Carb-counting and insulin-splitting woes

[cjmags]

Hi all! I've been T1 for 9 years, good-ish HbA1c (7.2%) but I've been advised to start carb-counting. I've also been advised to split my 1x Levemir dose (35 units) into two doses (15 units in morning, 15 units 12 hours later). I'm on a 1:10 ratio at the moment. Novorapid is my rapid acting.

I've no problem with that - it's just that my blood sugars are absolutely, categorically 100% worse than they've ever been!

This morning, my blood sugar was 15.3. I took 5 units to cover the 50g of carbs, plus a correction dose of 3 units (I'm on a 1:3 correction dose). So 8 units altogether, plus the 15 units of long-acting Levemir.

My blood sugar is 18.8 I don't know what to do. The whole point of carb counting was to go on a lower amount of insulin, but now I'm just making up for it all in correction doses.

I've only been carb-counting/dose-splitting for 2 days now - is this just a teething problem or is carb-counting just lost on me?

 

[novorapidboi26]

I would say the split Levemir is whats thrown you off......

you need to test those split doses and fine tune them to meet your overnight needs and daytime needs separately....

until that Levemir is correct you want be able to make any meaningful changes to your bolus insulin/carb ratios and correction factors.....

so carb free Levemir test overnight, record results, adjust if needed, test again until holding steady.....then you move on to the daytime testing, carb free breakfast, test regularly until lunch, then do a lunch to dinner etc....

When are you taking your evening dose of Levemir?

 

[Deleted Account]

This may be the change of your insulin regime But it could be something else.
If I was in your position, I would start by discounting other things as much as I can:
- do you feel ill? This would increase your BG.
- are you stressed? Silly question - I imagine the problems with your BG are enough to stress you (they would me) and push your BG up more. For me, understanding this, reduces my stress a little
- is it colder/warmer? Some people react to temperature with higher BG
- is your insulin working correctly? It may be worth changing your pen/vial just in case.

It is possible you carb ratio is slightly out but waking high (assuming you took a correction dose before going to bed) is more likely to be a basal issue.
I never split my basal so cannot comment on that - many people have so I am sure there will be plenty more advice coming.

Ever since I carb counted, I have felt more in control. I think it's worth going through these woes to come out the other side.

 

[cjmags]

I would say the split Levemir is whats thrown you off......

you need to test those split doses and fine tune them to meet your overnight needs and daytime needs separately....

until that Levemir is correct you want be able to make any meaningful changes to your bolus insulin/carb ratios and correction factors.....

so carb free Levemir test overnight, record results, adjust if needed, test again until holding steady.....then you move on to the daytime testing, carb free breakfast, test regularly until lunch, then do a lunch to dinner etc....

When are you taking your evening dose of Levemir?

As I suspected. My worry is that I'm already on a dose of Levemir that my specialist thinks is far too high - I'm currently on 30 units and I'm 65kg.

This may be the change of your insulin regime But it could be something else.
If I was in your position, I would start by discounting other things as much as I can:
- do you feel ill? This would increase your BG.
- are you stressed? Silly question - I imagine the problems with your BG are enough to stress you (they would me) and push your BG up more. For me, understanding this, reduces my stress a little
- is it colder/warmer? Some people react to temperature with higher BG
- is your insulin working correctly? It may be worth changing your pen/vial just in case.

It is possible you carb ratio is slightly out but waking high (assuming you took a correction dose before going to bed) is more likely to be a basal issue.
I never split my basal so cannot comment on that - many people have so I am sure there will be plenty more advice coming.

Ever since I carb counted, I have felt more in control. I think it's worth going through these woes to come out the other side.

At the minute, I'm splitting it 50-50, with 15 units in the morning and 15 units 12 hours later. Might it be worth trying 15 in the am and 20 in the evening?

I don't feel ill - I was very dizzy last night and this morning, but I wasn't sure if it was because my blood sugars have been so volatile. I'm not particularly stressed either. I will definitely try changing the vial!

