Differing insulin ratios, is it a real thing?

[Emmotha]

Hi.
I've been diagnosed 7 months and coming to the end of my honeymoon period. I've noticed something and wondered if it's normal.

My blood sugars are scarily inline with UK tax brackets with carbs as pounds and insulin as tax. Up to 10g I need no bolus, up to 40g my ratio is 1:20, then above 40 my bolus ratio changes again maybe 1:15.

Is this normal or is it a honeymoon thing?

 

[noblehead]

Could well be that your still in your Honeymoon Period, I need to inject for 10g of carbs and my average IC ratio is 1:10, but insulin needs vary from person to person so there's really is no template,

 

[DonnaC-T]

My ratios vary by time of day but also like yourself the more carbs I have the less predictable the outcome. I thought it was maybe that there's more margin for error? Or that because I low carb, the carbs I do have effect me more? X

 

[Diamattic]

I think I'm the same, I just lowered my basal from 13 down to 10 over this past week, and use a 1:20 ratio. Although I've never thought if adjusting ratio for a very high intake.

I have heard of honeymoons being weeks, months or some people claim to be on honeymoon years after diagnosis.

No real sense in trying to figure it out though eh? It doesn't actually matter does it?

 

[himtoo]

Hi.
I've been diagnosed 7 months and coming to the end of my honeymoon period. I've noticed something and wondered if it's normal.

My blood sugars are scarily inline with UK tax brackets with carbs as pounds and insulin as tax. Up to 10g I need no bolus, up to 40g my ratio is 1:20, then above 40 my bolus ratio changes again maybe 1:15.

Is this normal or is it a honeymoon thing?

Hi @Emmotha
varying insulin to carb ratios are definitely real
going on a DAFNE course will teach you about this
my morning rate is 2.4u per 10CHO , lunchtime is 2.5u and evening meal 2.1u

and yes a lot bigger meal say an Indian for example the additional fat and carbs would make me tweak my dose higher back to 2.5u at an evening meal -- i would also split the dose to allow for the slower absorbing of the meal because of the high fat

 

[smidge]

I think sometimes when we think we have different ratios depending on the time of day, it is actually dependent on the amount of basal still active and when its peak is. For me, Levemir has a fairly pronounced peak (and Insuman even more so) so if I eat around the time of the basal peak, I need less bolus whereas if I et when the basal is weak and almost worn off I need more bolus. I can see how people would think this is my ratios changing at different times of the day, but I don't think it's quite that straightforward - or maybe that's just me.

Also, a carb:bolus ratio isn't really that meaningful for a low-carber. I sort of use a bit of a ratio as a basis, but I have to add a bit on for the protein - in the end, the amount of bolus I use is largely dependent on the size of my meal rather than the specifics of what I'm eating. Carb:bolus ratios only really work if your meal is made up mainly of carbs.

Smidge

 

[tim2000s]

@smidge, I tend to agree. While I've spent plenty of time working out ratios, when eating mostly protein, that changes and you have to adjust both timing and insulin amounts. All adds up to a fun new set of stuff to learn.

I like your theory on bolus and basal though. Makes a lot of sense.

 

[himtoo]

I think sometimes when we think we have different ratios depending on the time of day, it is actually dependent on the amount of basal still active and when its peak is. For me, Levemir has a fairly pronounced peak (and Insuman even more so) so if I eat around the time of the basal peak, I need less bolus whereas if I et when the basal is weak and almost worn off I need more bolus. I can see how people would think this is my ratios changing at different times of the day, but I don't think it's quite that straightforward - or maybe that's just me.

Also, a carb:bolus ratio isn't really that meaningful for a low-carber. I sort of use a bit of a ratio as a basis, but I have to add a bit on for the protein - in the end, the amount of bolus I use is largely dependent on the size of my meal rather than the specifics of what I'm eating. Carb:bolus ratios only really work if your meal is made up mainly of carbs.

Smidge

it is an interesting observation @smidge .
I have been taking lantus for 18 years and it has an almost flat profile.
i take it once a day at tea time (6pm)
theoretically speaking weak and strong times will fall at more or less the same times each day yet my morning needs are always greater than evening when the lantus should be dropping off.

in addition as you are eating a very low carb diet. you are right to say that ratios will have less of an impact.

i am not an ultra low carber but sit in the middle -- aiming for 90-130 carbs per day.
as an additional note i have to bolus a small amount for a no carb meal as well

 

[Emmotha]

Maybe that's where I've been going wrong. I've been shovelling in the carbs over Christmas and my ratio just wasn't enough. Low carb must have a different effect.

Back to low carb tomorrow thank goodness! Not sure how anyone manages BG on carb heavy diets

 

[tim2000s]

@himtoo I haven't found a peak with lantus but have noticed that at the end of the day it stops working, which is why I split my dose. It seems to maintain a similar bolus ratio by doing this.

@Emmotha Did you increase your basal over Christmas? When you are increasing carbs and bolus, you need to roughly maintain the 50% split of total daily dosage between basal and bolus.

 

[ukocyigit]

I think it's not honeymoon period. My ratio is 1:23

 

[Emmotha]

@himtoo I haven't found a peak with lantus but have noticed that at the end of the day it stops working, which is why I split my dose. It seems to maintain a similar bolus ratio by doing this.

@Emmotha Did you increase your basal over Christmas? When you are increasing carbs and bolus, you need to roughly maintain the 50% split of total daily dosage between basal and bolus.

Nope I didn't, unfortunately didn't spot any posts about that. Still at least I know for next time

 

[AndyS]

I have found that my ratios change depending on time of day.

Morning 1.5UI:10g CHO
Afternoon is 1:10
Evening is 2:10

If I have a really late snack (after evening basal shot) then it can be anything between 1 and 1.5

/A

 

[mrman]

yeah, have different ratios through the day. I'm pumping so have minimum change in levels due to different basal rates over a 24 hr period. I need more bolus breakfast because I've been sleeping through the night so no activity to account for. During a standard day lunchtime I need less bolus which is adjusted down further due to any extra activity or adjusted slightly up if having a larger meal than a standard day. Evening bolus is in between my breakfast and lunchtime ratio and again decrease for any extra activity, increase if having a larger meal than normal.

 

[mrman]

forgot to add that if I've gone a longer time than usual without eating, such as basal testing/missing a meal or just behind schedule I need a bit extra bolus also.

 

[BethAliceC]

I think most of us inject for 10g. But it can be different for each person

 

[himtoo]

I think most of us inject for 10g. But it can be different for each person

it definitely can -- and ratios need to be reviewed as well by basal testing as a start

 

[himtoo]

yeah, have different ratios through the day. I'm pumping so have minimum change in levels due to different basal rates over a 24 hr period. I need more bolus breakfast because I've been sleeping through the night so no activity to account for. During a standard day lunchtime I need less bolus which is adjusted down further due to any extra activity or adjusted slightly up if having a larger meal than a standard day. Evening bolus is in between my breakfast and lunchtime ratio and again decrease for any extra activity, increase if having a larger meal than normal.

thanks for that @brett -- your answer defines the basal / bolus definition -- if basal is set correctly and foods react with different BG levels at different times of the day that is where I:C ratios come into play.

 

[iHs]

it definitely can -- and ratios need to be reviewed as well by basal testing as a start

Yea....spot on

 

[Spiker]

A number of people here reporting that they have to increase their I:C ratios for meals with lots of carbs, to me suggests that in a lot of cases the use of different I:C ratios during the day is covering up for just having the basal rates wrong. I'm with @smidge on this. Those of you who use different I:C ratios, are you sure that you have your basal rates flat, and you aren't just compensating for basal fluctuations?