Little bit depressed

[Spiker]

It's tricky to 'tune' these 3 values - basal dose(s), carb ratio, correction ratio. The best procedure is to have a day of fasting to verify that the basal dose is correct, with testing every 2-4 hours while you are awake.

Once you know that that basal rate is correct, it's then easy to verify the correction ratio and carb ratio by a few simple tests. For the correction ratio wait until you have a high reading, take some insulin, see how much it reduces your blood sugar by after 4 hours. For the carb ratio, sort of the reverse, start at a normal blood sugar, eat some carbs with a known value of grams of carbohydrate (gch), check your blood sugar 4 hrs later. Obviously don't eat during either of these tests, apart from the 'known' carbs.

There are lots of inaccuracies in the process because of the smallish BG numbers involved, the accuracy limits of meters, probably smallish insulin doses. BG over 10 is hard to get an accurate ratio from because of kidney dumping effects and increased insulin resistance. So you really only have a short range to play with, between 4-5 mmol/L and 9-10 mmol/L, to do both the carb ratio tests and correction tests accurately.

Nonetheless once you come up with a new set of ratios you can stick with them and keep doing the same tests from time to time to see if they still fit your data (carbs, insulin, BG).

Over time, basal rate and correction dose will vary with insulin resistance and body weight, carb ratio will vary with insulin resistance but not with body weight (except in so far as overweight can increase insulin resistance). Regular exercise is one of the main factors affecting insulin resistance, apart from overweight.

 

[Travelling enthusiast]

I never knew anything about these ratios. Seems quiet tough. A full day without food each time I do the test.
Do you mind me asking what your insulin usage is like?
How often do you repeat these tests?
Thank you for all the details, really appreciate it, just need to plan a day to do it.


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[Spiker]

You might do this basal test once a year, unless you started getting consistently unexpected blood sugar readings. The other tests (ratios) can be done just by not eating for 4 hours, so they are easy.

At the moment my basal rate is 22u/day, my carb ratio is 1u:8gch, my correction ratio is 1u:1.5 mmol.

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[Spiker]

The starting point proposed by DAFNE for these ratios is 1u:10gch carb ratio and 1u:2-3 mmol correction ratio. These are deliberately cautious and set as a starting point. The idea is to change them if you find they don't bring you to your target blood sugar 4 hours after food, or a correction dose.

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[Travelling enthusiast]

You might do this basal test once a year, unless you started getting consistently unexpected blood sugar readings. The other tests (ratios) can be done just by not eating for 4 hours, so they are easy.

At the moment my basal rate is 22u/day, my carb ratio is 1u:8gch, my correction ratio is 1u:1.5 mmol.

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Ok, so my current basal rate is 20 units, my carb ratio is 1u:5gch and my correction ratio is 1u:2mmol
So how much do you think my basal rate should be? Sorry about all the questions, I've had this 21 years this August and no doctor has even mentioned this to me, fecken ridiculous. So I really want to try and get it right, be great if I could help my overall control. Hopefully I haven't left it too late.

 

[Spiker]

Well pretty much the same here, no one taught me this stuff in nearly 20 years until I went to DAFNE, though I picked some of it up from Dr Bernstein's book and trial and error.

I wouldn't want to guess what your basal rate would be but the thing to do is start at your current dose and wwatch your BG run during the day and see if it goes up or down. As you know what your correction dose is, use that to adjust your basal. So if you go up by 8 mmol/L in 24 hours (or 4 mmol/L in 12 hours) then you would want to increase basal by 8u / (correction ratio of 2u/mmol) = 4u. Or if you go down, reduce it in a similar fashion.

 

[lizdeluz]

Hope you don't mind me butting in, I just want to say that this information about ratios is something I've basically missed, never learned, since diagnosis 29 years ago. Though I've attended 3 Dafne courses, unfortunately I didn't acquire the confidence to make my own adjustments to my insulin, apart from reacting wildly to high blood sugar readings. So all these posts have been really useful, many thanks!

 

[Travelling enthusiast]

Well pretty much the same here, no one taught me this stuff in nearly 20 years until I went to DAFNE, though I picked some of it up from Dr Bernstein's book and trial and error.

I wouldn't want to guess what your basal rate would be but the thing to do is start at your current dose and wwatch your BG run during the day and see if it goes up or down. As you know what your correction dose is, use that to adjust your basal. So if you go up by 8 mmol/L in 24 hours (or 4 mmol/L in 12 hours) then you would want to increase basal by 8u / (correction ratio of 2u/mmol) = 4u. Or if you go down, reduce it in a similar fashion.

Hi Spiker, can I ask another question please?
Is it possible to do the Basal test, but instead of not eating, just eat protein, maybe eggs for breakfast and chicken breast for lunch and fish got dinner, nothing else just meat and eggs, or does it have to be NO FOOD? I love my food, I'm finding the thoughts of a day without food a bit traumatic lol!
Just out of curiosity, can you let me know the difference it made to your BG control?
Thanks for all the information, it's really great.



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[Travelling enthusiast]

Hope you don't mind me butting in, I just want to say that this information about ratios is something I've basically missed, never learned, since diagnosis 29 years ago. Though I've attended 3 Dafne courses, unfortunately I didn't acquire the confidence to make my own adjustments to my insulin, apart from reacting wildly to high blood sugar readings. So all these posts have been really useful, many thanks!

