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Ratio: 0 Bolus???

RFAPT

RFAPT

Member
Messages
5
Type of diabetes
Type 1
Treatment type
Insulin
This is my first time posting on the forum.
I've been T1 for 2 years and have very good control. I take Apidra and Lantus and count carbs. Last A1c was 5.1%.
7 months ago my night time ratio went from 11g:1u to zero insulin required. I'll explain how I came to this.
I would hypo throughout the night so naturally looked at my ratios and made changes to the bolus. When this didn't give results I reduced my basal but this too failed to fix the hypos. I went back and looked at the bolus ratio and it seemed every night I tested with a higher and higher ratio going up to (for the sake of the test) 100g:1u and was still hypo'ing 20minutes later. I then tried taking zero bolus with the carbs and to my surprise I woke up the following morning at 5.0mmol. To test I ate more and more carbs each night and woke up each morning between 5-6mmol. Once I had established this I did hourly checks and I found that, when taking no insulin, the reading would rise steadily throughout the night up to about 12mmol, then drop back to my starting reading of 5-6. Because I didn't want to rise to this number I stopped eating after the 'cut off' time which I established to be 23.00.
After months of testing this I have found if I eat at 22.59 I require insulin and, if using my ratio, don't rise higher than 7mmol. If, however, I eat carbs after 23.00 and take insulin, I will hypo throughout the night and not even lucozade will bring me up.
I understand many will think it is just the ratio which is dramatically incorrect but I have tested this extensively and my endo looked at it too. He didn't know why and told me simply not to eat after 23.00.
Has anyone ever experienced this? I would love to hear from people who have or know about it? It would be great if I could find a way around it.
Thanks in advance.
 
strange.................

have you done test overnight to confirm what your Lantus dose is doing............?

for me if its a waking number that's causing concerns then the background would always be the first thing to look at......

I suspect your Lantus may be too much overnight and so a split may be required.........
 
novorapidboi26 said:
strange.................

have you done test overnight to confirm what your Lantus dose is doing............?

for me if its a waking number that's causing concerns then the background would always be the first thing to look at......

I suspect your Lantus may be too much overnight and so a split may be required.........
Click to expand...

Hi novorapidboi26.
I can confirm I have checked Lantus dose. When not having eaten after 18.00 my glucose stays between 5.5-6.5mmol throughout the night. It also stays the same throughout the day if not eaten any carbs.
The only time I experience the lows is when I eat after 23.00 (if I take insulin.) Even 1u is enough to make me hypo. Apart from this I rarely hypo.
 
I see,

its strange to see a single background dose of Lantus being so finely tunes to ones needs......I would expect you to have hypos quite often if you consider unplanned activity amongst other things........

as the Lantus is OK then your right the ratio of Apidra does seem to be the culprit.............

your insulin/carb ratios must change at around the 11PM mark.....

it would seem a difficult task trying to work out such small doses when eating after 11 and so you might just need to persevere or go without carbs at that time.....

being 2 years in to the diagnosis and with such good HbA1c its quite likely your pancreas is still making a small contribution........

what would be a typical snack in the evening/before bed......?
 
I don't often eat after that time but on the few instances I do it may be a slice of toast. A standard slice is approx 20g so if I were at 5mmol and I took no bolus I would go up to about 11mmol, then come back down to 5. I've got used to avoiding carbs after this time now but with the clock going back soon I thought I'd see if anyone had heard of it.
 
how could you come back from 11 to 5...........?

I assume the 5 would be your waking level.....?

if there was no bolus insulin on board, then the drop back down to 5 would normally mean your basal/Lantus would be responsible as it the only working insulin, and again that would also mean that the dose is too high as it should hold you steady between 1-2mmol.......
 
This is why I was asking. My endo sent me for tests where my glucose level was monitored 24 hours a day. If, after my evening meal, I didn't eat any more carbs, then my glucose stayed between 5.5-6.5 throughout the night. If, however, I ate carbs after 23.00 then the glucose increased depending on how much I ate and went up to 15mmol one night, but by 10am the following morning it had come down to 5mmol. It never hypo'd. The doctors said they had never seen it before.
In my own tests I decreased my basal and my readings, on a fast, went up to 10mmol before I was chasing with bolus.
 
Its hard to speculate I suppose...........

if it was me I would do an hourly test overnight to see whats happening...........you may be going up during the night or down even......

if I was confidant my basal was right with evidence over a few nights then I could only conclude the bolus needed changed.........if you are finding you need too small an amount to deal with your carbs at night then I don't know there is much you can do..........unless a pump can be obtained......;)...

I suspect this behaviour to carbs and insulin in the evening wont last forever though....
 
The simply solution is not to eat after 11pm, I'm just so surprised that 1 minute can make all that difference.
 
So it basically looks like after 11pm you get our own insulin production? :D

As I understand:
1) if you do not eat, your BG is stable => your basal (lantus) dose is correct
2) if you eat and don't bolus, you go up but come back down on "your own"
3) if you eat and DO bolus, the #2 still applies, but since you also bolused, you hypo.

Is this correct?

I've heard that some people require far less insulin at night (myself included), but this is like an extreme case :)

This may be some weird combination of honeymoon period and high insulin sensitivity at night?
 
PaulinaB said:
So it basically looks like after 11pm you get our own insulin production? :D

As I understand:
1) if you do not eat, your BG is stable => your basal (lantus) dose is correct
2) if you eat and don't bolus, you go up but come back down on "your own"
3) if you eat and DO bolus, the #2 still applies, but since you also bolused, you hypo.

Is this correct?

I've heard that some people require far less insulin at night (myself included), but this is like an extreme case :)

This may be some weird combination of honeymoon period and high insulin sensitivity at night?
Click to expand...

Hi PaulinaB,
That's it exactly. Over the last few months I have conducted many tests with timings, etc. and I come to the same result. I have simply stopped eating carbs after 11pm. I just wondered if anyone had heard of this before as with the clocks due to go back soon I presumably shouldn't eat carbs after 10pm, although I will test for a few weeks afterwards.

Thanks for all your help and advice!
 
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