Hi all,

Relatively new to injecting insulin, I am having some trouble with my bolus. I m still experimenting with I:C ratios, different kind of carbs and pre-bolusing. Today I had around 15 g of carbs for breakfast (brown bread, half apple) and bolused with 1 unit of Novorapid. After one hour I measured 241 (!!!), after 2 hours i was at 155, after 4 hours down to 105. (So back to where I started). My question: Did I under-bolus? But wouldnt I have maybe gone too low in my 4th hour with more bolus? (same if I corrected at the 2 hr mark, I would have ended up too low I think)
So now i m not sure what to do...I read a few times now that APIDRA seems to act faster and has a shorter tail – would that maybe be the answer to my problem? Has anybody got experiences they might want to share with switching to Apidra?
Thank you for suggestions!

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When you say you bolused for 15 carbs for a half an apple and "brown bread". A slice of regular bread is around 15 carbs; if it's cut thicker it is more like 20, so yes, 15 carbs for the whole meal sounds too low.

As for your questions: Yes, it sounds like you underbolused. So for corrections: it depends on your ISF. If you seek to correct at 2 hours you always have to check for IOB. So let's say you took 3 units; at 2 hours you still have one unit on board and if one unit drops you say 45 points, there would be no need to correct.

If you had taken more insulin would you have gone low in your 4th hour? You were 105 so if you took more it might have lowered you to let's say 95 or 85, neither of which are too low. As for Apidra, yes it works a bit faster and has a bit less tail. I consider my duration of action for Apidra to be 3 hours, so yes, that's a bit easier to handle if you are more insulin sensitive. But it's only a minor difference, and I don't see that you would have had a problem if you had taken a bit more.

Beta cells inject the released insulin directly into the portal vein. Thus the insulin will be circulating in your blood stream very quickly. To inject into the skin is a poor replacement for this rapid reaction. It needs some time to absorb the insulin from the upper layers of the skin into the blood stream. Another problem of being insulin deficit is that our beta cells produce pro-insulin. This pro-insulin then divides into insulin and amylin. The amylin slows the digestion down to give the insulin a head start. Without amylin the digestion is as fast as it can get leading to unwanted spikes after the digestion of carbs.

Now the best solution is to give the insulin some time to unfold its activity. So you inject before you begin the preparation of your meal. With roughly 10 minutes of waiting time the spike should be much smaller. After this adjustment you will have more information at hand whether or not the dosage was sufficient. You can combine this technique with any bolus insulin. But the apidra might work faster for you - as it does for many. It is worth to investigate this. I prefer to have an insulin with a little tail to cover the part of the meal that is absorbed slowly. For you it might be more convenient to have a very fast insulin to minimize the waiting time I have suggested.

Bread and a apple would be a poor choice for me....

Your insulin dose was fine but you may need to change your timing for some meals. If you are going to just eat carbs with no fat or proteins you will probably have better success if you bolus early maybe 15 - 30 min.... I have used all of the fast acting insulins and timing is the key to success no mater which one you use.

You need to tailor your meals so the sugar impacts your system at the right time. A small amount of fat will slow it down and give the insulin time to start working.

I have the most trouble with carbs in the morning and would try to eat mostly fat and protein for breakfast, I do eat bread sometimes but it's hard to stay under 140 if I do and it would be lunch or dinner when my insulin resistance is lower.

It's very difficult to get it right with fast acting carbs like bread and apples. Since my diagnosis, I now have three eggs and four slices of bacon every morning and cover it with two units of Regular. I usually land almost exactly at the same BG value two hours after breakfast as before.

I agree with others that one way to go about this is to adjust the timing of your shot. (And Zoe is correct that a half an apple can be 15 grams of carb all by itself - let alone with bread). But the real issue may be with the meal you chose as JohnG says. Bread and apple are both relatively fast carbs, and you are eating at breakfast, when most people are the most insulin resistant. I eat both bread and fruit, but I will eat them in a mixed meal unless I am trying to push up my BG. A mixed meal should have a significantly slower impact on your BG. So eat peanut butter on your bread, and cheese with your apple (or whatever).

Bread and an apple sound like foods you're eating on the run anyway - so if you want to eat only bread and an apple, you could try spacing it out - eat the bread when you get up but eat the apple while on the bus. Or try a lower carb breakfast option if you can't make some combination of these approaches work. Keep trying and testing and you'll find something that works for you.

I once got samples of Humalog, Novalog, and Apridra and tested them on myself to see if I could find a noticeable difference. The Humalog and Novalog were very similar, and if anything the Apridra seemed to be a bit weaker and to have a shorter tail - but it didn't seem any faster to me. I ended up sticking with Humalog. But it is worth asking for samples next time you're at your doctor to see if one works better for you.

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