I use Lantus, Novolog (a fast-acting insulin with a peak at 80 mins),
and just recently added Novolin-R (regular human insulin) to my
arsenal. Experience with the fast-acting suggests that it usually
works well in small doses (1 - 2 units at a time in my case) to cover
small, high-carb, high-GI snacks or to cover low-carb meals (meats,
vegetables, nuts, tofu, egss, etc.).
For me, the downside with fast-acting insulin is when I eat a low-GI,
but higher-carb meal, thus use a larger dose (3 or 4 units). In these
cases, I sometimes get either a mild low blood sugar 80 minutes after
injecting, or a moderate high (140's) at 2 hours after finishing the
meal. For meals eaten after exercise, I am also prone to experience
lows from fast-acting insulin, even with a lower insulin-to-carb ratio
than normal. For this reason, I nibble on carbs several times in the
hours following the meal. The problem here is that the fast-acting
insulin wears off quickly in this time and if I nibble just a little
too much or too late, I get a high reading (140's).
I am still in the learning phase of using the regular insulin, but I
am hoping I can fine-tune some of these problems by knowing when I
should use each type of insulin and how long to wait before eating.
From what I have read in Bernstein's book (I do not wholly agree with
his tactics, but I believe he makes some valid points.) It is better
to use regular insulin when you have the option of waiting 30 - 45
minutes to eat, but use fast-acting when you must eat right away or
are planning exercise 3 hours later. Is this correct?
Can you cover both a meal and a later small snack with a single shot
of regular insulin? Using the fast-acting insulin, I find myself
using an extra injection to cover a mid-morning snack. I can skip the
snack and have normal blood sugars, but still end up feeling crappy
for several hours. To me, the extra shot is much less of an impact on
my quality of life than spending several hours feeling crappy, but I
wouild like to keep the number of daily injections to a minimum if
possible.
Ted Rosenberg - 04 Oct 2003 21:30 GMT
Looking at the activity curve "fast acting" is not
in fact, it is not much faster than "R" - has a faster drop off, and
costs better than twice as much.
I use "R" and "L" - though I may have to switch from "L" to "U" because
Nove is stopping L
the L takes care of the basics and snacks, and the R takes care of
meals, or cny other peak.
> I use Lantus, Novolog (a fast-acting insulin with a peak at 80 mins),
> and just recently added Novolin-R (regular human insulin) to my
[quoted text clipped - 31 lines]
> wouild like to keep the number of daily injections to a minimum if
> possible.
IF YOU CAN'T SWIM DON'T JUMP IN - 04 Oct 2003 22:35 GMT
ANOTHER good reason for a pump if you got the bucks.
case
the case, minus a few cans!
Hypo Man - 04 Oct 2003 23:55 GMT
you beat me to it...in the pump you could use a dual wave bolus which allows
you to bolus some now and some over a stipulated period of time. You set the
the time...which is usually based on the carbs. It's kinda handy for things
like oat bran, pizza etc that may enter your bloodstream slowly and be
peaking in your bloodstream after the short acting insulin has worn off. I
guess with MDI you would give yourself 2/3rd's now and 1/3 maybe one hour
from now. It's not a true dual wave bolus but it spares you from the low's
up front.

Signature
Steve
Type 1 DM since 1967
MiniMed 508 since early 2002
Toronto, ON Canada
> ANOTHER good reason for a pump if you got the bucks.
>
> case
>
> the case, minus a few cans!
Bay Area Dave - 05 Oct 2003 03:46 GMT
I ate 2/3 of a large pizza at 5:30. Now it's 7:45 and my bg is 118.
Only because I have a pump and set it for an extended bolus...(lucky me!)
dave
> you beat me to it...in the pump you could use a dual wave bolus which allows
> you to bolus some now and some over a stipulated period of time. You set the
[quoted text clipped - 4 lines]
> from now. It's not a true dual wave bolus but it spares you from the low's
> up front.
IF YOU CAN'T SWIM DON'T JUMP IN - 05 Oct 2003 03:54 GMT
YES LIFE AS IT WAS MEANT TO BE
case
the case, minus a few cans!
Radioactive Man - 05 Oct 2003 05:19 GMT
>I ate 2/3 of a large pizza at 5:30. Now it's 7:45 and my bg is 118.
>Only because I have a pump and set it for an extended bolus...(lucky me!)
I am noticing a similar effect when I use regular instead of
fast-acting on that sort of a meal. One disadvantage of a pump is
that you have only type of insulin you can use. Correct me if I'm
wrong on that, but I've never seen a pump that allows multiple types
of insulin.
This morning, used 4 units of the regular to cover both breakfast with
90 g carbs and a snack with 30 g about 2 hours later. My reading
after the snack (a high-GI granola bar) was 115. For this reason, I
believe I will be able to reduce my daily injections from 5 to 4 and
still get my morning snack at work. For some reason, I find that I
need more carbs in the morning than any other time of day. In the
afternoon, I can go 5 hours or more with nothing but nuts and/or
cheese for a snack and feel fine. But if I try this in the morning, I
end up overeating the nuts and cheese, and feeling crappy even when my
blood sugars are normal. In the afternoon, I do not have trouble
eating the nuts and cheese in moderation.
>dave
>
[quoted text clipped - 6 lines]
>> from now. It's not a true dual wave bolus but it spares you from the low's
>> up front.
Bay Area Dave - 05 Oct 2003 06:46 GMT
the advantage of using one insulin is calculating boluses and basals are
much simplified, especially due to the faster action of Humalog vs
Velosulin or Regular. The MiniMed pumps have a "pizza" bolusing option
called a "dual wave" bolus. it's an initial bolus, plus a "square wave"
bolus, which is an extended duration bolus. works pretty well IF you
understand the type of foods that you are eating that require that type
of bolusing. For pizza and Mexican food it's remarkable at keeping your
bg's normalized. If I was on MDI, my bg's after eating pizza would be
all screwed up.
dave
>>I ate 2/3 of a large pizza at 5:30. Now it's 7:45 and my bg is 118.
>>Only because I have a pump and set it for an extended bolus...(lucky me!)
[quoted text clipped - 27 lines]
>>>from now. It's not a true dual wave bolus but it spares you from the low's
>>>up front.
Bay Area Dave - 05 Oct 2003 06:41 GMT
now it's 10:45 PM - I'm 102. not bad, for pigging out on pizza! :)
dave
> I ate 2/3 of a large pizza at 5:30. Now it's 7:45 and my bg is 118. Only
> because I have a pump and set it for an extended bolus...(lucky me!)
[quoted text clipped - 14 lines]
>> low's
>> up front.