Help please!! Insulin ratios

Hi @miles9

Would you like me to move this thread to the Type 1 section for you?

It sounds to me that your basal might be too low. Have you done a basal test?

Sounds like your bolus is too low. Did you try raising it? You should try raised ratios till you find the one(s) that work. Two hours after meals, your blood glucose should not be much more than 2 m.mols higher than before meals.
It'll be trial and error till you find the ratio(s) that work for you.

I've assumed that you know that basal testing isn't just your morning fasting reading ( though I must admit that's what I used when I was on MDI).

Hi @miles9 Are you relatively newly diagnosed, and how well do you understand the role of basal and bolus.
in answer to your questions, Yes, taking insulin late can cause a raise in BG. Why did you drop from 30 units down to 2units?
Apologies if this is over simplified for you, but hoping starting with the basics, will eradicate any simple oversights. Obviously, everyones insulin regime is very specific, so no one will be able to give you exact doses you should have, but for me, in any given day, about 50% of my TDD (Total Daily Dose) of insulin is basal, and 50% is bolus - but this varies from person to person. You need to do a basal test (to make sure, a basal test proves that your BG remains constant, and not just that it ends up at the correct level), to ensure this is correct, and once this is correct, then you should be able to bolus approx. 15 mins before food, to maintain minimal raise or drop in your BG. Should you eat nothing for a particular meal, also, you should expect a minimal change in you BG, but this is subject to the basal dose being correct. Consider reading "Think Like a Pancreas" as this explains everything very well, but feel free to ask more questions as well.

Never used Toujeo so have no idea what it's effect on bg levels is like, but NICE recommend a bg level of about 5 to 6mmol before a main meal, then allow a 2.5hr rise of about 8.5mmol which without eating a snack, should fall back to 5 to 6mmol again by the time the action of the bolus has more or less finished. If bg levels are above the 8.5mmol target, then that's the time to adjust the bolus ratio to deliver a bit more bolus........lots of trial and error with bg testing will find the way. It might be that because the Toujeo has been reduced (were nightime hypos the reason?), it's effect on controlling bg levels during the day isn't very much so at the moment, more bolus probably needs to be used. If possible, try eating lower amounts of carb which will help to prevent high bg levels. Do look at the 100 rule when figuring out a correction dose......google it. It helped to stop me from over correcting a high bg.

It can take a while to determine the ideal dosage of basal based on your activity levels and food intake. It took me quite sometime to find the correct amount - like a couple of years. I ended up starting at too high of a dosage and over time decreased it by about 20 units - I'm taking 22 units now - it used to be in the 40 unit range when I first switched basal insulins. I've never taken Toujeo so I can't comment on that - Once you think you have the proper amount of basal try fasting on your day off - it doesn't have to be the whole day. By fasting your BGs should stay within a normal range if you're taking the correct dosage based on your lifestyle. I suspect you will figure it out. We all do or at least the ones taking basal insulin.

I see you have only been diagnosed a few months from a previous thread. Are you based in the UK? Have you spoken to you Diabetic Nurse, Specialist or even GP to get advice before changing you Basal/bolus doses?
I am concerned that it sounds like you have cut out your basal, and are effectively replacing it with bolus. If this is the case, you are going to have to take many micro doses of bolus throughout the day, or simply suffer numerous highs, as the bolus wears off between doses. This approach is precisely what a pump does, but is incredibly hardwork / unmanageable by injection.
As others have said, you could increase your bolus, but in my personal opinion, this is not best-practice. It sounds to me like your basal is too low, and this needs to be checked corrected first.
Everyone here will willingly help and advise where possible, but if you are newly diagnosed, there is a high chance your pancreas is also affecting things, and if this is the case, your insulin requirements will eventually rise, and you have already dramatically reduced basal. I really would make contact with your diabetes team and ask them to run through things with you again. In time, you can make minor adjustments to your doses on your own, but I'd definitely get some specialist help in these early days. Best of Luck, Paul

miles9 said:

I will try to change my basal rates tonight. Any thoughts on how I should do it? Should I go to 12 units (TDD recommended) from 2 units? Or should I gradually increase it?

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No, definitely not! Any basal increase should be small and gradual. A large increase like that could be dangerous and is unwise. You should do a basal test first so you know how your current basal dose is working.

As you're fairly recently diagnosed, it would probably be best to discuss any basal changes with your diabetes nurse before you alter your dose.

miles9 said:

I will try to change my basal rates tonight. Any thoughts on how I should do it? Should I go to 12 units (TDD recommended) from 2 units? Or should I gradually increase it?

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I'm afraid medical professionals need to tell you how to change your basal. Do consider buying "Think Like a Pancreas" and reading that. It will explain all the fundamentals. Do you have a diabetes team? Personally, I would have been phoning them and asking for their guidance on a regular basis. You need to take plenty of blood tests whilst getting this sorted. Once your specialist team has given you guidance on what your basal should be, you can then do a basal test to finalise it, and at that point, you are unlikely to be making changes of more than 10% at any one time. The basal test is what will prove whether you need to increase or decrease your basal. https://mysugr.com/basal-rate-testing/
Why did you drop from 30 to 2 units of basal, was there a reason, or are you just trying to work things out?
Have you taken 8-10 blood tests in a single day(before and after every meal and in the evening and night), to see exactly where your BG goes?

miles9 said:

Is there anything else I can do besides wait?

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Read the url (https://mysugr.com/basal-rate-testing/), and do the basal testing
At least that way, you will work out if the basal you are now on is right or wrong. The thing you will have to learn, is that when you make a change, it should usually be no more than a 10% increase or decrease, and you need to leave it a couple of days to see how the change works. Everything has to be calculated, considered, and then reviewed. It all takes time I'm afraid, and there are no shortcuts.

miles9 said:

I have a team but I live in Canada so I can only get I contact by email or wait for the next appointment. I dropped it (gradually) because I was going low at night, but I think I made a huge mistake. My levels are 6 mmol in the morning so I thought it would be fine to keep it at 2 units. I have emailed my nurse right now. Is there anything else I can do besides wait? Are there any others that use toujeo in the forum?

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It's great that you've emailed your team If I was you, I'd test, test, test, including during the night so you know what's going on, and wait to see what your team say