How often does your insulin to carbohydrate ratio change?

[TypeZero.]

I’ve used a 1:10 ratio for the last three months (since my diagnosis) and it seemed to be working perfectly throughout all times of the day but for some reason the last few days I’ve been getting large post-prandial spikes, I really don’t know what causing it. According to my Libre I’m getting a small subdued first peak then for some time my blood glucose decreases before getting a massive spike. I know the Libre is supposed to be a bit inaccurate but I find it is very accurate at the start between days 1-10 then gets inaccurate after that. So far my blood glucose readings have only been 0.5 apart.

For example here is my blood glucose from today’s dinner:

Before: 5.8 mmol/L
2 hours after: 11.3 mmol/L
4 hours after: 9.7 mmol/L

The meal had 120g of carbs and I used 12 units of NovoRapid.

It’s also confusing me a great deal because I thought I was on my honeymoon period because my blood glucose sometimes decreases naturally without any bolus or exercise but over time the insulin I inject doesn’t even seem to work for me. It used to work perfectly. Why has it changed? I haven’t gained any significant weight since my diagnosis only about 3kg. I tried to use different insulin ratios but they don’t work: I either go low or I can’t really give myself the correct amount of insulin as I’m on MDI and don’t have a pump so cannot exactly give my self 4.7 units or 3.2 units.

I’m trying to deduce what has changed. I did start a course of vitamins a few days ago but I don’t know if that is related. I take:
- a tablet with 100% of all your daily vitamins and minerals
- 1 or 2 cod liver oil tablets enriched with 500% of your daily recommended amount of Vitamin D

I’m thinking I’m overdoing the vitamin D by a wide margin but is that even linked to anything? I’ve heard vitamin D boosts your immune system so did I just accidentally speed up the destruction of B cells in my pancreas? I have stopped taking the vitamins but vitamin D is a fat soluble vitamin so it’s going to take ages for my body to remove it.

Anyone had any experience with anything like this?

P.S. I have an appointment with my dietitian in 8 days so I will discuss this with her but it’s nice to hear suggestions

 

[DCUKMod]

I’ve used a 1:10 ratio for the last three months (since my diagnosis) and it seemed to be working perfectly throughout all times of the day but for some reason the last few days I’ve been getting large post-prandial spikes, I really don’t know what causing it. According to my Libre I’m getting a small subdued first peak then for some time my blood glucose decreases before getting a massive spike. I know the Libre is supposed to be a bit inaccurate but I find it is very accurate at the start between days 1-10 then gets inaccurate after that. So far my blood glucose readings have only been 0.5 apart.

For example here is my blood glucose from today’s dinner:

Before: 5.8 mmol/L
2 hours after: 11.3 mmol/L
4 hours after: 9.7 mmol/L

The meal had 120g of carbs and I used 12 units of NovoRapid.

It’s also confusing me a great deal because I thought I was on my honeymoon period because my blood glucose sometimes decreases naturally without any bolus or exercise but over time the insulin I inject doesn’t even seem to work for me. It used to work perfectly. Why has it changed? I haven’t gained any significant weight since my diagnosis only about 3kg. I tried to use different insulin ratios but they don’t work: I either go low or I can’t really give myself the correct amount of insulin as I’m on MDI and don’t have a pump so cannot exactly give my self 4.7 units or 3.2 units.

I’m trying to deduce what has changed. I did start a course of vitamins a few days ago but I don’t know if that is related. I take:
- a tablet with 100% of all your daily vitamins and minerals
- 1 or 2 cod liver oil tablets enriched with 500% of your daily recommended amount of Vitamin D

I’m thinking I’m overdoing the vitamin D by a wide margin but is that even linked to anything? I’ve heard vitamin D boosts your immune system so did I just accidentally speed up the destruction of B cells in my pancreas? I have stopped taking the vitamins but vitamin D is a fat soluble vitamin so it’s going to take ages for my body to remove it.

Anyone had any experience with anything like this?

P.S. I have an appointment with my dietitian in 8 days so I will discuss this with her but it’s nice to hear suggestions

TypeZero - I don't have anything to say about your carb ration/insulin doses, but what makes you think you are significantly overdoing Vitamin D. A very significant proportion of people in UK are actually deficient, and most supplements are pretty weak, in terms of their dosages.

If you were supplementing Vit D, how much were you taking?

When was your Vit D last tested?

 

[TypeZero.]

TypeZero - I don't have anything to say about your carb ration/insulin doses, but what makes you think you are significantly overdoing Vitamin D. A very significant proportion of people in UK are actually deficient, and most supplements are pretty weak, in terms of their dosages.

If you were supplementing Vit D, how much were you taking?

When was your Vit D last tested?

Never had my vitamin D checked. I’m taking the daily multivitamin for general health and it contains 100% of all vitamins and minerals while the cod liver oil I take incidentally just happens to have vitamin D added but has 500% of daily recommended.

If I take one of multivitamin and two of cod liver oil I am getting about 11 times the amount of vitamin D I’m supposed to have in a day which is making me thinking I’m overdoing it a lot. I have no idea if that has anything to do with my insulin injection. It’s really strange because I might be at a good level like 6 mmol/L and I’ll sleep on it but my blood sugar spikes over night then comes down to around 8 mmol/L.

