Unsure how to calculate insulin dosage? Results seem random.

Dave P

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Messages
100
Type of diabetes
Type 1
Treatment type
Insulin
Am I the only one who has struggles like this? I am really struggling to figure out my insulin to carb ratios. I know it varies for everyone and you should keep records of what and when you eat, how much insulin you used, what your blood sugar was before and after etc. I've done all that extensively. I've just been told I have background retinopathy, after having had no signs of retinopathy in the previous seven years since I was first diagnosed as diabetic. And despite having had a decent hba1c each year. A few months ago mine was 5.9%. Not perfect but you would hope that as a relatively new diabetic it would be good enough to avoid retinopathy. I do have occasional high blood sugar and more regularly I have brief and mild hypos. I wondered which of these, or both, are causing the retinopathy (I know it could also just be one of those things and not necessarily related to my blood sugar control. But nonetheless I figure it would be prudent to have another look at my methodology and diet to see if I am doing everything as well as I could and should be). I know that low blood sugar can be dangerous to eyes just as high blood sugar is. Some of my lows have been very low, doesn't happen often but who knows, maybe these are causing a lot of damage.

Here's the sort of thing I just find baffling. Firstly I usually find my numbers going high after eating in the mornings. My numbers on waking are good almost every time, so I believe my basal is correct. But after eating, the numbers can be seemingly anything they feel like being. The first thing I tried when really struggling with morning numbers was eating nothing whatsoever, but my numbers could still be 2-3 higher as presumably the liver 'helpfully' dumped glucose into my blood for me. So I read about this and I see that eating nothing is not a good idea and doesn't work anyway. So I think okay, low carb then? High fat low carb yogurt? Or zero carb eggs? Nope, doing that or even just eggs still results in a rise - a bigger one.

For example, yesterday I had a small breakfast with 21g carbs, which was a greek yogurt, two eggs and one piece of toast with olive spread. If I were to eat such a small meal later in the day or especially the evening, this would only need two units of insulin.

Normally my blood sugar in the morning is really stubborn and the only way to even keep it from rising after 2-3 hours is to take a much larger dose than I would need the rest of the day. So I had been just taking 10u regardless, as this worked better than trying to figure out a proper ratio. Usually this would keep my number down to more or less where it had begun the day, or with a small rise.

So yesterday I was 7.2 before eating - higher than ideal as it gave me little room for a rise. I'd prefer to be around 5. I took 10u. Just over two hours later it was 3.3. This was very surprising to me as my blood sugar is usually very stubborn about going down in the morning at all. I would have been happy for it to have not risen over 7.2 (or risen and gone back to 7.2 at least). But here was a big drop and of course I wasn't happy it had gone below 4.0 either. I corrected the low and for the rest of the day used my normal 1:10 ratio and all was fine, numbers were in the normal range for the rest of the day.

This morning I was 5.5. I ate exactly the same breakfast. I did exactly the same amount of physical activity. Mindful that I was low yesterday after taking 10u, today I took 6u instead. So after 2.5 hours I check my blood sugar and it is 8.9. So how on Earth are you supposed to figure out the correct ratio when it is this wildly inconsistent? This isn't a one-off inconsistency either, it's par for the course. Going high is typical, yesterday's low was the outlier. I hardly ever go lower at all in the morning, never mind into hypo territory.

Bear in mind that 21g of carbs even if NO insulin at all was taken, shouldn't have raised my levels to more than 7.5 or so. But even with 6u of rapid insulin it took them to 8.9?

It is hard not to be despondent at how random it all seems. I can learn any system but if it is this random, I don't know what to do. All I can do is tolerate the random low or high numbers and hope for the best re my future hopes for keeping my eyesight I suppose?

btw, I am not overweight, and both my cholesterol and blood pressure are fine, so I was told a few months ago at my last annual checkup. I don't smoke or drink.
 

