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Bolus ratio keeps changing, exhausted with it all!

JMoli

Well-Known Member
Messages
250
Location
Edinburgh
Type of diabetes
LADA
Treatment type
Insulin
Hi, I was wondering if it’s normal to have to keep changing carb ratios a few times a month? I think I’m still honeymooning and my nurse said I was very insulin sensitive (not sure what this actually means)
I go from 1:35 for a week then 1:25 then 1:15, back to 1:30 and now 1:10. I’ll probably be 1:30 again soon!! I rarely keep a stable ratio for anything longer than a week. It’s really frustrating and it feels like a guessing game. Will this stabilise once I’m out of the honeymoon phase?
 
I have been all over the place with both basal and bolus ratios since lockdown started and rarely been the same two weeks running. I've only just returned to pre-March ratios, which had been very stable for a long time, with my return to the usual activity levels as a result of being back at work.

I've kind of concluded for myself if I accept it's going to be changeable and not look for ratios stabilising, it seems to help me cope better with the frustrating phases. I have no idea about honeymoon phases for myself - it's all been such a long, slow development for me through mus-diagnosed T2 to LADA, I don't seem to think about it that way.
 

Hi there - being neither T1, nor an insulin user, I have no personal wisdom to offer you, but I was wondering if these ratio changes could somehow be linked to your menstrual cycle? Hormones do appear to be minxy culprits for lots of females living with diabetes.

It could be worthwhile reviewing/starting/adjusting any records you keep, relating to bloods, to add in foods and your cycle, to see if any patterns start to develop.

Hopefully, someone with some personal experience might pop along soon to make comment.
 

Thanks, that’s reassuring - I think I just assumed everyone had their ratio and that was that whereas I have to see how lunch goes and try and guess the ratio to apply for dinner from that (also factoring in exercise) and just as I get confident it’s all up in the air again. Maybe the uncertainty and anxiety of the pandemic isn’t helping things for us
 

Thanks, yes hormones can be really tricky just before my period and mid-month I become very insulin resistant. I’m also peri menopausal so that’s maybe also having an impact. Ugh.
 
It does stabilise but I have different ratios throughout the day. They change with exercise vs sitting in the office
 
This is what my diabetes does (I'm 4 years in with LADA).
I don't use ratio's, as it wouldn't make sense for me. I rather go with what happened in the last couple of days (did I need a lot, a little, or in between insulin) and adjust from there, based on what my meter and Libre tell me.
First insulin of the day is a strong clue as well: if I clearly needed more/less than I took, I can more or less safely guess subsequent meals/corrections need a bit more/less insulin than yesterday as well today.

To make things easier for myself I mostly choose lower carb foods, but not always.
 
JMoli said:
Thanks, yes hormones can be really tricky just before my period and mid-month I become very insulin resistant. I’m also peri menopausal so that’s maybe also having an impact. Ugh.
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One of the good things for me was I maybe had two very light and utterly irregular periods since initial diagnosis, and menopause was really a non-event for me. So, I've not had to deal with the other hormones in all this! I never could decide if the few months of night sweats and hot flushes prior to diagnosis was the build-up of ever-increasing blood sugars (I do get hot flush-type hyper symptoms) or the menopause.
 

I doubt your insulin sensitivity is changing often. What seems to be the case for you is that sometimes your pancreas makes more insulin sometimes less which is causing the constant change in carb ratios.

As sad as it may be, once your pancreas is completely dead your sensitivity should always be more or less around the same but there are obviously lots of factors that can affect your sensitivity but your carb ratios shouldn’t change so dramatically once your honeymoon is over.
 
JMoli said:
Thanks, yes hormones can be really tricky just before my period and mid-month I become very insulin resistant. I’m also peri menopausal so that’s maybe also having an impact. Ugh.
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I think peri-menopausal is what is doing it. I managed to keep pretty steady control through 2 pregnancies, breastfeeding and getting back to normal then in the last 18 months (I am now 47) keeping control has been so much harder than being pregnant. I have never had any fluctuations during my cycle, until recently but now I am nearly doubling my basal in the second half of my cycle and my insulin is like water. I have no other signs of being peri-menopausal other than my age and my blood sugars being all over the place but I can't put it down to anything else. It's a bloody rollercoaster.
Good luck
 

Thanks, this isn’t great is it. Ugh. I’ve never known diabetes without perimenopause as diagnosed this year age 47. It’s very erratic and is a total rollercoaster. I might ask my diabetes nurse about HRT, trying to cope with hormones and also IBS flare-ups feels impossible. Thanks, hope you navigate a way through all of this too
 

Thanks, is it not quite tricky not knowing a rough carb ratio? Yes, low carb is definitely easier and some days I admit defeat and cut the carbs out but I’m very slim and struggle to keep my weight up without them.
Do you think being female makes the carb ratio more difficult to stabilise? Those pesky hormones!
 
I gave up using ratios pretty early on, as they constantly change. I just follow the numbers - sugar surf. I find it a lot easier.
 
