BG up, how much insulin to take down?

[Spencer67]

I'm Type 1, and my BG goes up regularly but i'm struggling to inject the right amount to take it down without hitting a low and then i'm having to eat some carb to elevate it, so i feel like a yo yo.

Is there a bit of math i can use to get a standard regular reading and stay on a constant if that's at all near possible?

ie my BG reading is 13.3 mmol/L, what is a reasonable amount to effectively bring it to within a norm 4-7 mmol/L and not go under?

I'm using Novo Rapid and Novomix 30.

 

[totsy]

My ratio has changed,i used to use a unit of insulin to take me down 4mmol but that's no longer working so im going up by 1 till i get it right, we are all different and its trial and error,although it is ruddy annoying

 

[noblehead]

Seems an unusual combination taking Novomix 30 with Novorapid, wonder why your not on basal insulin such as lantus or levemir with your Novorapid.

The amount of insulin it takes to bring down bg down varies from person to person, so decide for yourself but go easy and make sure to check your bg for a few hours after correcting, come Monday you should contact your DSN and ask for their guidance on correcting your bg.

 

[donnellysdogs]

The only reasons for having tontake novorapid with novomix is because of

A) eating too much carbs at meals and the novomix not coping

B) you need to change insulin and go on to a basal bolus regime.

I take it that when you are high you are correcting with novorapid?

Your regime doesn't honestly seem suitable. I would suggest going back to your health care team and ask for a basal bolus regime.

 

[Spencer67]

@donnellysdogs @noblehead tx for the replies, well this has got me cos i thought the Novorapid was a bolus? but i have been using this more to cope with the carb intake whilst i change diets. I'm juicing raw veg and blending with fruit ie apples, blueberries etc lately as well as trying to progress to the LCHF regime.

The Novomix 30 i thought was a basal-bolus but didn't seem to work as well (going too high after meals), so yes i was topping up with Novorapid to compensate. Now i'm feeling confused, i'll see my DSN on Monday, i'm concerned ive been getting it wrong for some time. I will ask why im not on the lantus or levemir, to be honest i know little about the two.

I guess i need to incorporate a basal into my regime is this right?

 

[totsy]

Usually you are on something like novomix or a basel eg.lantus/levemir and novorapid, usually not novomix and then a fast acting although you can if u are on high carbs that novomix wont cover, i was on novomix at first for a couple of yrs then just lantus and metformin(which is also highly unusual) then i spoke to another diabetic who told me to ask for MDI(multi dose injections) which i was given as novorapid and lantus

 

[donnellysdogs]

Yes the novorapid is a bolus but it should not be necessary on a premixed bolus/basal injection.

You should be on either a basal/bolus mdi regime or a mixed insulin. Not combining the two.

This is probably why you are high then crashing lower. Because novorapid lasts up to 5 hours it could well be reacting with your background mix of your other mixed insulin.

And it is also forcing you to eat at set times and then having to give extra bolus... Thats not a good routine to enabling to to have flexibility around your life....

NICE guidelines do not recommend that regime at all and if your DSN is giving that advice she is going against the official guidelines...

 

[Spencer67]

My ratio has changed,i used to use a unit of insulin to take me down 4mmol but that's no longer working so im going up by 1 till i get it right, we are all different and its trial and error,although it is ruddy annoying

Seriously, no wonder people get complications carb counting and knowing the right dose of insulin is really hard to get your head around its giving me a headache.

 

[totsy]

lol mine is at the mo, been same ratio 11 yrs n now decided to change lol

 

[Spencer67]

Off to see the DSN today 11.10am and taking the thread with me.

 

[totsy]

How you got on?

 

[Spencer67]

How you got on?

Hey tx for asking. She didn't really give me any idea of what to do or make any changes but agreed about a possible bolus/basal change but she couldn't do it and so i've a new appointment to see the doc who will look at my recent overall blood readings from my meter and see what would be an appropriate change for my routine. back to the docs on Wednesday morning. I did have a check up on weight and hba1c etc though.

 

[Spencer67]

Saw the Doc tday he didnt see any reason why i should change my regime. Stating that NICE were just guidelines and every one is different. So i am to continue on the Novomix 30 and Novorapid. He did say i needed to stick to a routine which i have not really had through circumstances and continue with the carb counting to get the bg levels back down as they were more around the (embarrassingly) 10-13s or low at the hypo 4s.