KK123

Well-Known Member
Messages
3,967
Type of diabetes
Type 1
Treatment type
Insulin
Am I the only one who has struggles like this? I am really struggling to figure out my insulin to carb ratios. I know it varies for everyone and you should keep records of what and when you eat, how much insulin you used, what your blood sugar was before and after etc. I've done all that extensively. I've just been told I have background retinopathy, after having had no signs of retinopathy in the previous seven years since I was first diagnosed as diabetic. And despite having had a decent hba1c each year. A few months ago mine was 5.9%. Not perfect but you would hope that as a relatively new diabetic it would be good enough to avoid retinopathy. I do have occasional high blood sugar and more regularly I have brief and mild hypos. I wondered which of these, or both, are causing the retinopathy (I know it could also just be one of those things and not necessarily related to my blood sugar control. But nonetheless I figure it would be prudent to have another look at my methodology and diet to see if I am doing everything as well as I could and should be). I know that low blood sugar can be dangerous to eyes just as high blood sugar is. Some of my lows have been very low, doesn't happen often but who knows, maybe these are causing a lot of damage.

Here's the sort of thing I just find baffling. Firstly I usually find my numbers going high after eating in the mornings. My numbers on waking are good almost every time, so I believe my basal is correct. But after eating, the numbers can be seemingly anything they feel like being. The first thing I tried when really struggling with morning numbers was eating nothing whatsoever, but my numbers could still be 2-3 higher as presumably the liver 'helpfully' dumped glucose into my blood for me. So I read about this and I see that eating nothing is not a good idea and doesn't work anyway. So I think okay, low carb then? High fat low carb yogurt? Or zero carb eggs? Nope, doing that or even just eggs still results in a rise - a bigger one.

For example, yesterday I had a small breakfast with 21g carbs, which was a greek yogurt, two eggs and one piece of toast with olive spread. If I were to eat such a small meal later in the day or especially the evening, this would only need two units of insulin.

Normally my blood sugar in the morning is really stubborn and the only way to even keep it from rising after 2-3 hours is to take a much larger dose than I would need the rest of the day. So I had been just taking 10u regardless, as this worked better than trying to figure out a proper ratio. Usually this would keep my number down to more or less where it had begun the day, or with a small rise.

So yesterday I was 7.2 before eating - higher than ideal as it gave me little room for a rise. I'd prefer to be around 5. I took 10u. Just over two hours later it was 3.3. This was very surprising to me as my blood sugar is usually very stubborn about going down in the morning at all. I would have been happy for it to have not risen over 7.2 (or risen and gone back to 7.2 at least). But here was a big drop and of course I wasn't happy it had gone below 4.0 either. I corrected the low and for the rest of the day used my normal 1:10 ratio and all was fine, numbers were in the normal range for the rest of the day.

This morning I was 5.5. I ate exactly the same breakfast. I did exactly the same amount of physical activity. Mindful that I was low yesterday after taking 10u, today I took 6u instead. So after 2.5 hours I check my blood sugar and it is 8.9. So how on Earth are you supposed to figure out the correct ratio when it is this wildly inconsistent? This isn't a one-off inconsistency either, it's par for the course. Going high is typical, yesterday's low was the outlier. I hardly ever go lower at all in the morning, never mind into hypo territory.

Bear in mind that 21g of carbs even if NO insulin at all was taken, shouldn't have raised my levels to more than 7.5 or so. But even with 6u of rapid insulin it took them to 8.9?

It is hard not to be despondent at how random it all seems. I can learn any system but if it is this random, I don't know what to do. All I can do is tolerate the random low or high numbers and hope for the best re my future hopes for keeping my eyesight I suppose?

btw, I am not overweight, and both my cholesterol and blood pressure are fine, so I was told a few months ago at my last annual checkup. I don't smoke or drink.


