Insulin to carb ratios

[ChrisM28]

My aim is to get the end BG to match the start BG!!! Ambitious I know. How the basal comes into it is confusing me. If the injection is taken at 8am and it takes 5 hours to get back to the starting BG is the action time 5 hours (and the insulin to carb ratio was correct) OR does the basal take over at some point?

 

[Paddy_nz]

It gets interesting huh!?
I am only a few months into this ...but am quite strict with my note taking and dosage as well
The way I've figured it, I can get my readings the same before each meal if at least two hours apart
I'm taking novorapid and work on a 2.5:1 ratio

For adjusting my basal levels, I'm just caring about my morning readings
This has come with some fine tuning - as I do monitor my level before dosing basal - as if I take myself too low, I sometimes wake in the night near or into hypo
So I find that it's good for me to be around 5.5-6.5 before going to bed - that way with my basal dosage I wake with the same reading - also I find any adjustment requires 3-4 days to take effect - so you want small movements

I'm testing with a caresens n as well if that's worth knowing

 

[ChrisM28]

What basal are you on Paddy?

 

[paulliljeros]

Hi @ChrisM28 if your BG returns to the pre food leveland then remains flat after x hours, then yes, it implies you have taken the correct bolus does.
The best way to understand it, in layman terms is to think about how the pancreas and liver work in tandem. The liver stores and releases glucose as and when the body requires it. I.e. When you have a hypo, the liver actually dumps glucose, but then over the next 24-48 hours needs to replenish the spent glucose and hence the common predisposition to repeated hypos after earlier ones, or with dawn phenomenon, a "dump" of glucose occurs, literally to give you the energy for the upcoming day - but there lies another story!
So, throughout the day, the liver drip feeds glucose, and in a normal body the pancreas releases insulin, to create energy, that the body requires - this is an on-going process. As a diabetic, you need a slow acting, background, basal insulin to "do what the pancreas isn't doing". When you eat carbs, you need a "boost" of insulin, to convert the influx of glucose, and that is where bolus insulin enters the frame.
Therefore, when people talk about doing a basal test, no carbs are eaten, and you are looking for a flat line - no increase or decrease in BG. Although on a MDI (basal/bolus) regime there are 2 different insulins, this is only because the basal is formulated to work slowly over many hours. On a pump regime, only one, fast acting insulin is used, and that is drip fed (like a pancreas would do) as a basal, and then boosts of the same insulin are given as and when required in the form of bolus.
Sorry for the long post, I hope it helps but happy to clarify any bits if you like, but in summary, the aim is to take sufficient bolus to cover all the carbs.
edited to add - it wouldn't be right not to mention the book "Think Like a Pancreas" at this stage - it will explain all this infinitely better than I can!

 

[smc4761]

I recently started to take Levemir as my basal insulin, taken around 7 am and then again at 10pm. After meeting with my DSN and dietician, they suggested I try missing my Bolus insulin, Humalog and have no carbs. This would see how my Basal insulin was doing

Yesterday I skipped breakfast so no Humalog but took my normal Levemir. At 7am BS was 6.8 and by luchtime this had gone up very slightly to 8.2. So looks like basal is working, ( I know my BS are a wee bit high)

Today had breakfast and Humalog as normal as well as Levemir. Lunctime I skipped lunch so no Humalog. At lunchtime my BS was 8.2.By teantime it had dropped to 7.6 at 2.30pm, 6.8 at 4pm and finally 5.9 by 17.30 so pretty happy with that

I know I have a few tweeks to do to my basal but nearly there

The way to look at this is simply get your basal readings OK. All that you need to do from there, is get your fast acting insulin to cancel out any carbs you eat. See it is that simple

If only, but that is pretty much my understanding

 

[ChrisM28]

Hi @ChrisM28 if your BG returns to the pre food leveland then remains flat after x hours, then yes, it implies you have taken the correct bolus does.
The best way to understand it, in layman terms is to think about how the pancreas and liver work in tandem. The liver stores and releases glucose as and when the body requires it. I.e. When you have a hypo, the liver actually dumps glucose, but then over the next 24-48 hours needs to replenish the spent glucose and hence the common predisposition to repeated hypos after earlier ones, or with dawn phenomenon, a "dump" of glucose occurs, literally to give you the energy for the upcoming day - but there lies another story!
So, throughout the day, the liver drip feeds glucose, and in a normal body the pancreas releases insulin, to create energy, that the body requires - this is an on-going process. As a diabetic, you need a slow acting, background, basal insulin to "do what the pancreas isn't doing". When you eat carbs, you need a "boost" of insulin, to convert the influx of glucose, and that is where bolus insulin enters the frame.
Therefore, when people talk about doing a basal test, no carbs are eaten, and you are looking for a flat line - no increase or decrease in BG. Although on a MDI (basal/bolus) regime there are 2 different insulins, this is only because the basal is formulated to work slowly over many hours. On a pump regime, only one, fast acting insulin is used, and that is drip fed (like a pancreas would do) as a basal, and then boosts of the same insulin are given as and when required in the form of bolus.
Sorry for the long post, I hope it helps but happy to clarify any bits if you like, but in summary, the aim is to take sufficient bolus to cover all the carbs.
edited to add - it wouldn't be right not to mention the book "Think Like a Pancreas" at this stage - it will explain all this infinitely better than I can!

Thank you very much very clear. It was something the DNS said that had me wondering. She mentioned the basal 'picking up the slack'?

 

[Kristin251]

I'm not sure if you are low carb or not. I'm vlc, under 20 a day and I need to bolus for half my protein. So if I'm eating 22 G protein I bolus like it's 20 carbs or maybe slightly less if it's a fatty meal and they always are haha