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I still would like to know about "insulin on board". If you are taking rapid acting insulin and you have covered your carbs precisely, how can you still have insulin that is active for up to 4 hours? I don't understand this. :noidea:
This communication stuff isn't easy, but I think you are wondering about the time? If your carbs are in the bloodstream in 1.5 to 2 hours and the insulin takes 4 hours to act, how does that work?

The carbs are faster and that is really good. If you have a meal with only carbs, you get a surge of them quickly. The insulin works a little more slowly at taking down the hill (on the bell curve). That's how the time thing works.

Protein take about 4 hours to digest, so it is good that the insulins last this long.

With a carb meal it takes awhile for the insulin to catch up, and your glucose is above normal for the first part of that 4 hours.

Dr Richard K Bernstein "The Diabetes Solution" recommends eating mainly protein for this reason, and using R instead or rapid acting insulins. You would have to read the book for the details.

It's the only book on diabetes that I ever recommend. I don't follow it completely, but it is important to understand the way he uses insulin. Using his basic techniques, I have never had a 3 month average above the normal range.

That's as the normal docs define it. He gives a much more narrow normal range, and I haven't managed to stay in that for my 3 month averages.

best wishes
lia
 

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I haven't used Novolog, so don't even know how long it is active, but I think it is one of the fast ones, 4 hours?

I'll give an example with Humalog, which works well for me. It acts over about 4 hours.

If you think of the blood sugars and the insulin as bell curves on a graph, the curve from the sugars entering the blood will be high and short if it is a carb meal. They will be in the blood in about 1 and a half hours.

The Humalog entering the blood will be a lower, longer curve, about 4 hours. At the end of 4 hours, if the insulin has matched the meal, your bg will be back to normal.

Also, if the insulin has matched the meal, the area under the 2 bell curves will be the same.

If you are using a slow insulin, the sugars from the meal won't be covered until the insulin has finished acting. Your bg levels will be higher until then. The insulin does not just sit in a reservoir and jump out when sugars appear.

If I have eaten one meal and injected enough to cover it, and then have another meal 2 hours later, I will just inject again, enough to cover that one too. It will be 4 hours after the second injection before everything is balanced out.

This communication stuff isn't easy, and to me that's normal. It often takes a bit of back and forth to get at the key to a problem. If things aren't clear this is one of those areas where it is worth the effort to get them clear.

best wishes,
lia
 
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