Really low and really high. Check my results please?

[paulpapa]

Hi everyone

Can anyone have a look over my results? I'm finding it really hard to get my control stable. The only time when it's ever looking good is if I'm low carbing or just running off my basal. Both aren't really tenable for me at the moment.

Last night I went out and had a meal with a friend (I guessed it was 60g carbs) and I underestimated the carbs by about 20g. But by the time I next tested I was 20.0. I have no idea how I could have shot up so much. I corrected with 4 units of bolus and had my regular basal of 28 u and I woke up this morning at 2.6, which I only think happened because I had set my alarm for work. That's scared me quite a bit. Now I won't be making any adjustments to my bolus pre-bed - even though I knew I shouldn't have done it anyway - silly me.

Naturally, I'm high after going hypo - I can never seem to get the amount to eat right. Plus, I think being asleep and scared meant I over did it anyway.

I tried to use the 100 rule to find out how much 1u of Novorapid would reduce me by so I did. 100/75 = 1.3 mmol. But it seems like the Novorapid reduces me by much more than that considering how low I was this morning after just 4u. So maybe it reduces me by 4mmol. Who knows!

If anyone can have a look at my results and find any miracles then let me know. I know there's no magic formula, but I'd like to at least find some consistency and be able to eat decent meal without fearing for high sugars all night.

Thank you in advance

P

 

[robert72]

First thing to do would be basal testing. You are taking about 75% basal and 25% bolus and this would normally be nearer 50/50%.

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007 (written for pumpers but works just as well for MDI).

You can't ever get your bolus or correction ratios right until you have the correct basal doses.

 

[azure]

I just wanted to say that the rules are a good guide for a starting place, but they don't work for everyone. I'm proof of that : D So alwsys bear that in mind, eg with regard to corrections.

I agree with @robert72 Basal testing is important as you need to make sure that's ok before you can work in your bolus ratios.

 

[paulpapa]

Hi @robert72 and @azure. A nurse told me to take as much basal as I needed to get me to wake up around the normal range as possible and that seems to be working as I'm getting up, generally speaking, within range on certain days. It's just hard to test the overnight as I'm a teacher and need my sleep. I might do the overnight basal testing this weekend (as I went hypo today) and see what happens.

I'm trying to lose weight by lowering my carbs - I'm not as good a low carb-er as you (30g wow!) - so I'm relying more on the basal to control things. People seem to think I'm on a lot of basal for my weight (78KG) but it seems I need that much at the moment. I used to be on 44u basal once a day and recently changed it to two injections of 38u a day as it wasn't working too well for me. My control was terrible.

Can I just ask one question about this:

• BG changes of more than 2.0mmol/l between readings indicate the need to adjust the basal rate

So if my blood glucose was 8.2 and I tested it an hour later and it was 6.2 then my basal would be too high? Or is that a 2.0mmol/l change until the end of the test period? So no dinner to bed, for example, and I dropped by 2.o then it's set too high?

Thanks for your help!

 

[robert72]

So if my blood glucose was 8.2 and I tested it an hour later and it was 6.2 then my basal would be too high? Or is that a 2.0mmol/l change until the end of the test period? So no dinner to bed, for example, and I dropped by 2.o then it's set too high?

Yes, that would be too high. Also, the basal should keep you within 2.0mmol/l over the test period as well.

Also agree with @azure that the 50/50 guide is only a starting point - ultimately you need what works for you.

 

[paulpapa]

Thanks, I'll give it a go and see what happens. Thanks for your help; I really appreciate it.

 

[robert72]

Thanks, I'll give it a go and see what happens. Thanks for your help; I really appreciate it.

Share results with your team so they can advise if any changes are needed. We can only give opinions.

 

[paulpapa]

I will do, thanks. I email her every week; it's good to get some instant opinions.

 

[1Sarah1]

Hi sometimes it's hard not to overcompensate when you are hypo.
Are you keeping a food diary with what carbs you are having when and what time?
You can also have different insulin to carb ratios and correction ratios at different times of the day so bear that in mind. There are also like a hundred other factors that can influence-illness, weather (for me stress).
I'm trying to get to grips with it for my daughter (age2) diagnosed in December -I'm type 1 have been for 33yrs so at least I'm not having to start from scratch.
Ps looks like a lot of high sugars mid morning 10ish -when do you have your breakfast?

 

[paulpapa]

Hi @1Sarah1, I don't usually have anything until after 10:30 or so when I get a break at school. I'm slowly starting to understand it all as well. I'm sorry to hear about your daughter; she's lucky that she has such a competent mum looking after her.

