Double Digits! Good or Evil!? >;)

Andy_D85

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So a really interesting (to me anyway!) discussion popped up on another thread and I was beginning to feel like I was highjacking it by asking so thought I'd start my own!

The other thread asked 'what's the biggest does of <bolus> insulin you've injected to cover 1 meal?' and the subject that's come up is:

Double digits: Good or Bad?

There just seems to be a MASSIVE fear/reluctance/negativity towards doses of bolus (novorapid, homolog, whatever it is you bolus with) that reach into double digits for some reason and I'm curious as to
  • a) how far does that opinion stretch in this particular type-1 community
  • b) WHY does that opinion/fear/reluctance/negativity as such exist?

Did it come from NICE guidelines? Did a doctor/nurse tell you? Was it google?

I've never once been informed of a single medical reason why I should avoid a double-digit dose of bolus - sure I've been advised some of the foods I eat are not great from a NON-diabetic point of view, but so long as I test beforehand, carb-count accurately, and account for any bolus-on-board then when I'm testing, my levels stay as they do with a single figure dose, and I've never been informed I should avoid foods/portions that result in double digit doses by any diabetic specialist I've spoken to.

I suppose the logic for me is this: If i trust carb counting to work and do me no harm in single unit doses - then *I* HAVE to logically, trust it will do the same for a double-digit dose.- I'm not saying YOU do, but that's how my wee head is wired up.

There don't seem to be many who share my opinion though, and I would like to find out why that is! =)

P.S - just so we are very clear, I'm not suggesting folk who avoid foods that would result in double digit doses start eating them, nor am I having a go at the people who hold these views, I'd just like to get to the bottom of why they exist in the first place? Maybe I missed a leaflet and have been doing myself more harm than good over the years ON TOP of all my ignorance of testing/accurate counting etc.

Thanks dudes & dudettes - can't wait to hear everyones views! =)
 
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donnellysdogs

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Its never bothered me at all. I don't think about it...

Just let pump work anddo its thing.

I think my attitude is because years ago we didn't have internet and I dodn't know any other T1's,so my dose of insulin was private to me. My consultants have never menetioned dosage either.

I know if I eat more carbs On a consistent basis- say on holiday or staying with friends etc...I will have to double up my background insulin so that my bolus/basal % regime doesn't go out of kilter... My thoughts thenare just that carbs ceate need for more insulin but ceetainly never worry about how muchis needed.
 
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tim2000s

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For me it stems from unpredictability. As I've got older, I've found that the impact of a large dose in one shot is immensely variable and has been subject to interesting timing issues. Since undertaking my get fit plan which has also had the impact of massively increasing my insulin sensitivity (early morning corrections used to be 1u for 3mmol, now 1u drops me 5.5mmol at that time of day), I don't need the same level of insulin.

I also try to eat carbs that are lower GI as they work better with my fitness programme, and these are easier to insulate for with multiple smaller boluses than one larger one.

I guess the main reason I haven't used double digit novorapid shots was simply that I haven't needed to. I insulate based on carb counting and getting into double digits with novorapid is a lot of quick acting carbs (>100g) in a single feed.
 
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HelenLouise

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I went onto a pump in October last year and whilst getting it my nurse advised against doing more then 6 units in one go and instead to spread any over 6 over at least 15 minutes she said it was due to sensitivity and may lead to a hypo. I've stuck to her advice and things seem fine this way. I have to say when I enter carbs in my meter and it's suggesting above 6 units I feel a bit sad, maybe guilty to be eating so many carbs! It does happen though... My local fish and chip shop does Gluten free once a month and that is the carbiest meal I ever eat... I feel slightly guilty then just enjoy it!
 

tim2000s

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Isn't it bad that we feel guilty about eating carbs, even when we are treating them appropriately with insulin? :(
 
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Heathenlass

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I can only speak from my own experience and perspective of course...

Some of my points have been stated already , but the only time I have ever needed to bolus large amounts was when in desperation, I followed the NHS advice to eat more carbs and bolus accordingly. Prior to this, I had limited my carbs as that is what I had been used to from diagnosis. I found that larger amounts of carbs and larger boluses lead me into to poor control, weight gain, insulin resistance and a much higher HbA1c .

Very early on , the advice of a HCP was to try and keep my total daily bolus to less than 15 units a day through dietry control, and that had pretty much worked for me . The only reason I changed that for the experiment was because of crashing hypos that started with the prescribing of Lantus, and was pretty much disastrous , for the reasons given above, and I STILL had awful hypos ( It turns out that Lantus did not suit me,)

What I have found in keeping the Carbs and bolus low is that small numbers as @ Smidge has said, leads to better control, both in carbs and bolus with less room for error. My weight has returned to normal and is pretty stable, and insulin resistance caused by high doses has again returned to normal .

For all of my diabetic life apart from that episode, I have low carbed without consciously thinking of it as such,during which my blood levels are good, without frequent hypos. I don't actually feel deprived, as my food choices are my own, and I do like cooking, so it's a case of substitutions that make my carb load and insulin dosages low. I still eat pizza, for example, but not pizza as commonly found, the crust is different and low in carbs .

In another thread some time ago, I remember someone else posting something that I recognised in myself, that I have a resistance that is almost instinctive to actually eating carbohydrate when going low. I realised that was because it was dinned in to me very early on that this is something I need to avoid to remain healthy. Emphasis on the "I" here :D Obviously, I do use carbs to raise my BG, but I am the butt of family anecdotes about being force fed barley sugar to correct a hypo almost through gritted teeth, while my siblings were pinching the stuff out of the bag and scoffing it :rolleyes:

Signy
 
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BigRedSwitch

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Depends on your size more than anything. I'm 6'5", and weigh nearly 18 stone, but have low body fat (mostly muscle), and I need HUGE amounts of insulin - always have.