Hi Dave, I do feel for you as it can be demoralising when you take so much time and effort trying to manage it. I'm afraid it is nowhere near an exact science and is very random. A 'normal' person's pancreas releases insulin on a 24/7 basis, every second of every day, it switches on and off when it is needed no matter what the person does. Imagine trying to replicate that with the tools we have! Have you considered getting a libre to test what's going on for a few weeks? (Not sure if you would get one on prescription). They do have some minor ish issues but they are great for showing patterns and when your levels are on the way up or down. I think you've been type 1 for a while?, sometimes it's worth starting from scratch as it were and maybe contacting your team to see if you can adjust anything? Also, I was told on a recent course that the '2 hour' mark after a meal is not necessarily a great marker for insulin users, they said it can take up to 4 hours to come back to pre meal levels and as long as it doesn't go way too high in the meantime, that is ok. I know you like yours to be around 5 (so do I) but again, it is very hard to keep them that low without taking the risk of hypos...which mean treating...which means going high...which means contemplating a correction dose...which means going low again. Well, you get my drift. They also said the more 'interference' outside of your normal routine the MORE they would go up & down. x
 
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Dave P

Well-Known Member
Messages
100
Type of diabetes
Type 1
Treatment type
Insulin
I've been officially type 1 for about 18 months, was type 2 before that, initially with good control on a low carb diet, which became worse and then bad control where I had to tolerate a few weeks of 24/7 double figure blood sugar before I was put on insulin. My eye test a month or so after that, came back clear. But due to the pandemic, I haven't had another one until a few weeks ago. I am wondering if that unavoidable period of high blood sugar in 2019 caused eye damage, I have read it doesn't always manifest itself immediately but can take even years. Anyway short of a time machine there's nothing I can do about that... and I am told it is just a small bleed in one eye only, so hopefully it may be nothing major and might even get better on its own.

If I can maintain good control that is, which with these morning numbers is challenging. (I get inconsistent numbers at other times of the day too sometimes, but generally it's much more consistent and predictable later on.)

I've asked about a Libre before, I can't get one at the moment but the clinic said maybe in future. I'm not sure it would have helped me this week to solve this particular puzzle though. It would show when the rise occurred etc. but given I'd already taken a (for only 21g carbs) hefty dose of insulin, I'm not sure what more I could do.
 

TashT1

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Messages
308
Type of diabetes
Type 1
Treatment type
Insulin
I find that my breakfast ratio is 1u to 5g and it’s best to avoid toast completely unless I want to take a large dose of insulin. I eat eggs most days & don’t see a rise with just basal on board. You could try ditching the toast to see if it gives you more consistent results.

The other thing that springs to mind is that maybe you still have some insulin production which is making things unpredictable. When was your last c-peptide test?

I would get in touch with your team, maybe a tweak to your basal would help or consider moving it to a morning dose.
 

Dave P

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Messages
100
Type of diabetes
Type 1
Treatment type
Insulin
I think the toast is a red herring, because I only got the bread last week after my eye test result, and decided I would make some dietary changes. Toast was just a way to have some carbs with the protein of the eggs and yogurt, because I've read that if you just have a high protein meal and no carbs, that the protein turns to sugar anyway. I haven't had bread for years until now (had to stop it entirely when type 2, and didn't resume when I went on insulin as I'd got used to not having it).

I have previously tried a higher basal (I currently use 12 units of Abasaglar, taken at night. I have tried upping it to 15 or 18 and it's been too much, unambiguously. Any higher and I was going very low on waking or during the night. Granted I could take the basal in the morning instead but it would still raise the spectre of going low overnight the next night.

I can't rule out that I still produce some insulin, but if I do, it must be extremely random and sporadic because most of the time I never get lows which don't make sense. ie. I will get a low if I know I've made a mistake with my dose, or done a lot of physical exercise and not taken it into account properly relative to what I've eaten and dosed for. I've never had a c-peptide test, they diagnosed me type 1 on the basis of a GAD antibodies test.

What would be helpful to me would be if anyone could reply who also has inconsistent results like I described earlier, and also if others need to use a higher ratio in the morning.

Another thing, I did a lot of record keeping to see if I didn't actually need more in the mornings but if it was just slower, but eventually caught up. It doesn't catch up, for me it does seem that I really do need more in the morning. If only it was consistent.
 

