Re: [IPk] Post-Lunch highs
Hi Fiona and Di
Along the lines of increasing the basal, if it is the basal that needs to be
increased (Fiona, you can check this yourself by delaying lunch by 3 hours
past your normal lunchtime and testing every 30-45 mins. between when you
*usually* check your bg before lunch and when you actually sit down to eat
lunch), perhaps increasing the Lantus isn't the ideal solution but changing
to Levemir might be.
I would be hesitant about upping the dose of Lantus for a couple of reasons.
First, doing so might result in slightly better midday bgs but hypos in the
afternoon and evening. Second, and I can't fathom why I seem to be the only
person who tells people this, if you look at the graph for the time-action
profile of Lantus it is very clear that the stuff needs 6 hours from the
point of injection to reach full operating strength. The 'observation
period' shown on the graph ends at 24 hours with the insulin still working
full strength. Thus we may conclude that the way to represent the ideal
nature of Lantus' basal coverage in a line drawing might be:
/IIIIIIIIIIIXIIIIIIIIIIIXIIIIIIIIIIII &etc. D'you notice the X represents a
period of time when one dose is wearing off and the next one is just getting
up its strength? That period of time is supposed to be of little consequence
to the average person with type 1, but what if, for YOU, even if you were to
up the dose, Lantus lasts 18 hours?
If Lantus does not last a full 24 hours (or more) for YOU, your line drawing
might look like this:
/IIIIIIIIIVIIIIIIIIIVIIIIIIIII with the Vs representing periods of time when
you have little to no active basal insulin on board because you have
metabolised all the Lantus already. If the insulin is effectively wearing
off 20 hours after injection but you take it every 24 hours, you've got a
few hours of insufficient basal insulin to contend with.
Does that help, or does it even make sense?
I'd be more willing to try Levemir than to up the Lantus if it is indeed the
basal that needs adjusting. The other good thing about Levemir, imho, is
that if you need a larger dose to meet your daytime needs and a smaller dose
for night time, you can have it that way because Levemir is optimized for 2x
daily injection. [I really don't work for Novo Nordisk!!!! I even use
Humalog in my pump, honest]
As for correction dose: you can check out a way to figure your insulin
sensitivity factor (aka correction factor) at
Type 1 12+ years; MiniMed pumper 7.5 years; Animas pumper 2 years 1 month
----Original Message Follows----
From: Diana Maynard <email @ redacted>
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] Post-Lunch highs
It might be that you need more Lantus in the morning to cover the afternoon
highs. I mean, it might not be the bolus for lunch that is causing the
highs, but a lack of basal insulin.
If you don't eat lunch, or you eat lunch late, does your BG go up?
If so then you have your answer.
I've always had problems keeping my post-lunch BG in control when I'm at
work and sat down at a desk all afternoon. I do find that a short walk
immediately after lunch helps in that respect, though it may not be feasible
Another alternative might be to eat less carbs at lunch and then have a
snack before you exercise....
Good luck, I know how frustrating it is trying to get it right!
email @ redacted wrote:
> Hi everyone. I joined the mailing list a couple of weeks ago and although
> pumper, have found your comments and tips very interesting Ive learnt
>stuff that my diabetes team have never mentioned!
> I am desperately trying to sort out my control on MDI (Novorapid/Lantus)
>regime. A ratio of 20g CHO to 1unit of insulin seems to work pretty well
> breakfast and evening meal (using a correction dose of 1 unit for 4
> necessary). However at lunchtime even using at least twice this (10g to 1
>results in a very high BG in the afternoon (16 or higher is typical, 2
> after lunch). Any suggestions as to why this should be and what
>I should use? I often exercise in the late afternoon after work and want to
>avoid a hypo before dinner.
> I think if I can get these highs sorted this would really improve my
> averages and SD. I have a meeting with my care team on Feb 15 and want to
>that Ive tried my best on MDI. One of the things they wanted me to do was
> avod hypos but by tightening my control Im averaging about 1 hypo per
>like to sort out the post-lunch high though. Thanks for any suggestions.
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