I'm going to up my dose of novomix in the morning to about 17 units (was 12) and then see what happens, will be correcting with novorapid about 2 units seems to drop me about 6mmol/l and continue with my exercise routine.

Its all so complicated but im getting there. I think. but my finger tips are sore from all the bg readings.

 

[Spencer67]

@donnellysdogs @noblehead Is the lavimir really better than the Novomix? i've done some reading and people seem to get better control, but when i went to the doc he seemed really not bothered about it but i also felt he wasn't really listening, it is hard to explain though as i had no solid evidence i suppose apart from a few reading on my meter he briefly looked at.

I read this thread http://www.diabetes.co.uk/forum/threads/basal-bolus-or-novomix.13947/ and i feel the same way. Maybe i should go back and insist he changes me and at least try the levemir / rapid regime.

Do you think levemir would really help with my highs and lows, perhaps stabilize me more?
I will be researching more so i can get my head round it all. I don't know if its me, my diet or my regime.

 

[Robinredbreast]

I'm Type 1, and my BG goes up regularly but i'm struggling to inject the right amount to take it down without hitting a low and then i'm having to eat some carb to elevate it, so i feel like a yo yo.

Is there a bit of math i can use to get a standard regular reading and stay on a constant if that's at all near possible?

ie my BG reading is 13.3 mmol/L, what is a reasonable amount to effectively bring it to within a norm 4-7 mmol/L and not go under?

I'm using Novo Rapid and Novomix 30.

I was told by my DSN 1 unit should bring me down by 3 , but that isn't always correct and this would make me too low. Also depends on whether I am active or sedentary. Everyone is different in their diabetes regime, also build and weight would make a difference too. I'm 5ft 2 and weigh 9 stone.

Best of luck RRB

 

[donnellysdogs]

@donnellysdogs @noblehead Is the lavimir really better than the Novomix? i've done some reading and people seem to get better control, but when i went to the doc he seemed really not bothered about it but i also felt he wasn't really listening, it is hard to explain though as i had no solid evidence i suppose apart from a few reading on my meter he briefly looked at.

I read this thread http://www.diabetes.co.uk/forum/threads/basal-bolus-or-novomix.13947/ and i feel the same way. Maybe i should go back and insist he changes me and at least try the levemir / rapid regime.

Do you think levemir would really help with my highs and lows, perhaps stabilize me more?
I will be researching more so i can get my head round it all. I don't know if its me, my diet or my regime.

Was it GP you saw or a Consultant? If GP I would ask to be referred to a Consultant.

Personally I preferred a bolus/basal regime for flexibility with my living, as I am not a regular eater.

 

[Spencer67]

Was it GP you saw or a Consultant? If GP I would ask to be referred to a Consultant.

Personally I preferred a bolus/basal regime for flexibility with my living, as I am not a regular eater.

He is a GP but is meant to be specialist in Diabetes, i don't get the specialist vibe at all.

 

[donnellysdogs]

GP's are just that.. General Practitioners.... Our diabetic GP just got elected to look after diabetics by the other Partners... No specialist interest at all.... He relies totally on DSN's.....

As a type 1 you are entitled to see a Consultant at hospital and I would certainly be asking for a referral if I was you. Consultants specialise in diabetes... GP's don't...

 

[noblehead]

He is a GP but is meant to be specialist in Diabetes, i don't get the specialist vibe at all.

It's entirely your decision to whether you stay on the Novomix or changed to a basal insulin like levemir, however if your struggling with your diabetes control and you don't think your gp is giving you the support you need you can ask to be referred over to a hospital diabetes clinic where you will get specialist advice, type 1 diabetes can be quite a complex condition and is often outside of the remit of your average gp (although appreciate yours is a specialises in diabetes).

 

[Spencer67]

I was told by my DSN 1 unit should bring me down by 3 , but that isn't always correct and this would make me too low. Also depends on whether I am active or sedentary. Everyone is different in their diabetes regime, also build and weight would make a difference too. I'm 5ft 2 and weigh 9 stone.

Best of luck RRB

Yah thanks for that i've just worked out that 1 unit brings me down 2mmol/l
I'm 6ft and 12.4st so makes sense,

How many units of fast acting do you use to deal with say 15g of carb?