Help with insulin/carb ratio

[smidge]

Hi Sam!

I agree with the advice the guys are giving on splitting your basal dose. I use Levemir and split it twelve hours apart (6.60am and pm) in about a 60% morning and 40% evening split. If I take it all at night I hypo overnight, if I take it all in the morning I hypo around lunchtime. I also find that it doesn't last anywhere near 24 hours - probably about 14 to 16 hours at best for me, so I have to have the two shots.

I don't know how you're dealing with low-carb or no-carb meals, but I find I do have to take a small shot of bolus for those meals. e.g. I take about 1.5 units apidra for bacon and eggs even though there's no carb in it. I noticed you're on about 70g carb a day. I eat about 50g carb, so quite similar.

Take care

Smidge

 

[Paulasensio]

I agree with Dillinger - they are the golden rules - just one comment though.

Dillinger says "I would suggest that you address the short acting insulin first; your blood sugars are high but that seems related to the carbs/insulin ratio you are on; whilst high these readings are pretty steady." If readings are steady but high this suggests to me the bolus ratio is correct as it is steady - you are just working a few levels higher than you should be. So to me this suggests that the basal dose needs looking at first. Your basal dose is definitely too low in my opinion. To me the high morning readings (when you have had no carbs for 8 or 9 hours) are a clear sign of this.

Look forward to seeing how this one pans out as you keep increasing by a couple of units. Sort your basal dose first please.

 

[samantha13]

Thank you Paula. Will split and increase my basal and keep testing and posting. Can't stress enough how much you are all helping. Thank you so much xx


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[donnellysdogs]

Yep agree with Paula and iHs... Basal first. You need to go to bed at a reasoable level, wake up reasonable and then sort the bolus factors out. This will then give you a chance to say go without breakfast, delay eating till midday and see hiw your basal rates stay.. And then change carb ratios as necessary for breakfast times etc.

Basal has to be right first, as you should not have to eat at set times and set meals everyday... You need some flexibilty to stay happy with your new living... And getting basals right first, I believe, is right.

 

[iHs]

Hi

Tonight use Dillinger's 1u to 3g carb ratio for your evening meal and if your bg levels are above 7mmol factor in a correction dose based on what Dillinger has said. So if your bg level is 9mmol or above correct back to 7mmol and then eat about 30g carb as that is a good carb level to work out ratios on. Try to keep your meal consisting of some potatoe or pasta, witth some meat and vegetables. So a bg level of 9mmol and eating 30g carb would mean that you use 1u as the correction and 10u for the meal = 11u. Then start testing your bg levels 2.5hrs after eating, then 3hrs, 4hrs etc. Hopefully your bg level will be a bit lower when you go to bed and then you can start to see what the basal does overnight.........

 

[Dillinger]

OK - I'm out voted!

Go for the basal first; the only thing is (and this is something I'm having trouble with at the moment - hence my interest in this whole discussion) that blood sugars can go up (without you eating) between about 4:00 am and 7:00 am and it's almost impossible to get the bolus to deal with that - if you increase it you risk a hypo in the early hours of the night. The suggestion is that the bed to breakfast levels are not flat - and so the level release Levemir doesn't quite match them.

That's all I was thinking; but the important thing is to make a change; and carefully follow what happens.

On the Levemir front I take 11 units in the morning and 8.5 at night so I'm not on a strict 50/50 split - it's just probably easier to start at 50/50 to see what happens. By the way I think that it will take a few days for the changed dose of Levemir to 'bed in' so unless you are hypoing don't make too many corrections to it within the first 2-3 days.

Best

Dillinger

 

[robert72]

Hi Samantha

I'm not sure we can say anything about the night readings without a smooth run in from the preceding evening.

I agree with iHs about reducing your evening carbs as there is less room for error but not sure about increasing evening bolus to 1u : 3g as you hypo'd on 1u : 5g yesterday

I think you did quite well yesterday apart from the hypo and a slight overcorrection for it. Can't advise about Levemir split as I have never used it.

 

[iHs]

Hi

Have just looked at the msg that Robert refers to and can see that you went a bit low after eating your evening meal.

So hope you havent injected your eve meal bolus yet as you probably need to use 1u for 6g carb and only use the 1u for 3g carb in the morning at breakfast time and at lunch. Also, try to remember to not 'over correct' your high or low bg levels, use a correction factor to work out the correction dose..for high levels and work on 10g carb will raise a low bg level up by about 2mmol.

 

[cezzle]

Haven't read all the replies but my daughter has to have her Levemir split morning and night. She has 6 units at night and 4.5 in the morning so it's not an even split. She's 7. Levemir is well known for not lasting the whole 24 hours.

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[noblehead]

The first thing they tell you on DAFNE is to start with your basal insulin

 

[candiloo]

hi - it depends on lots of factors, but you really need a course where they can work out the correct calculationfor you to use. It really is worth it if you can get on it. It helps you understand what affects your bg. Also found I have to exercise on the days when I don't go to work, as I have an active job and that affects it on days off.