Biggest bolus ever? Probably about 60 units. Biggest these days is around the 30 mark.

No dramas - I'm just not an average person. :)

p.s. I try to make my food up of protein more than carbs, but even for a 100g bowl of shredders, in the morning you'd be talking 24 units for me.
 
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Stefano

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I don't do low carbs and I change the amount of insulin needed ( sometimes double digits) based on the amount of carbs I need and this works for me. However I guess the point is not how much you inject but how much you eat and how fat it is which can cause a slower absorption. This means that you could have too much insulin for the 1st hours when all carbs are not absorbed and not enough when the remaining carbs get absorbed. Hope it makes sense.
 
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dannyw

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The trouble with large insulin doses is the margin for error. It's extremely difficult to count accurately every carb in a meal as different foods in different combinations can give varied results. Take into account varying ratio's etc and the task of accurately matching correct dose to meal becomes much harder. Because of these issues, the chances of underestimating or overestimating dose is very real. This can lead to a spike or a hypo. The higher the dose, the higher the probability of error.
 
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tim2000s

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I try to make my food up of protein more than carbs, but even for a 100g bowl of shredders, in the morning you'd be talking 24 units for me
Wow! That's a lot of insulin! For the same bowl with milk I used to take 10.
 
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tim2000s

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Yes - and that was only about 9 months ago! But I currently get 1u per 12g of carbs and used to be about 1u to 9g.
 
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BigRedSwitch

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The trouble with large insulin doses is the margin for error. It's extremely difficult to count accurately every carb in a meal as different foods in different combinations can give varied results. Take into account varying ratio's etc and the task of accurately matching correct dose to meal becomes much harder. Because of these issues, the chances of underestimating or overestimating dose is very real. This can lead to a spike or a hypo. The higher the dose, the higher the probability of error.

That's simply not true - the higher the dose, the less margin for error! If you only take half a unit for 10 carbs, say - you have a real hard time adjusting for, say, 12 carbs (0.6 units of insulin!), whereas, if the margin is wider, it's easier! I take 2.7 units for 15 carbs (between 12 and 4pm) for example. 10 carbs is 1.8, 20 carbs is 3.6 - the higher the volume, the more control you have. :)
 
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BigRedSwitch

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Yes - and that was only about 9 months ago! But I currently get 1u per 12g of carbs and used to be about 1u to 9g.

Like I said - my insulin intake is down to my size and structure. Was a competitive swimmer until my late teens, then have been to the gym ever since. I'm gutted at the moment as due to the fact I've just had my operation I can't go to the gym! :p
 

tim2000s

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I think danny was making the point that if you have a low u:high carb ratio, then eating a lot of carbs and taking a bigger dose creates much more margin for error, which is what you are also effectively saying!
 
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BigRedSwitch

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I think danny was making the point that if you have a low u:high carb ratio, then eating a lot of carbs and taking a bigger dose creates much more margin for error, which is what you are also effectively saying!

Ah, OK - my bad. Apologies, @dannyw :)
 
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So a really interesting (to me anyway!) discussion popped up on another thread and I was beginning to feel like I was highjacking it by asking so thought I'd start my own!

The other thread asked 'what's the biggest does of <bolus> insulin you've injected to cover 1 meal?' and the subject that's come up is:

Double digits: Good or Bad?

There just seems to be a MASSIVE fear/reluctance/negativity towards doses of bolus (novorapid, homolog, whatever it is you bolus with) that reach into double digits for some reason and I'm curious as to
  • a) how far does that opinion stretch in this particular type-1 community
  • b) WHY does that opinion/fear/reluctance/negativity as such exist?

Did it come from NICE guidelines? Did a doctor/nurse tell you? Was it google?

I've never once been informed of a single medical reason why I should avoid a double-digit dose of bolus - sure I've been advised some of the foods I eat are not great from a NON-diabetic point of view, but so long as I test beforehand, carb-count accurately, and account for any bolus-on-board then when I'm testing, my levels stay as they do with a single figure dose, and I've never been informed I should avoid foods/portions that result in double digit doses by any diabetic specialist I've spoken to.

I suppose the logic for me is this: If i trust carb counting to work and do me no harm in single unit doses - then *I* HAVE to logically, trust it will do the same for a double-digit dose.- I'm not saying YOU do, but that's how my wee head is wired up.

There don't seem to be many who share my opinion though, and I would like to find out why that is! =)

P.S - just so we are very clear, I'm not suggesting folk who avoid foods that would result in double digit doses start eating them, nor am I having a go at the people who hold these views, I'd just like to get to the bottom of why they exist in the first place? Maybe I missed a leaflet and have been doing myself more harm than good over the years ON TOP of all my ignorance of testing/accurate counting etc.

Thanks dudes & dudettes - can't wait to hear everyones views! =)

I personally prefer single digits, not that often do I go into double digits, unless I am sick, illness, trauma etc as these type of situations seem to affect me badly.
But for me, single = good :happy: double = hmmm, not so good.:stop: :oops:

RRB
 

Flowerpot

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I've evolved from having a strict carbohydrate amount per meal drummed into me back in the 1970's on one injection and have never grown out of controlling carbs in this way despite MDI and a pump giving me the freedom to do what I want. I'm happy with my system and don't deprive myself.

My insulin to carb ratio is 1:20g so I'd have to pack in 200g CHO to reach double figures, my maximum meal bolus is usually about 2.5 units. It's not from fear, reluctance or negativity it's just I never come close to needing that much insulin.
 
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