Maco

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Messages
278
Type of diabetes
Type 1
Could it not be your basal insulin (background) causing the rise? Taking 10 units for 21grams of carbs seems absolutely mental, even 6 is high. Another thought is are you getting the carb amount right for the slice of bread? It can vary so much from a thin slice large slice or medium slice & obviously different breads are different carbs. Another thought is are you weighing out your yoghurt? Again your carb amount could be out if your just putting some in a bowl and guessing the amount. For instance a quick look on google 100g of greek yoghurt is 3g of carbs. But then honey greek yoghurt is 14g of carbs for 100grams. Ive been type one since I was 14 so 12 year, I weigh out every meal because that's the only real way you can be 100% on the carb content.

My carb ratios change throughout the day, 1:9 for breakfast 1:9.5 for lunch 1:10 for evening meal. Today im 99% in range so once you get them carb ratios Dailed in you should be fine. Have you sat down with your DSN & worked out any ratios as a starting guide?

Also, make sure to take your breakfast insulin at least 20 minutes before you eat as most of us are insulin resistant at that time. If I take mine 5/10 minutes before eating I will spike
 
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Hopeful34

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1,693
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It's hard not to get despondent, but many things can alter blood sugar levels, not just the obvious, and a lot of people struggle with inconsistent results at times too. I gave up eating breakfast a while ago as it spiked me horrendously, and it was better for me not to eat till later. Getting a pump helped a lot as I can set a slightly higher hourly rate before I get up to take care of the 'foot on the floor' rise, and dawn phenomenon. However, I can still get inconsistent results when I've eaten exactly the same thing 2 days running, and basically done the same thing too.
 

TashT1

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Messages
308
Type of diabetes
Type 1
Treatment type
Insulin
I can't rule out that I still produce some insulin, but if I do, it must be extremely random and sporadic because most of the time I never get lows which don't make sense. ie. I will get a low if I know I've made a mistake with my dose, or done a lot of physical exercise and not taken it into account properly relative to what I've eaten and dosed for. I've never had a c-peptide test, they diagnosed me type 1 on the basis of a GAD antibodies test.

What would be helpful to me would be if anyone could reply who also has inconsistent results like I described earlier, and also if others need to use a higher ratio in the morning.

Another thing, I did a lot of record keeping to see if I didn't actually need more in the mornings but if it was just slower, but eventually caught up. It doesn't catch up, for me it does seem that I really do need more in the morning. If only it was consistent.

It makes sense for you to need more in the mornings even type 1’s can have some insulin resistance. Mine are 1:5 at breakfast, 1:7 lunch and 1:8 tea.

I’m GAD negative but my c-peptide is being checked twice a year (or atleast that’s the plan as I’m now 7 months in). If I were you I’d ask to have this test so you know how much/ little insulin you have to play with. I was told because I’m in this honeymoon period to expect completely random lows and highs as my body might chuck some extra insulin in at any time or just choose to do nothing.

I’d wonder if your low was extra insulin coming in on top of the 10u & the high the effect of zero help from your pancreas. Very frustrating either way.

Protein can be converted into sugar but at half the rate so 30g of protein would be akin to 15g of carbs. I find that eggs do zilch to my levels but that’s just me, obviously something else is going on for you. I also weight all my portions so I can be sure of the carb count, when I don’t it goes wrong.
 

Dave P

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Messages
100
Type of diabetes
Type 1
Treatment type
Insulin
Could it not be your basal insulin (background) causing the rise?
Are you suggesting it could be too low? Please see my last post, when I tried a higher basal it was too high to prevent me having lows overnight and/or first thing in the morning.

Taking 10 units for 21grams of carbs seems absolutely mental, even 6 is high.
Indeed, but what can you do, what would you do? What would you do if taking less insulin results in even higher blood sugars, and if you've already established that your basal is correct? And if physical activity makes no difference? ie. the numbers can be wildly different even with ALL the exact same everything from one day to the next.