I’ve been getting hypos frequently after meals then a large spike. I suppose I just need to get on with it and need to stop looking for an excuse. It’s so strange because I was managing perfectly and this started to happen

 

[DCUKMod]

Never had my vitamin D checked. I’m taking the daily multivitamin for general health and it contains 100% of all vitamins and minerals while the cod liver oil I take incidentally just happens to have vitamin D added but has 500% of daily recommended.

If I take one of multivitamin and two of cod liver oil I am getting about 11 times the amount of vitamin D I’m supposed to have in a day which is making me thinking I’m overdoing it a lot. I have no idea if that has anything to do with my insulin injection. It’s really strange because I might be at a good level like 6 mmol/L and I’ll sleep on it but my blood sugar spikes over night then comes down to around 8 mmol/L.

I’ve been getting hypos frequently after meals then a large spike. I suppose I just need to get on with it and need to stop looking for an excuse. It’s so strange because I was managing perfectly and this started to happen

So how much Vitamin D is actually in there? How long have you been taking it? How much sunshine do you get in a day, and finally, what is your ethnicity, as that can impact Vit D levels.

 

[TypeZero.]

60 micrograms a day in total, been taking it for around 4 days (which is around when my insulin went a bit weird), I go to shops daily but mostly indoors, my parents are from Turkey but we are very pale and European looking, I can pass off as central or Eastern European

 

[Antje77]

My insulin to carb ratio changes over the day (about 3 times as much insulin for the same amount of carbs in the morning as in the evening), and it changes over the weeks. Some days I need over twice the amount of insulin to stay in range as on other days, even with comparable carbs and exercise. I'm not sure if that's usual, but it works for me.

I don't take extra vitamins, except vit. D on prescription because I have a deficiency.

 

[EllieM]

I’ve been getting hypos frequently after meals then a large spike. I suppose I just need to get on with it and need to stop looking for an excuse. It’s so strange because I was managing perfectly and this started to happen

If you're still on your honeymoon then at some point you are going to need more insulin. Also, your current ratio is the standard start up amount used by many hospitals, so I wouldn't expect this to necessarily stay the same. But the first thing I would check in your position is whether your basal insulin is OK. It's very hard to get insulin ratios right if you've got the basal wrong. Will your dietician discuss insulin amounts, or do you have to speak to a nurse for that?

 

[Rokaab]

@TypeZero. do remember it might just be your honeymoon period throwing a spanner in the works, I've heard for some that honeymoon can be quite volatile
But yes both basal rates and bolus ratios can change, some have different ratios dependent on day of time (I do need more insulin in the morning), time of month, stress, illness, temperature and sometimes the carb ratio that normally works just doesn't - the body does not always play fair by a long way and can be chaotic and its just something we all have to deal with - as much as we'd rather not have to deal with it.

 

[DCUKMod]

60 micrograms a day in total, been taking it for around 4 days (which is around when my insulin went a bit weird), I go to shops daily but mostly indoors, my parents are from Turkey but we are very pale and European looking, I can pass off as central or Eastern European

As others are addressing your main question, I will dip out after this.

60mcgr is not a huge dose of VitD. Whilst expressed differently, I take 4000iu per day, and have been for a couple of years, without issue - following a loading dose of 10,000iu per day for a period. Of course, that it is fine for me doesn't necessarily mean it's fine for everyone.

I'd be surprised if the Vit D itself was interfering with anything, although were you sensitive or allergic to any of the ingredients, those could be having an impact.

Personally, I only supplement where I know there is a quantified need, and then only to address that need. Again, personally, I'd never take a multi-vitamin.

About the only thing I would take without a quantified need is VitC, as our bodies can ditch any excess quite easily.

 

[TypeZero.]

If you're still on your honeymoon then at some point you are going to need more insulin. Also, your current ratio is the standard start up amount used by many hospitals, so I wouldn't expect this to necessarily stay the same. But the first thing I would check in your position is whether your basal insulin is OK. It's very hard to get insulin ratios right if you've got the basal wrong. Will your dietician discuss insulin amounts, or do you have to speak to a nurse for that?

We already basal tested and 14 units of Lantus seems fine for me and keeps my BG stable.

The Diabetes Specialist Nurse was only involved in my diabetes management around 2 weeks after getting out the hospital then I was given a phone number of the assistant of my consultant as well as the contact details of my dietitian and we arrange everything through there.

IMy 1:10 ratio seemed to be working very well. I always had larger spikes in the morning ever since starting insulin but my BG seemed to return back to pre-breakfast levels

 

[sleepster]

I’ve been getting hypos frequently after meals then a large spike.

I would ask your dietitian about splitting your bolus. I was having this problem (though with less carbs than your 120g) and my dietitian said that if I was having over 50g of carbs in a meal to not have all my insulin in one go, I use a pump so I was advised to do a dual wave. I'm not advising you to do the same because I'm not a medical professional, but maybe ask about it, assuming it's not something you already do. I was told that if you eat a big meal then the carbs/glucose will take longer to get into your blood as the whole meal takes longer to digest so the insulin is getting there first, making you hypo, seems obvious when you think about it