Thank you, both x

 

[novorapidboi26]

As I suspected. My worry is that I'm already on a dose of Levemir that my specialist thinks is far too high - I'm currently on 30 units and I'm 65kg.

Well, I cant comment on what one should be taking according to their mass but I've always thought you need what you need.....injected insulin isn't actually very efficient, only some of it is actually used, as opposed to 100%.....so everyone is different in terms of the dose they actually need.....

you may find that you need a smaller dose overnight and more in the day but with a split it could reduce and balance itself out....

you need to get the Levemir right first though.....thats important....you can then go on to hopefully making more reductions in the bolus.....

Consult with your specialist but its not a bad idea to offset the split timing and take your evening dose before bed, thus helping keep waking levels down.....

 

[Fairygodmother]

Hi all! I've been T1 for 9 years, good-ish HbA1c (7.2%) but I've been advised to start carb-counting. I've also been advised to split my 1x Levemir dose (35 units) into two doses (15 units in morning, 15 units 12 hours later). I'm on a 1:10 ratio at the moment. Novorapid is my rapid acting.

I've no problem with that - it's just that my blood sugars are absolutely, categorically 100% worse than they've ever been!

This morning, my blood sugar was 15.3. I took 5 units to cover the 50g of carbs, plus a correction dose of 3 units (I'm on a 1:3 correction dose). So 8 units altogether, plus the 15 units of long-acting Levemir.

My blood sugar is 18.8 I don't know what to do. The whole point of carb counting was to go on a lower amount of insulin, but now I'm just making up for it all in correction doses.

I've only been carb-counting/dose-splitting for 2 days now - is this just a teething problem or is carb-counting just lost on me?

I find that if my BS is high and I eat, even if including a correction dose, then it'll go higher still as it'll take longer for the insulin to deal with the increase in carbs and it may also be that my liver orders the carbs to wait in a slow queue.
You've dropped 5 units of Levemir so as others have said, a basal check seems a good idea and you may find that you can solve your problems that way.
I don't use Levemir, I'm on Lantus, which I've found gets a head start in the evening if I inject at the same time as the evening meal, so I've no experience of splitting a basal, just what happens when eating with high BS. (Yes, before anyone says, I know morning's recommended but I can better rely better on meeting the regular 24-hour time gap.)
Time to get in touch with the Health Professional who gave you the new regime?

 

[slip]

With any basal change you should give it 3 days to bed in.

What was the thinking behind changing your basal regime from 1x to 2x a day? Were the any actual issues with it?

 

[Kristin251]

My thoughts exactly.

If it was to try to reduce insulin doses one could always cut some carbs.

But as stated above if you don’t want to do that, then you need to take the proper doses.

If your original basal was working and you weren’t hypo, why are you changing it ?

 

[Daibell]

Hi. Levemir is generally slightly better than Lantus but not much difference. I'll be honest although most/many have split Basal, I don't and my DN advised against it! Splitting makes it more difficult to get the balance right and the lack of 24 hour cover can be corrected by changing the Bolus ratio during the day. It's not for me to challenge what the majority do. It sounds like your Basal does need balancing and your Bolus ratio needs tweaking

 

[novorapidboi26]

Hi. Levemir is generally slightly better than Lantus but not much difference. I'll be honest although most/many have split Basal, I don't and my DN advised against it! Splitting makes it more difficult to get the balance right and the lack of 24 hour cover can be corrected by changing the Bolus ratio during the day. It's not for me to challenge what the majority do. It sounds like your Basal does need balancing and your Bolus ratio needs tweaking

I wouldn't say getting the balance if any more difficult to be honest.....its more work testing two doses instead of one I suppose....

its the flexibility of a split to accommodate illness, physical activity and alcohol that makes its a winner in my book.....or was a winner...lol...pumping now with 7 different basals.....

 

[himtoo]

after reading through this whole thread............

first Hi !! and welcome !!!

just remember that everything you are doing is happening in real time -- so you need to give it time for things to happen.

whenever I make changes in my routine I always test more -- and allow at least 3 days to observe any changes in patterns , BG's etc.

try to be kind to yourself -- you will get there -- just be patient - talk to your DSN -- we're all in this for the long haul !!!