More than welcome to the conversation. It's great to be getting advice now. I asked my GP Feb to go to a DAFNE course and she said she saw no point in me going and wouldn't recommend it for me. Do I need a GP referral?



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[lizdeluz]

I'm not sure, Travelling enthusiast. At some point it was decided, on my behalf, that I attend the diabetes clinic at the hospital, rather than the GP clinic, and I go to the hospital clinic about every 6 months or 4 months if they think I'm doing badly. So I don't really see my GP about my diabetes. I always get the impression that the GP practice is on the back foot in terms of their expertise with diabetes patients, but I'm probably being unfair, and anyway I expect it depends on regional differences in the way things are managed.

If you haven't been on a DAFNE course, then you need to go on one, especially since you are wanting to learn to manage your ratios as you said above. I know I didn't make enough use of the three (!) DAFNE courses I went on, but that wasn't because I was a bad student! I did lack confidence, and I literally didn't understand how to work it out. I feel silly about that now, but I wonder if I would do any better now - I've got a feeling I wouldn't. I needed one-on-one instruction and of course that wasn't feasible. There were quite a lot of 'students' in the class and our situations were all so different.

I'm doing better by picking up information from contributors to the forum. At least I can discuss my results more intelligently with the consultant and the diabetes nurses when I see them shortly!

So I don't know whether you need a GP referral where you are, but you can probably persuade your GP to refer you for a DAFNE course. I can't understand why she thinks there's no point! Ask around. We diabetics aren't thin on the ground!

 

[Travelling enthusiast]

I'm not sure, Travelling enthusiast. At some point it was decided, on my behalf, that I attend the diabetes clinic at the hospital, rather than the GP clinic, and I go to the hospital clinic about every 6 months or 4 months if they think I'm doing badly. So I don't really see my GP about my diabetes. I always get the impression that the GP practice is on the back foot in terms of their expertise with diabetes patients, but I'm probably being unfair, and anyway I expect it depends on regional differences in the way things are managed.

If you haven't been on a DAFNE course, then you need to go on one, especially since you are wanting to learn to manage your ratios as you said above. I know I didn't make enough use of the three (!) DAFNE courses I went on, but that wasn't because I was a bad student! I did lack confidence, and I literally didn't understand how to work it out. I feel silly about that now, but I wonder if I would do any better now - I've got a feeling I wouldn't. I needed one-on-one instruction and of course that wasn't feasible. There were quite a lot of 'students' in the class and our situations were all so different.

I'm doing better by picking up information from contributors to the forum. At least I can discuss my results more intelligently with the consultant and the diabetes nurses when I see them shortly!

So I don't know whether you need a GP referral where you are, but you can probably persuade your GP to refer you for a DAFNE course. I can't understand why she thinks there's no point! Ask around. We diabetics aren't thin on the ground!

I agree, I think GP's are great, but mine won't discuss options really, I asked about a pump, was told no, I asked about new types of insulin, I was told no. To be honest I've never got great care from GP's. My HbA1c went from 46 to 52 and she told me that it was fine and that the test isn't reliable and that I was fine. That's when she told me not to worry about DAFNE. Maybe I should push a little harder, in my mind I went from 6.4 to 6.9 and that's not good, it was a year apart, I was doing more exercise then, so I've started walking again, so hopefully that will make a difference.
Thanks for the information, hopefully if I go with a load of facts my GP May get irritated and refer me just so she doesn't have to deal with me

 

[Spiker]

Hi Spiker, can I ask another question please?
Is it possible to do the Basal test, but instead of not eating, just eat protein, maybe eggs for breakfast and chicken breast for lunch and fish got dinner, nothing else just meat and eggs, or does it have to be NO FOOD? I love my food, I'm finding the thoughts of a day without food a bit traumatic lol!
Just out of curiosity, can you let me know the difference it made to your BG control?
Thanks for all the information, it's really great.



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Good idea but, no, not really. If you skip carbs and just eat protein, some of the protein, effectively a random amount, is likely to be converted into carbs.

I guess doing a basal test this way would be better than not doing one at all. It would be approximately right.

 

[Spiker]

I agree, I think GP's are great, but mine won't discuss options really, I asked about a pump, was told no, I asked about new types of insulin, I was told no. To be honest I've never got great care from GP's. My HbA1c went from 46 to 52 and she told me that it was fine and that the test isn't reliable and that I was fine. That's when she told me not to worry about DAFNE. Maybe I should push a little harder, in my mind I went from 6.4 to 6.9 and that's not good, it was a year apart, I was doing more exercise then, so I've started walking again, so hopefully that will make a difference.
Thanks for the information, hopefully if I go with a load of facts my GP May get irritated and refer me just so she doesn't have to deal with me

As a T1D you should be entitled to be referred to be managed directly by a hospital based specialist diabetic unit. The GP will continue to do you an HB1ac and other tests annually, but all the 'clever' stuff will be handled by the hospital clinic. This is true even if you live in the middle of nowhere and would have to travel a long way to the nearest specialist unit. I would ask for that referral, at least until you are happy with your treatment again. At that point you could go back to the GP if you wanted.