Diabetic nurse changed my carb ratio

[Tracey167]

Hi all

I'm Type 1 diabetic on humalog 3 times a day and levemir split morning and night, went to diabetic nurse last wednesday and she decided because my sugars were higher than usual of a morning she would increase my night time levimir 1 unit and change my 1-1 ratio to 1.5 to every 10g of carbs which i started on the thursday morning BUT ever since changing it i have had a HYPO every mid morning or before lunch. She told me to ring and let her know but the thing is you never get to speak to the nurse you actually see so to sit there and explain everything over the phone for them to just tell me to return to 1-1 ratio again i decided just to return to a 1-1 ratio obviously 1.5 ratio is just to much insulin for me. But how do i overcome the high levels of a morning cos i don't think 1 unit increase of levemir in the night is gonna make a great deal of change. my levels were range from 7.4 upto 14.5 ok 7.4 is ok for me but when it starts going over the 11. Can anyone advise me the best thing to do do u think if i raise my night levemir up 1 unit more it will help. The thing is i suffer with frequent hypos with no awareness anyway so to add to them on a 1.5 ratio is a nightmare i can do without.

Tracey167

 

[iHs]

Hi

Before you increase your nightime levemir dose, make sure that your evening meal insulin to carb ratio is correct so that when you go to bed, your bg is near enough the same level every night. This info that I got from reading Nobleheads msgs on the forum, helped me no end. I started to realise the common sense in it all. Once you've done that, calculating your nightime basal starts to get easier....

Regarding your morning bg levels try using a ratio of 1u to 8g carb and use trial and error to see how that affects your levels. You can always adjust it again if you are going too high or too low Sometimes its easier to adjust the carb in the ratio than adjust the insulin.

 

[Tracey167]

Hi iHs

Thanks for that i have only been told to do carb counting a year ago before that i was just given units of insulin to take before each meal time and if i run high or low for 2 days at the same time of day i would have to adjust the insulin up or down 2 units, so when starting carb counting first it was all abit daunting but i will try what you said.

tracey167

 

[weeezer]

hi tracey

whilst i can't help...i just wanted to say i'm in same boat, rubbish at carb counting (did an aussie DAFNE course type thing about 5 years ago but have a terrible memory & lost all my paperwork on it in the move back to UK). i have just kind of 'guessed' at my insulin dosage over the last 12 years - the course gave me more courage to adjust more liberally, with a little bit of knowledge, but i still only half know what i'm doing. hbA1c's all good so they leave me to it, and haven't been to a clinic for over 2 years, but trying to change all that now. i was supposed to be referred to a dietician a year ago to help with carb/insulin blah blah have chased this a few times, and hopefully will be getting an appointment soon!

i am waiting also for a place on a DAFNE-esque education course so i can get a grip on it all, fed up of my vague guesswork! i want to be able to eat what i want, when i want, so believe it will really help. did you do a DAFNE type thing? or were you just advised on carb/insulin ratio's?

AMBrennan kindly pointed me in the direction of the BDEC diabetes learning programme, which i have yet to get into (need some spare time to look) but looks ace, lots of info & learning tools about how carb counting. look it up!

just wanted to let you know we ain't all experts! x

 

[xMenace]

You likely have a pronounced DP (dawn phenomenon). Many of us do. Our I:C in early morning is much higher than our I:C from mid-morning on. The more we eat at breakfast, the lower we go before lunch. As we drift into better i:c range, our insulin on board (IOB) drifts into overdose range; it becomes more effective.

I can adjust with temp-basals on my pump, but on MDI, you should consider postponing breakfast until 10AM, if you can. Another strategy is eating very low to no carbs for breakfast.

*caution: John is not a health professional. Run these ideas by your nurse who, in all likelyhood, will call John crazy and dangerous. Tell that to my 5.6 A1C with almost zero hypos.

 

[Cheryl]

The nurse did the same to me a few years ago, I had the worst hypos I've ever had & it made me very poorly. I found the simple conversion of 1u, 1.5u or 2u per 10 grammes of carb to be too crude for me. I looked at it from the opposing angle, despite being told that the nurse didn't like doing it the other way around (which made me ask: who's important here me or you?) I work it out always on always 1u of insulin to X amount of carbs. You get a much more accurate dose that way.
1u to 10grc is easy to work out of course
1u to 6.66grc is the same as 1.5u to 10grc
You could therefore try, for example 1u to 8grc (somewhere between the two things you've tried) & see if that works.

Only you can tell with much trial & error what the best ratio is for you. And bear in mind, it's often different for different meals.