Carb Ratios

Hi all,
I am new to this forum so sorry if this has been posted elsewhere.

I was diagnosed with T1 in September, 2012. I was given very little advice at the time of my diagnosis and have learnt to deal with it independently. I did attend the dafne course shortly after my diagnosis and have used the principle of carb counting and adjusting ratios with my most recent A1c result 5.1%.

A problem which has plagued me in recent months, however, is my change in carb insulin ratio. To begin with I was on 15:1 throughout the entire day. The ratios then changed for different times but remained fixed for many months and made treating the condition very easy. However, beginning in June this year and continuing up to now, my ratios appear to be changing every few days, sometimes changing from one day to the next.

For example: One day my ratio is 13:1 for my breakfast. I have established this after documenting my carb totals over a series of days, (eating the same foods and different foods to establish the approximate ratio). Then a week later, I check my level a few hours after eating and find it at 11 mmol/L upwards, normally averaging 15 mmol/L. (This is after eating the same foods and the same daily routine, including exercise.) I therefore make the necessary changes to my ratio and try it the following day. The following day it works perfectly and I never cross over 7 mmol/L. Then 2 days later I either have a hypo shortly after eating or find my results getting higher again, and have to recalculate my ratio. It can, over a short number of days, move all the way from 13:1, to 6:1 up to 14:1. It does become very difficult when a ratio of 6:1 suddenly reverts to 14:1 and I have administered far too much insulin. (obviously not knowing before feeling the indications of a hypo.)

This is a recurring problem with me and is starting to become very frustrating, battling this ever changing ratio, which is impossible to know beforehand, and has become a matter of injecting and hoping it hasn't changed from the previous day.

Can anyone tell me if this is common or does anyone have any advice on what to do? I am fully aware of 'the honeymoon period' so don't know if this is still a contributor or I am becoming insulin resistant at spontaneous times?

Any help would be great!
Thanks in advance,

James

brett said:

With your ratios changing so frequently I would run the basal checks as thats normally the indicator for me. Also, has a 12 month period of erratic levels at start due to "honeymoon period". Started producing insulin shortly after the introduction of insulin allowing my insulin producing cells to rest. Have had to adjust both basal and bolus at the start of the winter months, and probably will ned adjusting as it warms up. Your doing the right things, testing, recording, adjusting hopefully things will settle down for you.

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Thanks for your replies.
I am currently on 11u Lantus once a day. I haven't changed this dosage for some time as found it works very well. On a carb-free day, and allowing it to settle the previous night before sleep, (and refraining from exercise) I find it stays level between 5-6 mmol/L until the 23-24 hours have passed from my last basal. A few weeks ago I accidentally administered 12u and definitely felt the consequences, continually going into the 3mmol/L range despite treating. I also find that, if I am more than 45 minutes late to administer the Lantus, my readings rise.

Are you suggesting that when I administer the bolus (Apidra) it is possible that the pancreas is creating some of its own insulin, thus I am hypo'ing only on certain occasions? If this is the case then, although very frustrating for my control, it is out of my control and only a matter of time before it begins to settle. I thought that I was becoming insulin resistant and requiring more, as opposed to it being down to insulin production.

victry77: It's comforting to learn it is not just me but I agree with you; the sudden changes can be very annoying as it nullifies everything you've done up to this point, having to start all over again. I've heard ratios can fluctuate but I thought maybe a few times each year, not every day. On Saturday I required 8u for my evening meal; for the same meal the following day I required 15u!

brett said:

Have you recently done basal tests, divided.into 3 different.ones a day and the night one. If you normally eat carbs a major factor would be amount eaten at meal times. Different size meals may require different ratios, different fat content needs to be adjusted for, along with any activity done beforehand and.planned activity afterwards,oh and stress,temperature to name a few. Would not advise doing a basal test in one go for a 24 hour period as it will give misleading figures. Do them seperately on different days. Hope things settle down soon for you.

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I've not heard about the test you are suggesting. Would you mind explaining in more detail so I know exactly what to do? (I'll do anything.)
My exercise is the same every day and I keep the fat content in food to a minimum so that shouldn't be the reason, but sizes of meal and all the other variable factors could be contributing.

Thanks for your help - I really appreciate it.
I'll do exactly as you've recommended and hopefully help these fluctuations to end.

Riri said:

Just to let you know that you are not alone with this problem. My bolus ratios and basal rates hardly ever stay the same and I very often have to change things week by week. By all means try what the others have mentioned but I just wanted you to know that some of us have the same issue as you - frustratingly changing insulin needs for no apparent reason. My DSN tries to ignore it or she puts it down to my hormones at my time of life. I test more often because of the unpredictable nature of things!

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Thanks for your post Riri. At least I know now that it is not an isolated thing. I'll just have to keep on top of it.

G2ADY said:

Hi James,

Like you and others I'm finding that my ratios change and I was only diagnosed T1 a few months ago. I've done a similar fasting test as described by Brett and found that once I've found a stable Basal dose then everything becomes easy again. I was told it was a honeymoon period and that it wouldn't last however I read plenty of people on here including Riri who are experiencing this problem years after diagnosis.

I guess we all differ and evolve and so our rates will always be in a constant state of flux dependant on many factors. At least this forum helps us all to figure out simple ways to manage, measure and adjust. I've found everyone on here a great source of inspiration.

Good luck!
Steve

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Hi Steve,
Thanks for your post - it's, 'good' to know others experience the same problem.
I too have attempted what Brett suggested and found my basal dose correct, yet I continue to experience the fluctuations in bolus ratios.
A test I try is to replicate the daily routine over a few days, so meal times, the actual meals (weighing food), exercise, waking times, etc. and continued to document my readings, and all I am able to conclude is they are consistently inconsistent.
Yesterday, for instance, I required a 1:10 ratio for breakfast, and today it had increased to 1:8 so my readings rose.
It's very frustrating but I hope for it to settle sometime soon (hopefully).
As for you, since you are so recently diagnosed, it may genuinely be the 'honeymoon period' and so to expect your readings to settle within the next few weeks, (hopefully!)
If, in the meantime, you have any questions, don't hesitate to message me.

Good luck, James.