Another thought is are you getting the carb amount right for the slice of bread? It can vary so much from a thin slice large slice or medium slice & obviously different breads are different carbs. Another thought is are you weighing out your yoghurt? Again your carb amount could be out if your just putting some in a bowl and guessing the amount. For instance a quick look on google 100g of greek yoghurt is 3g of carbs. But then honey greek yoghurt is 14g of carbs for 100grams. Ive been type one since I was 14 so 12 year, I weigh out every meal because that's the only real way you can be 100% on the carb content.
That's easy, the bread is pre-sliced and the slices are uniformly sized, 15g carbs according to the packaging. The yogurts are 100g single pot portions, 5.5g carbs (Tesco greek yogurt). 21.5g total and zero carb for the eggs.

My carb ratios change throughout the day, 1:9 for breakfast 1:9.5 for lunch 1:10 for evening meal. Today im 99% in range so once you get them carb ratios Dailed in you should be fine. Have you sat down with your DSN & worked out any ratios as a starting guide?

Also, make sure to take your breakfast insulin at least 20 minutes before you eat as most of us are insulin resistant at that time. If I take mine 5/10 minutes before eating I will spike
They put me on 0.5:10 initially to see if it was sufficient (in case I was still producing my own insulin presumably), it wasn't so we went to 1:10 and it is usually there or thereabouts. I already take insulin 15-20 mins before eating.

So after the 8.9 at around 12pm, I took 10 units. I then waited until around 12.50pm before eating 50g carbs. The 10 units should have covered the 50g and got me well under the 8.9 as well.

3pm I tested again, now it's gone up to 10.3.

So as you can see, I have a problem. Insulin resistance?
 

In Response

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A few thoughts
- could the rise you see in the morning have little to do with what you eat but more to do with "Foot on the Floor" (your liver dumping glucose when it notices you getting up in the morning? Some people find they just have to give themselves a "correction bolus" to countreract this
- have you tried a carb free breakfast to see what the affect is?
- have you tried pre-bolusing earlier for breakfast. Many of us are more insulin resistant first thing in the morning.
- you are relatively new to Type 1. Some of the inconsistencies could be due to the honeymoon period. For me, I found my insulin requirements rose very slowly over the first 8 years of my diagnosis so I assumed my honeymoon period lasted this long - it is certainly longer when diagnosed later in life. My honeymoon period was pretty straightforward but some find their pancreas occasionally splutters into life for a while and then goes back to sleep again. This makes working out insulin doses even more of an art than usual
- when do you take your basal? Are you seeing your basal run out before your next dose?

Sorry, nothing concrete there but a few ideas that could be worth investigating (if you haven't already)
 
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Maco

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278
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So the only thing I can suggest from your reply is to ask for your basal insulin to be changed, Maybe something like novomix that can be given twice a day. I used to take it on a morning then before bed, basically every 12hrs. Your basal could need to be lower for throughout the evening & higher for a daytime. Im on a pump these days which automatically does my basal insulin based on my needs. Im a bit at a loss to be honest, even with a basal that needs adjusting taking 10units of insulin for 21grams of carbs should surely see you drop.

I wouldn't really worry about trying to correct a reading of 8.9 either. Im quite baffled by what your saying to be honest, if your 1:10 and ate 50grams of carbs taking 10 units realistically you should of seen your readings drop well below 4.0. Im guessing your correction ratio is around 1:2 or 1:3?


One other thing that could sound really really stupid, your insulin isn't out of date is it?
 
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Maco

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@In Response, Not sure if you agree but if Dave is taking his long acting once a day could it possibly be running out? Maybe a twice a day long acting insulin could help with different doses if he is running low on a night?
 
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Dave P

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Messages
100
Type of diabetes
Type 1
Treatment type
Insulin
A few thoughts
- could the rise you see in the morning have little to do with what you eat but more to do with "Foot on the Floor" (your liver dumping glucose when it notices you getting up in the morning? Some people find they just have to give themselves a "correction bolus" to countreract this
- have you tried a carb free breakfast to see what the affect is?
- have you tried pre-bolusing earlier for breakfast. Many of us are more insulin resistant first thing in the morning.
- you are relatively new to Type 1. Some of the inconsistencies could be due to the honeymoon period. For me, I found my insulin requirements rose very slowly over the first 8 years of my diagnosis so I assumed my honeymoon period lasted this long - it is certainly longer when diagnosed later in life. My honeymoon period was pretty straightforward but some find their pancreas occasionally splutters into life for a while and then goes back to sleep again. This makes working out insulin doses even more of an art than usual
- when do you take your basal? Are you seeing your basal run out before your next dose?