 

[snufflebabe]

Hi there, i personally would leave your basal alone for now, and increase your carb to insulin ratio from 2:1 to 2.5:1, remember though if ypur testing 2 hours after food its normal to have a higher reading, it should be 2-3 mmols higher than the pre meal reading. Also remember Fast acting insulin stays in the body for around 4 hours, so if your testing say 5 hours after food, than its more than likely to be your basal. Write it all down, and leave for 3 days after any adjustments.

 

[samantha13]

Just an update peeps. In the past week I have lost 3lb. Almost halved my carb intake and therefor insulin bolus'. My fasting bs is now around 6/7 and I havnt had a reading over 10! This is massive for me. All your advice has helped sooo much. A few more tweaks and I'll be well on the way to good control. Am feeling so much better and a lot less stressed and it's all down to you guys so a big big thank you!! Xx


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[donnellysdogs]

Wow, great results from a great effort!!! Well done!!! Hope you dont mind the weighloss- that loss is brilliant!!

 

[JontyW]

Just an update peeps. In the past week I have lost 3lb. Almost halved my carb intake and therefor insulin bolus'. My fasting bs is now around 6/7 and I havnt had a reading over 10! This is massive for me. All your advice has helped sooo much. A few more tweaks and I'll be well on the way to good control. Am feeling so much better and a lot less stressed and it's all down to you guys so a big big thank you!! Xx
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Hi Samantha,

I have been following this thread with interest, since although I've managed my Type 1 well for 43 years with no complications, only in the last 8 months did I find this excellent site and learned all about basal testing by fasting, carb counting, insulin-carb ratios, ratios varying for each meal throughout the day, knowing my accurate correction factor etc, etc

A few comments ....
1) Even though you can't get on a DAFNE course, this ebook from Diabetes UK gives all you need to know about carb counting and calculating ratios .... https://shop.diabetes.org.uk/usr/downlo ... educed.pdf. (See Chapters 3 and 4)
2) You have done really well so far .. well done
But please can you share with us a summary of the carbs, doses and factors you were on BEFORE and also AFTER you started all these changes ....

So what were/are these for a TYPICAL DAY? We all need to know all this data/factors in order to manage your diabetes successfully.

1. BG on waking
2. Levemir dose (am and pm)
3. Breakfast carbs, ratio used and hence bolus. Typical BG after 4-5 hours?
4. Lunch carbs, ratio used and hence bolus. Typical BG after 4-5 hours?
5. Dinner carbs, ratio used and hence bolus. Typical BG after 4-5 hours?
6a. How many correction doses needed? 6b. How many snacks needed?
- in an ideal well controlled diabetic on basal/bolus, neither should be needed ...
7. How many hypos during night and day?
8. What is your Correction Factor (e.g. 1u bolus reduces BG by 3 mmol/l)?
- for me 1u reduces BG by 1 mmol/l
9. How much does BG increase for 10g CHO?
- for me 10g CHO increases it by 1.4 mmol/l. So for a 4.0 BG I'll have x3 Jelly Babies (6g ea) -> 4.0 + (1.8 x 1.4) -> 6.5 (and so doesn't overshoot!)
10. Last question ... where do you record all the data so it can easily be reviewed?

- I use a detailed Excel spreadsheet that I have developed myself, and use conditional formatting so the cells change colour depending on the value. So each BG column uses a traffic light system (green - in target, amber - just out, and red OUT of target).
- in addition I have graphs to show the trends, so I can easily spot what is going off course. But, like everyone else, I still get a few random high or low readings that I can't account for .... so don't change anything .. and see if it is repeatable :-(

This has been a really interesting thread and just shows the power of such forums where fellow diabetics, who have gained much detailed knowledge from this forum and their own experience of managing their condition, assisting you so ably to achieve better control. To me there seems to be many more T1s on this forum who are struggling for better control, and using an interactive session such as this where you have supplied daily updates on carbs, insulin and resulting BGs is ...... REALLY POWERFUL.

Jonty

 

[chrissyp]

what does basal and bolus mean please ???my nurses use these terms but I don`t know (and have never asked ) what they mean ???

 

[chrissyp]

having re-read this thread I could weep ! I am not controlling my diabetes through knowledge - I am not a fool but this thread may as well be written in Urdu for me ! HELP.

Type 1
Levemir was 16ml now up to 20 ml
Victoza 1.2 mg

 

[mo1905]

Basal is the background insulin that normally last around 12 hrs or so. Most people take it before bed and waking. The bolus is the fast acting insulin that you take with meals. Depending how many carbs you have determines the amount if insulin you take. Don't be overly concerned with all the complicated terms and words, eventually you'll pick them up. Just don't panic. Ask any more questions you're unsure of and we'll try to help ;-)


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