Carb ratio adjustment - looking for basic start point

Sanober

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Not really knowing what's going on inside my Endocrine system!!!
Hello

Any folks on varied insulin to carb ratios for each meal?

My sugar levels decided to go a bit crazy a few weeks ago, the main bug bear is where my basal (Lantus) held steady until well into 7 hours or so was starting to pull be down 3-4 laters after my morning jab. I noticed that I tend to go low by 11-1pm and again around 5pm. I pared back my basal about 2u over 7 days or so but I ended up with far more highs and generally felt very unwell even when sugar levels were normal. So I know my basal's fine (and stays ok over night).

My D nurse was too busy to sit down with me today at my annual check to discuss but she suggested to focus on bolus to carb ratios lunch and dinner, instead rather than basal, and to go for 0.5u per 10g carb which personally I think is too drastic. (I've been on 1u per 10g carb for several months now).

So I thought I'd try 1 to 12g carb, testing this for tonight's dinner.

I wonder is this too small an adjustment? Or is this the right way to do it?
 

Neicy0412

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166
Type of diabetes
Type 1
Obviously it's up to you to do what you feel comfortable with, I went up in 0.5 increments so 1.5u to 10g of carb. I only did it initially with my evening meal as that was when my BG was too high. Try it for a day or two, it's not set in stone and you can always readjust your ratio if it's too much or not enough. Good luck
 

smidge

Well-Known Member
Messages
1,761
Type of diabetes
LADA
Treatment type
Insulin
Hey Sanober!

Personally I'd go with 1:12 for a try - I think they try to adjust you half units to the 10g because it makes the maths easier :lol: I've been doing 1:8 for a while, but I'm all over the place again now because I've just changed my basal from Insuman to Levemir, so it feels like I'm back to square 1. Anyway, good luck!

Smidge
 

pickle76

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118
Hi,

I always changed ratios by 0.25 at a time instead of 0.5 simply because I was so sensitive to changes. Try it and see if works for you.
 

Sanober

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Not really knowing what's going on inside my Endocrine system!!!
Thank you for the input everyone.

I've been doing 1:12 bolus (basal at 15u) but what happens is I could be 5-7s before hand, then 1 hour after eating and bolus up into 8-10s (not pleasant when going up from pre food at 5...) then another hour later I can be around 7-9s but then a further hour I'm into <3-4....

So reducing amount of bolus isn't really helping I'm going too high then slump...

According to the TDD approach it suggests I have basal at 12u and carb ratio of 1:20 (this carb ratio will only lead to more highs surely...if I'm barely coping with 1:12....)

My carbs the past few days have been routine in that30g breakfast 20-30g lunch and 50-70g carb dinner.

I have to confess that I'm getting down about this and I haven't felt very good for a few weeks now :(

Hey Smidge, why Levemeir?
 

smidge

Well-Known Member
Messages
1,761
Type of diabetes
LADA
Treatment type
Insulin
Hi Sanober!

I changed to levemir because the Insuman has a distinct peak at 4 - 6 hours and was often coinciding with the peak of my Apidra and causing hypos mid morning and mid evening. I decided on Levemir rather than Lantus because fewer people seem to have problems with it (although that might just be my perception) and because it is recommended to split the dose whereas Lantus is recommended as a single dose (although loads of people do seem to split it). I've been on Levemir a week now and I've had far fewer hypos - only two mild ones all week and one of those was my own fault because I miscalculated my Apidra :oops: My BGs were high at first (8 - 10) and I was starting to wonder if the switch to Levemir was worth it, but I've increased the dose a little and have been in the 4s - 6s for a lot of today, so maybe things are settling down a bit. My BG has certainly been more stable on the Levemir - previously I was ranging from the high 2s to 10ish, whereas now I'm holding steady most of the day - just need to try to hold steady at the right numbers and I'll be happy :lol:

Hope things are improving for you?

Smidge
 

Pneu

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Messages
689
Sanober.. covering incorrect basal with bolus adjustment is going to cause problems..

I would suggest..

1. Have you tried spiting your basal dose? you might find this gives a flatter more predictable profile..

2. Changing your basal.. I didn't get along at all well with Lantus or Levemir and ended up on Insulatard which worked a lot better