I tested was 10.9, ate some sushi (56g of carbs - which I covered with 8u of basal worked out to the ratio of 1u:8g CHO so 7 unites for food and one for the high sugars) and was 16 mmol or so when I tested 3 and half hours later. I corrected with 2 units of bolus and now I'm 6.2 mmol. Such a quick drop in only 2 hours! It seems crazy to me! I have no idea what is going on when everyone is saying 1u will drop you by 3mmols. I can't do half doses on my pen either. We shall see what happens in another 2 hours!

 

[Gaz-M]

sushi sends my sugars mad, its the rice having thjat effect

I love it and used to make it alot but I just will not eat it at all now

 

[Kristin251]

I take my basal to keep me steady while I am asleep. If I go to bed and 90 I take 2 units and wake up within 10 pts of that. If I go bed at 115 I will take 3 and usually wake up around 85. So basal will lower me. I take 1 until Novolog with structured meals. If I need a correction dose I have found 1/2 unit will lower me about 20 and 1 unit 40 IF I don't eat with it and it is at least 2 hours from may last meal. This is where it gets tricky. IF I eat something that makes me insulin resistant all my insulins can act like water. I also cannot eat any carbs other than above ground veggies or I have NO control of hypos/hypers. Getting my insulin there at the same time as my carbs was impossible for me. Also if I don't have enough fat in my meal I will rise and not come back down after meals. On the other hand, too much fat makes me insulin resistant. It's all a testing game. Grains, too many nuts, especially peanuts and almonds make me insulin resistant for ho

 

[Kristin251]

1 carb raises me about 7 but 1 unit away from food can drop me 40 if that helps

 

[azure]

Hi @1Sarah1, I don't usually have anything until after 10:30 or so when I get a break at school. I'm slowly starting to understand it all as well. I'm sorry to hear about your daughter; she's lucky that she has such a competent mum looking after her.

I tested was 10.9, ate some sushi (56g of carbs - which I covered with 8u of basal worked out to the ratio of 1u:8g CHO so 7 unites for food and one for the high sugars) and was 16 mmol or so when I tested 3 and half hours later. I corrected with 2 units of bolus and now I'm 6.2 mmol. Such a quick drop in only 2 hours! It seems crazy to me! I have no idea what is going on when everyone is saying 1u will drop you by 3mmols. I can't do half doses on my pen either. We shall see what happens in another 2 hours!

Correction doses vary person to person, so don't worry too much about other people's. You need what's right for YOU, however much or little that might be.

Sushi, with all that sticky white rice, can put me high too. I either have a tiny bit more insulin or bolus more in advance of my meal. I also stick to the smaller packs which have something around 45-54g of carbs. There are even smaller packs than that, but they need supplementing with more food.

This may be different for you, but I find that if I don't eat within an hour or so of getting up, then my blood sugar goes higher than it would do with an earlier breakfast.

 

[paulpapa]

Yeah, I'll play around with it some more.

Oh, that's interesting. I didn't think about eating breakfast to stop my sugars going up. Seemed counterintuitive to me. I'll try it and see. So do you just eat something small and bolus for it?

I love sushi so much. Don't want to miss out on it.

 

[azure]

Yeah, I'll play around with it some more.

Oh, that's interesting. I didn't think about eating breakfast to stop my sugars going up. Seemed counterintuitive to me. I'll try it and see. So do you just eat something small and bolus for it?

I love sushi so much. Don't want to miss out on it.

Yes, if I know I'm going to have to delay breakfast, I usuallly have something small eg a 10g carb biscuit or cracker and bolus for it. That's what works for me. I've learnt from experience how much I need to bolus to deal with the carbs plus control the rise. I'm on a pump so I can take a fraction more insulin. If you want to try small breakfasts, you may have to experiment to see what carb amount and what insulin ratio works best for you.

Yes. I love sushi too : D

 

[noblehead]

Oh, that's interesting. I didn't think about eating breakfast to stop my sugars going up. Seemed counterintuitive to me. I'll try it and see. So do you just eat something small and bolus for it?

It does sound crazy but I'm the same, if I don't eat upon waking my bg levels go into double figures with an hour or two, I know this from experience when fasting for a cholesterol check, by eating and bolusing it keeps my bg in single figures.

btw @paulpapa I do agree with Rob & Azure about basal testing, it's the foundation stone on which to build on, looking at your results your SD is 4.6 which indicates huge swings from high to low, in the book Think Like a Pancreas the author says this should be nearer to 2 or below when good bg control is maintained.