Sorry, nothing concrete there but a few ideas that could be worth investigating (if you haven't already)

My numbers are almost always good upon waking, the only time they aren't is if I made a miscalculation the previous evening, but this is rare. I already give a correction dose if the numbers are higher than ideal.

Breakfast eating nothing at all, or eating only zero carb, both can result in a rise of up to a few points. Not always though, sometimes there is no change.

I already pre-bolus early, I could do so even earlier I suppose, but it would be difficult for practical reasons and I doubt it would be a magical bullet. See a previous post above where I took 10u this afternoon 50 minutes before eating, and it still wasn't enough to prevent a rise.

I'm taking the basal before bed. I have no way of knowing when it runs out exactly, but I should be able to assume it is still very much working in the morning, and indeed I know it is because when I have tried increasing it, it results in consistent lows in the morning, and I also found myself regularly dropping steadily through the day if I didn't eat anything regularly.
 

Maco

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278
Type of diabetes
Type 1
Breakfast eating nothing at all, or eating only zero carb, both can result in a rise of up to a few points. Not always though, sometimes there is no change.

This to me seems like a basal issue, If your raise is more than 1.7mmol then your basal rate is too low. If you drop more than 1.7mmol your rate is too high.

https://diatribe.org/beyond-basals-–-part-ii

This link could help.
 

Dave P

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Messages
100
Type of diabetes
Type 1
Treatment type
Insulin
So the only thing I can suggest from your reply is to ask for your basal insulin to be changed, Maybe something like novomix that can be given twice a day. I used to take it on a morning then before bed, basically every 12hrs. Your basal could need to be lower for throughout the evening & higher for a daytime. Im on a pump these days which automatically does my basal insulin based on my needs. Im a bit at a loss to be honest, even with a basal that needs adjusting taking 10units of insulin for 21grams of carbs should surely see you drop.

I wouldn't really worry about trying to correct a reading of 8.9 either. Im quite baffled by what your saying to be honest, if your 1:10 and ate 50grams of carbs taking 10 units realistically you should of seen your readings drop well below 4.0. Im guessing your correction ratio is around 1:2 or 1:3?


One other thing that could sound really really stupid, your insulin isn't out of date is it?

I agree with what you're saying about how it should be, which is why I made this thread because all of my understanding about how all this works (or is supposed to work) says that what is happening shouldn't be happening. No the insulin isn't out of date and has been kept in the fridge until started, and afterwards kept at normal room temperature indoors the whole time.

Nor is it (as far as I know or believe it should be) over-use of the same injection sites, or a faulty injection device or meter, or that I am not injecting it properly (not that you said it was, but if we're considering every possibility, they are reasons but I don't think those apply to me).
 

Dave P

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100
Type of diabetes
Type 1
Treatment type
Insulin
This to me seems like a basal issue, If your raise is more than 1.7mmol then your basal rate is too low. If you drop more than 1.7mmol your rate is too high.

https://diatribe.org/beyond-basals-–-part-ii

This link could help.
Hmm, the problem is that while having a higher basal today would have solved or mitigated my high numbers, if I'd had that basal yesterday, it would have been too much because on that occasion either my body made much better use of the insulin I'd injected, and/or who knows if my own pancreas didn't produce some of its own as was suggested earlier.

It's a shame my pancreas doesn't have an 'off' switch so I can just turn it off and prevent it from throwing any spanners in the works I guess.
 

