid question



## hotchop (Jul 10, 2011)

Good morning 

I have been on Novorapid now nearly a month and had a 15 min appt with the hospital DSN who prescribed and talked about how to do it.

She looked at my food diary and said that i needed 2 units for brekkie, 4 for lunch and 6 for dinner... I am a moderate low carber and usually stick around80-100 g of carbs per day.

These amounts are not working and im unsure on what Info I should be using to adjust these doses.

She also talked about correcting and I find this easier than injecting at the time so I know that I need 2 units of insulin to come down 1 mmol.

My question is.....because I dont know before i eat how much my bg will rise, is it ok to inject reactivley, after the event or does this just defeat the object?


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## Robster65 (Jul 10, 2011)

Hi Hotchop

Novorapid works over about 4 or 5 hours, with its peak at about 1.5-2 hours, so it needs to coincide with the spike from your food. Depending on what you've eaten, you can probably get away with injecting straight after eating, but usually it's better to inject about 10-15 minutes before.

If you're eating v low GI, after is often better but med-high GI spikes quickly and needs the novorapid to be in and running.

The doses sound low, which I suspect is to start you off and see how it affects your BGs, so probably best to get in touch with your DSN and discuss a strategy for increasing. It would be difficult to suggest doing it from here, since 1u would be a 50% increase on your breakfast dose and could make a big difference.

Rob


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## everydayupsanddowns (Jul 10, 2011)

interested to know in what way they are 'not working'. 2u to 1mmol/L seems quite insulin resistant (many T1s start on the basis of 1u to 3mmol/L and tweak from there). At 2:1 I'd almost expect your 2u to only be processing around 3-6g of carbs (only guesswork based on my own levels of course) what sort of breakfast do you eat? Have you got an idea of the carb load?


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## Northerner (Jul 10, 2011)

I agree with Mike. If you can work out the amount of carbs in each meal then you can work out your insulin:carb ratios. You should then be able to look at your post-meal numbers as compared to your pre-meal numbers and get some idea of how much under or over the dose is for those meals. All this will come in time, I am sure - it takes time to build up the experience, but I understand the desire to get it all working as soon as you can. When I was first learning I had a tendency to inject too much so ended up feeding the insulin/treating hypos.

As Rob says, injecting prior to eating is better because it lessens the possibility of spikes - it sounds like you are waiting for the spike so you can correct it - this won't be good long term as even though you may be bringing levels down, you will be yo-yoing with levels constantly. If you find that the doses are too high, then it might be worth asking for a half-unit pen so you can fine-tune things more.


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## hotchop (Jul 10, 2011)

Thank you both for your replies

I have maybe grilled bacon and egg for brekki or nothing at all. for lunch i may have tuna salad and a roll and for dinner its usually meat of some sort or spag bol or something quick.. all home made and not processed.

 If im having a binge day, i may eat 4 slices of bread which is 7.9g of carbs each


I suspect that im afraid of taking too much novorapid incase i go too low which is why im waiting to correct afterwards... which sort of defeats the object of novo.. to stop the highs in the first place

This may sound really stupid as ive been a near daily reader to this site for 18 months but what exactly does insulin resistant actually mean?


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## Northerner (Jul 10, 2011)

hotchop said:


> Thank you both for your replies
> 
> I have maybe grilled bacon and egg for brekki or nothing at all. for lunch i may have tuna salad and a roll and for dinner its usually meat of some sort or spag bol or something quick.. all home made and not processed.
> 
> ...



As I understand it, the glucose gets into your cells via receptors that use insulin to allow the glucose to pass through (insulin is often described as a 'key' that unlocks the cell to allow the glucose to enter). If you are insulin resistant then you have fewer of these receptors or they are damaged (not the right 'shape'), so the insulin can't work as well. When you exercise, more receptors are created on the cells which makes you more insulin-sensitive and therefore helps to overcome the resistance - as a result you may need less insulin after or during exercise.

Hope that makes sense! 

Try not to be afraid of going low. It might be worth discussing it with your nurse so they can calm your fears about this. I've had a lot of hypos recently and they are mostly an irritation rather than something scary, as they signal their appearance pretty well usually and can be dealt with very easily 

It sounds like you are very low carb, hence the low doses. Some people that are on higher doses inject part before and part after so at least they have some insulin working as the food digests, but ideally, you should give it all upfront - you will quickly learn whether you need to adjust the dose up or down


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## trophywench (Jul 10, 2011)

Could you not eat a carefully measured (but small) amount of carbs and see what your BG goes up by?  Then you'd know what to shoot for that number?  And then apply that formula to however many g of carb you happen to be eating ....

Or .. do you find you also need to inject fast-acting for protein/fat only meals?


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## Northerner (Jul 10, 2011)

Have a look at the links I just posted in this thread, they might help you understand what to do:

http://www.diabetessupport.co.uk/boards/showthread.php?t=19188


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## hotchop (Jul 10, 2011)

Thank you for the links... i found this one especially helpful.

http://www.leedsth.nhs.uk/sites/diab...eTestMeals.php 

Ive not noticed that protein raises my bg unless its with something else. I tend to nibble on ham if im hungry and this seems fine.



 actually explains the doses quite clearly. I think I need to properly measure what im eating more carefully and start testing before i eat so that i know what im actually injecting for. I was more concerned with covering insulin for the food.

My basal is a steady 5-6 mmol and since starting on novo, my levemir has nearly halved and dsn asked me to stop splitting for the time being.

 I was injecting after the meal with the aim of coming down to my basal level.  I hope that makes sense.

Im assuming that my ratios will change from meal to meal ( using the caluculator on the website ) rather than a straight across the board ratio.

Cor blimey, I have a headache now. Im off to investigate the website..

Much appreciated, thank you


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## Northerner (Jul 10, 2011)

hotchop said:


> ...Im assuming that my ratios will change from meal to meal ( using the caluculator on the website ) rather than a straight across the board ratio.
> 
> Cor blimey, I have a headache now. Im off to investigate the website..
> 
> Much appreciated, thank you



Yes, I have found that I need more insulin per 10g of carbs in the morning and progressively less through the day. So, a slice of toast in the morning needs 6 units novorapid, but lunch of e.g. 2 boiled eggs, 2 slices of toast soldiers and a yoghurt are also 6 units! Then, Chilli con carne and rice, plus ice cream and tinned peaches for tea is 9 units! I still get headaches from time to time!


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## squidge63 (Jul 12, 2011)

I used to inject my novorapid before my meal, but last year my DSN told me to inject after my meal in case I had given too much before and not eaten enough of the meal, so I find injecting after easier.

I am 4u:10CHO and my correction dose is 1.5u for every mmol that I am over 7mmol.


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