Carb counting and insulin

[Daveni50]

Hi all new to the forums. I have been diagnosed T2 for 2 years although for the past year i have been told i am a late developing T1.. i was put on insulin - 3 units novo rapid each mealtime and 5 units lantus before bed along side 4 metformin each day. My blood sugar levels remain quite high, anywhere between 7.5 - 18. It seems to be linked to carbs.. i have cut down, however i have never been told to adjust insulin against carb intake and was wondering if there is a common ratio to adjust to. Its still quite new to me and am awaiting first appointment with consultant, so any advice would be appreciated. Thanks

 

[Deleted member 527103]

As we are all different, our insulin to carb ratios all differ to providing a "common ratio" could be very misleading.
Furthermore, before adjusting carb ratios. the first thing to check is that your basal (Lantus) dose is correct - there are lots of threads on basal testing. There is little point playing with your bolus if the base it not correct.

If you want to learn about carb counting, you may find the BERTIE online course useful.

 

[TashT1]

I would agree that taking the BERTIE online course is a good step, it’s how I learnt to carb count without any help of a dietician or my diabetes team. It’s not very long, takes maybe half a day & you can’t stop/ start when you want.

I’d be cautious of common carb ratios as you’ll still be producing some of your own insulin. You are far better off testing what works for you. Keep in mind we often need different ratios for different times of day too.

Check your basal, keep an accurate food log with carb counts & check against your pre & post meal levels. After a few days you will see how many carbs you can tolerate for those 3 units of bolus, from there you can play around with ratios.

 

[EllieM]

Hi all new to the forums. I have been diagnosed T2 for 2 years although for the past year i have been told i am a late developing T1.. i was put on insulin - 3 units novo rapid each mealtime and 5 units lantus before bed along side 4 metformin each day. My blood sugar levels remain quite high, anywhere between 7.5 - 18. It seems to be linked to carbs.. i have cut down, however i have never been told to adjust insulin against carb intake and was wondering if there is a common ratio to adjust to. Its still quite new to me and am awaiting first appointment with consultant, so any advice would be appreciated. Thanks

Welcome to the forums.

First things first, you were probably never T2, you've always have been T1 or LADA (late onset T1, there is a specific sub forum for it here which you may find useful, though the T1 one will cover you as well). It's very common for GPs to diagnose anyone over the age of 30 as T2 without bothering to do the tests to see if they are in fact T1.

It amazes me that doctors can prescribe insulin without telling you how to adjust the dose, but as @TashT1 said your insulin needs will likely be a bit variable at the moment as you are still in your honeymoon period and producing random amounts of your own. In the medium to long term, you'll adjust your basal (the lantus) so your morning reading is similar to your before bed one (ie it acts to keep you level when there is no food or bolus insulin in your system). You'll then adjust the bolus, your novorapid, according to the insulin ratio given by your team. They'll likely work this out when they see your food, insulin and blood sugar records. Remember, in the short term, hypos are more dangerous than hypers, which is why teams tend to start people on low doses of insulin and gradually increase them.

Good luck.

 

[Daveni50]

Welcome to the forums.

First things first, you were probably never T2, you've always have been T1 or LADA (late onset T1, there is a specific sub forum for it here which you may find useful, though the T1 one will cover you as well). It's very common for GPs to diagnose anyone over the age of 30 as T2 without bothering to do the tests to see if they are in fact T1.

It amazes me that doctors can prescribe insulin without telling you how to adjust the dose, but as @TashT1 said your insulin needs will likely be a bit variable at the moment as you are still in your honeymoon period and producing random amounts of your own. In the medium to long term, you'll adjust your basal (the lantus) so your morning reading is similar to your before bed one (ie it acts to keep you level when there is no food or bolus insulin in your system). You'll then adjust the bolus, your novorapid, according to the insulin ratio given by your team. They'll likely work this out when they see your food, insulin and blood sugar records. Remember, in the short term, hypos are more dangerous than hypers, which is why teams tend to start people on low doses of insulin and gradually increase them.

Good luck.

Thank you all for your feedback. It already makes more sense! I guess it will be a bit of trial and error. Deffo going to do the BERTIE course. I hope you all well in these times and i’ll be back with more questions as this develops. Once again.. thank you and keep safe.