Good to know the sting isn’t too bad for you. I’ll ask about Lyumjev at my next appointment if NovoRapid is still a bit too slow for breakfast.
Humalog seems to work fine for me at lunch and dinner, but once I get breakfast nailed down and have an idea of how NovoRapid compares to Humalog for me, I’ll try it out for other meals. I’ve just been using it at breakfast, for snacks and on picnics so far.
I have noticed one thing which I’m not sure what to make of - about 30 minutes after I bolus for breakfast (whether I use Humalog or NovoRapid), I do start to trend down. But once the food hits, it’s like a rocket to the moon, then a slow decent back to 100. So Humalog and NovoRapid do seem to start acting 30 minutes after bolusing for me, but they neither have the “oomph” to keep the breakfast numbers down if I eat all in one go. Have you noticed any difference with the “oomph” of Lyumjev vs Humalog?
TAG also works when you eat larger amounts of protein and fat.
It is best done with split bolus though, and the newer pumps like the Tslim can’t do this with the Control IQ still active.
I still think it is something to keep in mind, especially when it looks like you just can’t bring the BG down like it should have. By the time the Carbs start coming down, the fat/protien start bringing it back up again.
If you don’t eat much for fat/protein, then there is very little to be concerned about though.
As for Lyumjev, I like it better than Fiasp. It doesn’t degrade the t slim cartridge, so it will last longer. It does sting/hurt at times, but I fully accept it and the great results I get from it.
I usually don’t bolus until I have either started eating, or something when I finish.
I only prebolus if my BG was high to begin with.
I do have the control IQ on my pump set very aggressively though. So it handles a lot of the overflow work so I don’t have to.
One trick I use for that kind of situation is the overbolus technique. I take too much insulin to start, which will make it act more forcefully, but I know that I will have to eat more later to prevent a low. You can think of it as the opposite of the split-bolus technique, which is used to effectively slow down the insulin action. The split-carbs technique eats part at the beginning, and part later, which has the effect of speeding up the insulin action (because there is less glucose in the bloodstream early on that needs to be vacuumed up.) Considering the size of the bolus and the amount of carbs eaten in the first half, it’s an overbolus.
This is exactly what I did when I used Humalog for breakfast.
I’d bolus for toast and fruit, eat the toast 30-45 minutes after bolusing, then a few hours later when I was starting to come down or when I was at 100 (whichever I’d notice first), I’d have a second breakfast of the fruit I’d already bolused for. I work from home so it was doable, but it’s a bit of a pain. I was hoping NovoRapid would solve that, but it doesn’t seem fast enough or “oomph-y” enough.
Hi Finn. Why does coming down from high take much longer than going up? Annoying. Not matter what fast acting insulin I use I am going to spike if I eat something with a lot of carbs. And yep takes awhile to come down. So I try to maintain low carb diet. Not always but most of the time. So no real spikes. Right now I am struggling with Tepezza infusions for thyroid eye disease. One side effect is hyperglycemia even for non diabetics. But doing ok. I just don’t think I would personally want 3 different insulins to deal with. I recently switched to MDI from pump so two insulin pens are enough for me. Have a co pay. Pump was free. Don’t get it. But that’s Medicare for you.
As a few of you said, NovoRapid doesn’t seem to be much more rapid than Humalog. I think the results I saw on the first few days were just from the change in insulin. After a while, it didn’t seem much different than Humalog. I ended up using NovoRapid for all meals and I’ve finished one of five pens.
So I’m back to second breakfasts.
Tomorrow, I’ll be opening a new toy: an Humalog Junior pen. I only use 4-6 units each meal, so the half unit pen will give me more flexibility with my carbs.
After the first Humalog Junior pen, I’ve got a bit of a pen backlog to work through: 2 Humalogs, 4 NovoRapids and 4 more Humalog Juniors. Each pen lasts me 2-2.5 weeks if I use it for all meals, so that’s about 5 months worth.
I’ll probably request a prescription for Lyumjev at my next appointment (October). They only prescribe boxes of 5 pens when it’s a new insulin or pen, then boxes of 10 pens after that.
I inject bolus into my abdomen and basal into my thigh. I’ve got a rotation system in place (breakfast is nearer the center of my belly, dinner is toward my hip, lunch is in between), but I hadn’t thought about the locations’ absorption being different.
I’m not even a year into this diabetes game (I was diagnosed in August 2021) so I doubt I’ve got scar tissue or issues from overusing an area.
