Getting frustrated

Gaffer type 1 said:

Can anyone shed any light
I keep having high bg in evenings
Before dinner 7.9
I had wholemeal pasta lentil bake with lots of veg Included a few nuts. Half a glass of milk and an apple bg now 15.7.
Basel 5 units before meals
Bolus 10 units before bed
Just can't seem to get in the zone

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Are you carb counting ? Do you know your insulin to carb ratio?

I prebolus half my insulin a half hour before I eat to stop the highs. If it's not coming down enough, for me that means I needed more insulin. It might not be normal for you, but things happen that sometimes require more insulin and that can change in a day.

I'm going to make an assumption here...................
I don't know how long you have been a type 1, but the honeymoon phase lasts up to 8 years in some people, which means your insulin requirements will slowly go up. I'm assuming since it looks like you are saying you are taking a set amount of insulin, the best thing to do is to learn how to carb count so you can start taking a more appropriately needed amount at every meal. That was quite a high carb meal and it might have required more insulin. Your night meals maybe are higher carb than your earlier meals so the dose isn't always working. It's important to learn to carb count so you can customize your dosing. I believe you can check with your team about taking a class in carb counting.

Yea, it way to common still to be misdiagnosed. I was for over 9 years, luckily I was put on insulin fairly early because medications made me sick. Learn to carb count, it becomes second nature to learn to dose. It will clear up those 15 blood sugars!

Gaffer type 1 said:

That's a typical lunch or dinner for me

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Looks delicious. Are there any carbs in it? (Can't make out what's in the veggy bit?)

So you know how a basal/bolus regime works? The basal is meant to cover your insulin needs when you're not eating (eg at night). It's generally a fixed dose though people's basal needs can change (eg if you get sick or stressed your needs go up). You take the bolus whenever you eat and also as a correction dose. Typically your clinic should calculate some insulin ratios for you
1) insulin/carb ratio. eg 1 unit of insulin for 10 units of carbs. This varies enormously between people and can also vary with times of day and exercise levels.
2) correction ratio. eg 1 unit of insulin brings your blood sugar level down by 2 mmol/L. This also varies from person to person.

So if your carb ratio was 1 unit to 10 carbs and your correction ratio was 1 unit to 2 mmol/L and you had a blood sugar of 8 before a meal of 40g carbs and you wanted to have one of 6mmol/L, you'd inject 5 units, 1 for the correction and 4 for the meal.

I believe the bertieonline course can be used to teach carb counting? (Someone correct me if I'm wrong).

www.bertieonline.org.uk

Note that you can do correction doses at any time though be careful not to overdose by over correcting when your bolus is still in your system.

Gaffer type 1 said:

I have had not one phone call or message off anybody

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That's pretty disgusting. Please tell me they've at least explained about hypos? Hint, never ever go anywhere without glucose or fast acting carbohydrate.

Dosing will vary person to person and even the time of day. Especially if you are still making some, which I bet you are. It really can vary, you have to learn by what you give and what works. Insulin lasts for up to 6 hours so you also don't want to do what we call stacking and adding insulin before what you've taken has already worked. But most of it insulin is used say 1-3 hours after.

Are you carb counting yet? First you want to learn to do that, then it will become second nature on what to take. There will be common things you can give an estimate to. But start looking up things so you can get an idea.

But this book would be really helpful.

think like a pancreas by gary scheiner

Gaffer type 1 said:

I don't like the thought of keep upping my insulin I seem to think less insulin the better
I was on 4 Bolus now in the past four days put it up to five before meals.
5 weeks ago I was told I would be put on dafne course but I've heard notning

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Hello, that thinking is a tad dangerous, if you don't have enough insulin, you'll run high and running high isn't good. You need to push to see a dietitian soon to get some basic idea of carb counting. You need enough insulin to cover that meal, if the insulin is correct you wouldn't run high or low.

Hi. Yes, do start carb-counting. It's not for me to tell you exactly what to do on that as the advice should come from your nurse. Simply it means adjusting your Bolus at each meal to suit the meal carb content. So for pasta you would inject more than for egg and bacon. The important thing in the early days of adjusting insulin is to test frequently to avoid hypo risk. Try small steps and test 2 hours after a meal to check. Your Basal may also need tweaking a bit. The purpose of Basal is to balance the background output of glucose from the liver. If you don't eat for several hours and your BS goes up then your Basal may need tweaking up and vice versa. Only small steps should be taken and leave 2-3 days between any changes and as usual test frequently. As others have said, if you are in the honeymoon period your insulin needs may go up anyway over the coming months/years. BTW there is no correct insulin dose as long as it matches your body's needs.