Dave P

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Type of diabetes
Type 1
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Insulin
Another thing is that it is hard to get the diabetes clinic to take issues like this seriously. I mean, they tend to just look to look at the hba1c and declare everything fine. When you try to explain that the 'good' hba1c is masking regular lows and highs and thus all is not well, they just tell you that these are inevitable and occasional lows/highs don't matter. They don't have the time, or possibly inclination either, to sit down with you and do the necessary detective work to figure out a better solution.
 
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Maco

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278
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Type 1
Hmm, the problem is that while having a higher basal today would have solved or mitigated my high numbers, if I'd had that basal yesterday, it would have been too much because on that occasion either my body made much better use of the insulin I'd injected, and/or who knows if my own pancreas didn't produce some of its own as was suggested earlier.

It's a shame my pancreas doesn't have an 'off' switch so I can just turn it off and prevent it from throwing any spanners in the works I guess.

But you took more bolus insulin yesterday which will of lead to the low? Think earlier you said you took 10units where as today you took 6 & went up to 8.9. If you manage to get a correct basal (Long acting) & then have the correct carb ratios for your fast acting you shouldn't see much raise/drop. It was the increased fast acting (bolus) insulin that sent you down to 3.3 yesterday I would imagine.


So if the 6 units you took today where the correct amount & you'd slightly increased that background insulin you probably wouldn't of seen much of a raise. Where as yesterday, if you'd increased the basal but then over dosed your fast acting by taking 10 units you will go low like you have. Make sense? I know your not stupid & you clearly know what your doing, just trying to think of different things.
 

Dave P

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100
Type of diabetes
Type 1
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But you took more bolus insulin yesterday which will of lead to the low? Think earlier you said you took 10units where as today you took 6 & went up to 8.9. If you manage to get a correct basal (Long acting) & then have the correct carb ratios for your fast acting you shouldn't see much raise/drop. It was the increased fast acting (bolus) insulin that sent you down to 3.3 yesterday I would imagine.


So if the 6 units you took today where the correct amount & you'd slightly increased that background insulin you probably wouldn't of seen much of a raise. Where as yesterday, if you'd increased the basal but then over dosed your fast acting by taking 10 units you will go low like you have. Make sense? I know your not stupid & you clearly know what your doing, just trying to think of different things.

Indeed if I had been on a higher basal yesterday then I would have needed less bolus, yes. On that occasion, the rapid insulin did actually work rapidly, but normally in the morning it isn't so effective - if only it was. If it was always consistently that good, I could fix this in no time. Just trial and error a few different ratios until I hit on the correct one, and that would be it.

I don't know if you or anyone else is better at the maths of all this than me, and can reverse engineer these numbers to see what is going on.

Yesterday morning 7.2, ate 21g, 10u, at noon 3.3. Drop of 3.9.

This morning 5.5, ate 21g, 6u, at noon 8.9. Rise of 3.4.

As far as taking 12 hour basal twice a day instead and taking a higher dose in the morning, would there be any practical difference between doing that, and simply using a higher ratio / adding a few units as applicable, to the breakfast bolus? ie. as I have already been doing? And which usually works. ie. if I'd taken my usual 10u this morning, on this occasion it likely would have done the trick.
 

Maco

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278
Type of diabetes
Type 1
@Dave P, you need a phone call with your dsn. A higher basal doesn't affect how much bolus you take, you only bolus for carbs you eat. So taking a higher basal wont mean you lower your bolus insulin.

As for the numbers, You where 7.2. You needed no corrective insulin at all just insulin to cover carbs so realistically you should of only took 2units. You say you took 10 units which give you the Hypo.

This morning 5.5, took 6 units with a 3.4 raise. That raise could purely be down to not enough background basal insulin, if it had only gone up 1.7mmol then your insulin amounts where pretty much correct. What I would say is it doesnt seem like your 1:10 at all.

As for two 12 hr basal, yes it would massively make a difference. Like said earlier you can't get round an incorrect basal by just adding more bolus it doesnt work like that. Your body may need more basal for the first 12hrs than it does for the last 12, you cant counter this by injecting more bolus.


Honestly from what you've been saying I think your struggling to understand how your basal & bolus insulin work so id have a chat with a dsn