Does novolin r work better for meals that arent very high carb?
Hi @stixxs512. I used R for many years. For me, R takes a little longer to start working, and starts to fade over 4 hours, if you looked at a graph of “blood sugar lowering ability over time” it is a wider but shorter mountain compared to the faster insulins such as Novolog rapid (aspart)
I’d have to guess no. R isn’t better for lower carb meals. R is better for maybe fattier meals because the fat can slow down carbohydrate absorption. So if you took R, because it’s slower, it would be a better match for some mixed-carb meals. I use a pump and so I can deliver a meal bolus over time and so I can deal with higher fat content. Anyway. That’s my opinion.
R is a good insulin and in tough economic times it would definitely be my fallback insulin. What were you thinking about using R for? Cheers!
Ok that’s better insight . My daughter has a nice mixed diet of healthy carbs ,fat and protein . Her diet isnt super high in carbs .I heard about R but I wasnt sure if it would be appropriate for her.
You could always try it and see. No harm in that @stixxs512
Hi @stixxs512, to say what @Joe already wrote I will add that the rDNA style insulin “R” formulations [Novolin-R, Humulin-R] are categorized as FAST-Acting, whereas the analog insulin formulations [Humalog, Novolog] are RAPID-Acting.
In addition to the earlier onset of glucose lowering action that the Rapid-Acting insulin, they usually deplete themselves and now longer affect glucose sooner than the FAST-Acting. Also, your daughter, when using Novolin-R, may need to bolus longer before start of her meal [pre-bolus] start of a meal so as to avoid a glucose spike.
I’m considering it. I’ll give an example of the issues I’m having with humalog. For dinner 5pm she started at 189 she had lemonade (lemon water and stevia drops) broccoli, pasta ( very low carb, gluten free) , and shrimp. I gave her a lower carb meal because shes been running high all day. I gave her 1 unit ( anything more makes her crash) humalog 15 min before dinner. At 8 pm which is the time she has always had basal her sugar was 362. I corrected her she went down to 279 by 9 pm. I gave her the usual 4 units of lantus . At 4 am she was 250. I corrected her with 1.5 units of humalog she went down to 62 a couple hours later I gave her a starburst. She woke up at 10 am thismorning at 82. We didnt have this much of a rollercoaster when she was on novolog but insurance switched what theyll cover
Hi @stixxs512. Discuss this with your doctor but it is very easy to keep dosing insulin when numbers are high, only to have them come crashing down later: it’s called stacking insulin and most of us are our have been guilty of it. Unfortunately insulin doesn’t always work as fast as we would like - especially when we’re high - but the key is to be patient and wait. I believe my endo told me to wait 3 hours but check with yours. I’ve also found that no amount will start bringing my numbers down unless I drink something sugar free to wash out any ketones that may be in my system - even a large glass of water will get me started, in time.
That leaves the question of why the numbers soared in the first place, even when you give the insulin a 15 minute head start. That would be a discussion for her doctor and perhaps nutritionist; but I would add that if she was more stable with Novolog as her background insulin you could ask your doctor to try to authorize an override for it. My insurance switched their preferred formulary a while back but there was the caveat that we could continue with the old one in the event of medical necessity. That must come from your doctor - I’ve found mine is well versed in providing the documentation and information required.
it doesn’t sound like stacking to me. IMO the corrections were way far apart in time. It sounds like she is intermittently making a little insulin, given the tiny doses you are currently using. such small doses are difficult with a syringe, anyway I think a discussion with the doctor is in order as well. good luck @stixxs512
I come to this forum for suggestions due to the fact that these issues have already been discussed with her endo. He is a wonderful endo but his response is always increase her dosage. Like many doctors I’ve been told by different doctors that diabetes is very tricky and it’s a rollercoaster . So my concerns are all answered with it’s normal. What’s frustrating is that as joe pointed out my daughter does still make a little insulin after all these years . Due to this and her bloodwork that has been done her new doctor calls her diabetes monogenic not type 1 .even though at initial diagnosis her 1st endo diagnosed her with type 1
@stixxs512 Monogenic diabetes is very often misdiagnosed as TypeOne. It is not a very common, and not easy to diagnose.
The possibile good news is that what you have already learned can be applied in caring four daughter.
I’m thinking about the “very low carb, gluten free” pasta, and wondering if that’s your culprit. We tried “Miracle Noodles” awhile back, and for whatever reason, they sent my daughter’s sugar through the roof.