I have been mixing up my location choices after reading your post and haven’t noticed any patterns yet, although it’s possible that toward my hip gives faster absorption (but also bleeds more, which is annoying). Time (and data) will tell!
I take Abasaglar/Basaglar twice a day - at breakfast (6 units) and at bedtime (4 units). I did a basal test last week (fasting from an early dinner to lunch the following day) and stayed very consistent, even going down a tiny bit in the morning. So I don’t think I’ve got DP at all. There was a tiny 20-mg/dL bump when I got out of bed during the test, but it came down after half an hour, so I don’t think that’s a FOTF increase.
I’ve got different factors for each meal and they seem to get me to my target eventually. Breakfast just gives a much higher peak and reaches the target slower than lunch and dinner. So it’s back to second breakfasts until I can try Lyumjev on for size.
Thanks for all your help and the food for thought!
You don’t have to have a full prescription just to try out a new insulin.
Drs often have ‘trials’ for you. They will give you a vial or two to just try out.
That is how I first tried Fiasp and Lyumjev.
I have about 25g of carbs for breakfast, about half of which is whole wheat bread with soft cheese or cream cheese, and the other half of the carbs come from fruit. I usually save the fruit half for second breakfast, although I may try switching it to first breakfast to see how that goes.
I have 250g (1.5-2 cups) of raw veg with every meal - peppers, cucumber and tomatoes at every meal, plus carrots at lunch and dinner. This accounts for more than half my plate. I don’t count veg in my carbs at all (veg are free in German carb counting so this is how I was taught).
I have a cup of tea with breakfast (herbal, no sugar), plus a 12oz thermos of hot water that I use to top it up over the next hour. I have this tea regime 3-4 times over the day, with or after every meal plus at least one more between meals, and always herbal tea except one black tea with milk (I estimate the carbs in the milk at 3g) after dinner.
I’m in Germany and I’ve never been offered a trial besides a few test strips to get me home when I was first discharged after diagnosis. This is my first med switch, so this didn’t even cross my mind. But at €1-2 a pen, it’s easy to just get the box. The insulin prescription costs €10 regardless the pen count of the box. So a box of 10 comes to €1 a pen and a box of 5 comes to €2 a pen. €1 is pretty closed to US$1 at the moment, so it’s not a big expense to try a box.
Luckily, NovoRapid seems to work the same as Humalog for me, so I’ll be able to use it as normal. I’ll ask about a trial pen for Lyumjev though, since the doctor mentioned side effects were common and she was hesitant to prescribe it for me.
Ah, I missed the Germany part of this.
In the US, doctors are often given different insulins by the sales reps. And the Drs can hand them out for free.
But, at your cost, I wouldn’t even bother, just get the prescription and try them out.
Be forewarned, Lyumjev can sting/hurt. I find that it was more for when I first tried it. It is also location specific for me on where it hurts.
Fiasp would also sting, although not as bad. But it doesn’t last as long in my Tandem pump cartridges. Lyumjev lasts up to 5 days without issue (well, my site isn’t always that happy being used that long, but it still works.)
I found that Novolog and Humalog both had the same basic profile for me.
Lyumjev and Fiasp both have the same basic profile for me as well. Albeit much faster/better than the slower Novolog/Humalog variants.
She wanted me to try NovoRapid for this reason. She said about 1/3 of the people she prescribed Lyumjev report stinging, so she wanted me to try NovoRapid first.
I don’t see why she wouldn’t give a prescription for Lyumjev at my next appointment (October). Since it seems to be the same insulin as Humalog (insulin lispro), but faster, the only possible issue should be the stinging, right?
Stinging, and potentially bruising. I had a couple that had bruises at first.
Some people cannot take the pain from it and stop. I imagine this will affect everyone at different levels.
And it is noticeably faster. And it has a shorter overall duration.
This means you really have to be careful with pre-bouses, and for over bolusing, and stacking.
These things can cause you problems until you understand how YOU react to it.
I definitely do not want to go back to the slower insulins. My quality of life is so much better with these ultra rapid insulins that I don’t care if it stings, hurts or bruises me. Btw, I don’t have those issues anymore, most were at the beginning. Every once in a while I will get a little stinging, but not very often, and usually nothing more than enough to notice it.
I only use 4-6 units each meal, so the half unit pen will give me more flexibility with my carbs.