Hi @JMoli, I do carb count but it is never an exact science for me. It depends on so many other variables that all I can really do is have a general idea of how many units of insulin I'll need per carb. For example, 30 carbs of one thing may require 2 units or at another time it seems to require 1 unit...or 3. I think this is because our days are NEVER the same even if we think they are. I've always assumed that's why a 'normal' persons pancreas stops and starts its insulin production 24/7 every minute of the day. You would drive yourself mad by trying to get it exact. Of course if your overall levels are too high or too low and you are trying to get it right then I do sympathise. I think I'm still in the honeymoon period too and I consider that a good thing but it is tricky. If I aim to eat 50 carbs, I'll aim to take insulin around 15 minutes before but if I am too late then I suspect (without it even asking me!!!) my own insulin kicks in first so then I take the exogenous insulin, it says hello to my own and I go low! If I decide not to take any for a relatively low carb meal, my own insulin or what's left of it decides it's going to do nothing and I go higher than I would wish! On a recent type 1 course, all I can say is that those who were NOT in the honeymoon period had overall higher levels and they virtually all said the levels swung widely. Be careful what you wish for in many ways. I think insulin sensitive means the insulin is getting through easily (ie no resistance) and you respond well to the insulin you do produce/take. I'm quite fond of my pancreas as it seems to still be trying to help me out! Would you mind giving us some numbers, we may be able to comment from our own experiences if similar. xx
 
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ert said:
I gave up using ratios pretty early on, as they constantly change. I just follow the numbers - sugar surf. I find it a lot easier.
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I agree. I do keep in mind a general ratio but it changes from day to day so I go with the flow and if necessary use corrections or find an excuse for a yummy 15g of carby deliciousness. Having said that I am using low doses of insulin in single units so I sympathise with anyone having to juggle with higher amounts and trying to get that right. x
 
Ah, I'm rather overweight, so if eating less carbs prevents me from gaining more weight it's only beneficial.
Another thing which possibly makes things easier for me than for you is that I seem to have a fair bit of insulin resistance going on. Larger doses means it's easier to take 10 or 20% less insulin for the same food as yesterday, I can simply take 8 or 9 units instead of 10. When you only use 1 or 2 units you'd need to choose between double or half the amount of insulin.
Do you use a half-unit pen?

The being female part is a thing too, but because I've never wanted to be female it took quite some time for me to accept it could be worth seeing if I could find a pattern over the month, and I still have trouble keeping notes on what happens in different weeks. I did find one pattern; I usually need way less insulin around the start of my period. It would be interesting to see patterns in other weeks but I just can't put myself to it.
I'm 43 now, and it seems the thing before my period is becoming less predictable. I'm suspecting I'm seeing early signs of menopause coming up. In which case trying to track patterns wouldn't make sense anymore, so I won't.
 
Yes! Mine have just changed again I feel it’s just as get good levels boom it all starts to go up or down and need to adjust again. My nurse said (by my awful latest hba1c) that I am probably now making very little insulin. So it’s changed in the past few months again. I’m also v sensitive to insulin and am about to try a 1/2 unit pen which I think will be good. Hormones play a big part for me, just before my period resistance and levels go v high. Nurse said up basal then 20% then come back down. I have been on the pill for a month whilst waiting for a referral and it’s impacted my levels a lot! I’ve stopped as it was hard to manage my diabetes. It’s such a complicated thing, I’d cope much better if it just stayed the same day in day out heheh.
 

I’d forgotten about this thread after asking, total brain fog! I have a half unit pen and it’s so handy - you can also double check how many units you have injected afterwards which is great too.
Sorry your hbac1 wasn’t great, mine was disappointing too and higher than the Libre estimate. I did have a shambles of a month beforehand (hormones!!) maybe you were the same?
It’s reassuring that so many others are in the same boat and that carb ratios don’t tend to stay the same (I wish they would!!) I was 1:10 for a few days, then a few rollercoaster hypo days and now it seems to be 1:20 and I’m hoping that I can get at least a week of this because I’m nicely in range and past the crazy hormonal patch! I spoke with my diabetes nurse yesterday and she said it wasn’t that my carb ratio was constantly changing but it was more likely to do with how much activity/exercise I was doing (I don’t think that’s true as I stopped walking anywhere for a few weeks due to hypos) and my pancreas still trying to work sporadically? Who knows. I’m so grateful to have found a sort-of-ratio as the three weeks before were a hot mess and meal times were becoming a bit of a nightmare x
 
JMoli said:
I spoke with my diabetes nurse yesterday and she said it wasn’t that my carb ratio was constantly changing but it was more likely to do with how much activity/exercise I was doing
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As for myself, I'm very sure this isn't the case for me.
Yes, of course I need less insulin on active days, but this in no way explains the difference in the amount of insulin I need on pretty much the same days, activity and food wise.
 
@JMoli yep me too. Gave up on permanent long term ratios a long time ago. It is too frustrating. I just need to know my ratio in the morning is at least 3-10 the majority of the time, at least half that at lunch. (1-3pm) Then if I do eat later which is rare, an awful lot less. Like others I take a note of previous days reactions/exercise/stress to dictate what I do. Then I get evenings and nights like last nights just to throw a spanner in the works. Went low in the evening and ate a Dextrose, Apple, yoghurt with seeds in, 2 cream crackers, and still needed 2x2 lots of Jelly babies in the night. Felt like the very hungry caterpillar! Woke on a 6! Not a drop of insulin taken. You couldn’t make it up. Will need to look at basal again.
 
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