Its not the noodles it has happened when she doesnt eat them. She doesnt eat them much and when she has she actually has no blood sugar rise with them .
hi @stixxs512, it is possible to dilute insulin. The reason why you would want to dilute insulin is it will give you more precise control using a syringe… for example, how would you give her 1/4 unit? so each manufacturer has a method for diluting for example, Lilly makes specific sterile solution allowing you to make your own U50 or even U10 insulin.
there is an article here https://www.diabetesdaily.com/blog/diluting-insulin-when-its-beneficial-and-how-to-do-it-591809/
No matter what kind of diabetes, getting perfectly even blood sugar is very very difficult. .If you are making zero insulin, the sugar in 5 skittles can send you from low to high in 15 minutes. the very fastest insulin takes 10 to 30 minutes to start to work and chugs away for 4 hours, relentlessly.
I consider myself an expert in insulin, an insulin Ninja with 40+ years experience, but my 90 day blood sugar min and and max are 29mg/dl and 450mg/dl - because that is the nature of blood sugar control. believe me - it’ s not normal, but it is the truth.
don’t forget especially if she is making her own insulin, NORMAL blood sugar is 70-100. Her own pancreas will drive her to 70 and that could be a reading of 63mg/dl to 77 mg/dl on a standard finger test. That’s NOT LOW if you are making your own insulin. so treating an 80 with sugar and you’ll be fighting her natural insulin (you’ll lose). use her finger stick machine against your own blood before a meal you’ll see,
The point is that your standards for treating a high and low might be different than mine. anyway I can’t think of much else but you’ve been on my mind. cheers good luck.
Wow! That’s definitely some helpful information. I tried the novalin r for a few days but it made me nervous. Yes it helped her sugars but she kept complaining that she felt weird all day. When she says weird she usually means she feels like she does when shes low or high even though when her sugar is checked shes within range. She also doesnt have as much energy as normal once we started novalin. My daughter bounces off the walls and she was very sluggish. I know insulin has side effects on everyone but shes never shown this on novolog, humalog, basaglar, levemir, or lantus.
Glad it’s not the noodles.
Side-note: thank you, Joe, for sharing your 90-day min/max. That really helps.
No worries. The high high was actually 480 I checked it when I charged my meter tonight. Not a proud moment. Pushed a site change, just past where I should have and it went to heck overnight.
I’m glad it’s not just us. 39/401 (and the “401” is code for something more but unknown, since after that the Dexcom only reads “high” and she didn’t do a finger stick before treating). Lots of those the past 90 days as we try to figure out what’s happening with her sites.
Some folks seem to have really well-managed BG (Dennis, I’m looking at you with nothing but admiration —well, that and envy ) which is awesome and inspiring, but also may have set me up for unrealistic expectations. So like I said, it was affirming to see that even “insulin ninjas” get numbers like that sometimes.
Hi @srozelle, something has thrown me off these last couple of weeks - not “admirable”. At least according to my Dexcom graphs with the Standard Deviation increasing because of some crazy wide swings.
The last few says my glucose readings are back in place and the graph-line is now showing small hills rather than alpine peaks and deep valleys. Interesting, that with all those wild swings - going from “Low” reading to 295 mg/dl in a matter of a few minutes, my average showing on both Dexcom Clarity and on Tandem t-Connect is 121 mg/dl. I did need to make some changes to my basal rates, almost doing a flip from AM hours to PM hours.
I’m attributing some of the crazy stuff to faulty sensors and transmitter. On Sunday, my Dexcom Transmitter quit over night, and while I was trying to figure out “how to do” at 2:30 AM, I got a “Change Sensor Now” alarm. Day 7 for sensor, and day 84 for transmitter.
Yup, still nothing but admiration.
Thank you @srozelle. I am certainly appreciative of your comment, and compliment. You also deserve compliments in the way you have helped your daughter learn and know how to manage on her own; I recall a few years ago when you first wrote that you were “searching”. I hope that the tips offered by many “good” people gave you hope and guidance.
What I failed to mention in the last message, that when my CGM was giving me the “Low” reading, and the readings in the 40s, is that my finger-stick readings at that time ranged 90 to 120. When I was up around 300, I didn’t bother with finger-stick confirmation; I just allowed my pump Control IQ to bring me back “home”.