Blood sugars running far too high

Hi

This is just my thoughts on your problem, others will have others....... although you've been advised to split your basal, have you done any basal testing to determine whether its the correct dose? It might need adjusting a bit more.

Also a carb ratio of 1u to 10g carb will be just 1u whereas a ratio of 1u to 7g carb will give you 1.3u for every 10g carb that you eat. Therefore as your bg levels are going so high, why don't you use the 1:7, test your bg levels frequently and use the results to determine whether you need to adjust the bolus insulin a bit more.

Don't give up.... you will get there eventually...... you've just got to be willing to test bg a lot more and adjust the ratios :wink:

Go to supermarket and buy a few packets of sugarfree jelly as that has no carb in it so can be eaten willy nilly :thumbup: Also, you may be able to eat dark green cabbage leaves chopped up in small pieces and fried in a frying pan with a very tiny bit of oil. When the leaves go towards being brown, the cabbage can be served up to look like Chinese version of 'seaweed' and again is more or less carb free. Jelly and seaweed will help to satisfy your brain that you have eaten something so you shouldn't feel hungry. If you normally drink cups of tea and coffee during the day with milk in them, then include these in your basal dose otherwise if you just drink water or diet coke,then the basal fasting wont be correct.

to do basal testing look at this link viewtopic.php?f=15&t=47174. A safe bg level of 6mmol is what you need to calculate your fasting basal to and also IMO the ideal target to use when figuring out the correct insulin to carb ratio.

If you can buy a copy of the book TLAP by Gary Scheiner, he goes into detail about basal testing and mentions about the 94 rule being used to calculate the correction factor a bit better than the 100 rule as most people in the UK wont really eat 500g carb per day.

At the moment though you need to adjust your ratios to deliver more insulin so that your bg levels will start to get lower. Once they start to get lower, you can then test the effect of just your basal insulin dose without eating carb to see what your background bg levels are and if they are a lot lower than 6mmol, then reduce the basal, if they are higher than 6mmol then increase it by 0.5 to 1.0u at a time and then wait a day or so before testing basal again and go back to eating carb and using the bolus ratio. Usually, adjustment to morning basal, starts to take effect from very late morning/early afternoon so keep on the ball and test bg levels allowing for a rise of 3mmol mid morning/mid afternoon and then hopefully by lunch/eve meal, the bg levels will be back somewhere near 6mmol. If your bg levels are 6mmol or 7mmol mid morning/afternoon, you will need to eat a small amount of carb to lift bg levels up a touch. Usually a 10g carb snack will do but keep testing to monitor the changes.

It does sound complicated but becomes easier when you start doing it. Aim to have a before you eat bg level of 6mmol, then by adjusting the carb ratio, aim to have a mid morning and mid afternoon bg level of 8.5 to 9.0mmol. This should ensure that you wont have to eat a snack if you don't want to and that the insulin will carry on working to lower you a bit more so that your bg level will back at 6mmol or near it, by the time you eat your next meal. Bolus insulin usually has an action time of about 4-5hrs.

a bit difficult to comment on. If you inject the basal twice daily along with the bolus used in the carb ratios, this should give you better more even control than just injecting the basal in one go at night. Lantus used at night is well known for causing overnight low bg levels if the dose is not monitored by doing bg tests about 2-3am. Some diabetics just eat some carb before going to bed and that usually prevents the low but they find that their insulin to carb ratios differ greatly at different times, whereas injecting the basal twice daily, the carb ratios stay somewhere near the same. Tresiba once daily basal insulin is now available and that is said to keep bg levels more stable than Lantus. I like Levemir so would not use Lantus again unless I really had no option but even then I would opt to use one of the older longer acting insulins before using Lantus. Tresiba is fairly expensive at the moment so that is why diabetics are not being offered it.

Its all about balancing up the effect of the bolus with the basal so that bg levels stay within the required target range and don't keep needing to be corrected by eating food to correct a low, or by giving a correction all the time because bg levels go too high.

If you haven't done so do register with BDEC online carb counting course and download the carb counting guide spdf on the DUK website. DUK will mention the carb ratio of 1:10 as a starter but as DD has said just recently on one of her msgs, the ratios can be adjusted

Through being type 1 for 48 years, using all different insulin regimes and reading all the messages posted on this forum over the past 5 years and looking at the web links posted and then trying to understand it all taking a simple viewpoint.

A good tip is to enter the amount of carb that is eaten against each bg reading and also write down the ratios and the correction factor that you are using and then according to the results that you get, make adjustments. As you are using Lantus, Aventis do a fairly good bg monitoring book that is larger than the average bg monitoring booklet that the meter companies send. The Aventis bg monitoring book is free to get hold of. Just phone them and ask.