 

[rjsDG_USA2016]

Adding Insulin to T2 diabetics is as you were giving alcohol to alcoholics. This is the opposite solution.
Please look into Dr. Jason Fung on youtube.

 

[col101]

For me getting my basal right was the key to sorting things out.
Have you tried basal testing? If you Google Salford NHS basal BV test there's a good description of it.
Be kind to yourself I'm sure you'll get there but it's hard sometimes

 

[TheBigNewt]

As I suspected. My worry is that I'm already on a dose of Levemir that my specialist thinks is far too high - I'm currently on 30 units and I'm 65kg.

30U is not "far too high". I weigh 70kg and take 25U Lantus and it works just fine. Supposedly Levemir tends to be a twice daily injection as opposed to Lantus. I tried it briefly once a day then twice. Didn't work for me. The whole "carb counting" thing is real cute and real trendy and all, you get to deal with all these "ratios" it sounds real scientific and quantitative. but if you have half a head on your shoulders you can probably do without it for the most part, just from experience. True, it helps to know what carbs do the most damage (white rice, pasta, etc). And I'm not sure how much it lowers the amount of insulin you take either.

 

[beebyboss]

Hi all! I've been T1 for 9 years, good-ish HbA1c (7.2%) but I've been advised to start carb-counting. I've also been advised to split my 1x Levemir dose (35 units) into two doses (15 units in morning, 15 units 12 hours later). I'm on a 1:10 ratio at the moment. Novorapid is my rapid acting.

I've no problem with that - it's just that my blood sugars are absolutely, categorically 100% worse than they've ever been!

This morning, my blood sugar was 15.3. I took 5 units to cover the 50g of carbs, plus a correction dose of 3 units (I'm on a 1:3 correction dose). So 8 units altogether, plus the 15 units of long-acting Levemir.

My blood sugar is 18.8 I don't know what to do. The whole point of carb counting was to go on a lower amount of insulin, but now I'm just making up for it all in correction doses.

I've only been carb-counting/dose-splitting for 2 days now - is this just a teething problem or is carb-counting just lost on me?

Hi I had the same problem what I was told to do was increase my novorapid at lunch time to 1.5units to 10 carbs I think you are not getting enough novorapid

 

[Tykess]

Oops my reply seems to have gone in the wrong place :-

I also carb count and found control extremely difficult while on levemire. I had a word with my liaison nurse who changed my treatment to tresiba (I think that’s how it’s spelled). Approximately four years ago I was in hospital and had 3 heart attacks, pneumonia and kidney failure. I was sent home to die. (I was given a year maximum). I am still here. Also I have survived the risk of amputation 3 times Because of my heart problems they couldn’t operate and even though (as diabetics know) any healing is difficult, my leg was saved all three times. I’m only telling you all this to let you know that life after diabetes is not all gloom and doom. Have a word with your liaison officer and explain your difficulty. There is another long acting injection out there and it’s worked wonders for me. Good luck. Xx

 

[[email protected]]

They !make you split you basal because you are now Carb counting. It will take you several days or even weeks to get your ratios right. Having split your basal you may find you have hypos overnight which can cause a high BG in the morning. Try checking your BG at 3am. Also a bolus of 1:10 at breakfast is low, try upping that. Hang in there and Don't stress it tamkes time but you will get there!!

 

[Skim]

Agree with comments above.. get your levrmir right first. I'm similar weight and take 11 units at night and 4 in the morning but I always test levemir periodically to make sure it's right. I had to split mine to get decent coverage. Everyone is different so test it using techniques mentioned above.. ie check bs before meal due.. dont eat.. before next meal is due bs should be within 10% of last test. Do this for each meal over a couple of weeks (once every few days) and then overnight. During thus time keep your daily routine the same.

Only then adjust your novorapid. And never take a correction dose for at least 2 hrs after your last insulin shot.

I also carb count and find it great.. I'm on the same insulin brands as you. I also use exactmeals.com - not free but worth it..