Help with insulin/carb ratio

[samantha13]

Hi have been trying hard this past week to get my ratio right as my diabetes has gone uncontrolled for too long. Iv drastically cut back my carb intake (for me) but bm still high. Any advice on how to work out my ratio? I currently take 18u levimer at night and roughly 2u to 10g carbs but feel even tho I'm adding correcting doses I'm not getting it right. I have no method to my madness it's all guesswork.

A typical day would be:

730am 9.1
930am 13.8 2biscuits 20g 4u+2u to correct
1130am 17.6 2biscuits/small apple 30g 6u+3u to correct
130pm 11.6 2boiled eggs
330pm. 5.7 ham/wheaten bread 30g 6u
530pm 10.5 crisps 15g 3u+1u to correct
830pm 9.1 taco/mince 15g 3u+3u to correct
1030pm 9.8
730am next morn 10.2

This was a working day and I find the mornings very stressfull and physically challenging. My bs always seems to be high at that time. I know the food I eat is not that nutritious at all but it's a big improvement on my previous diet! Thanks in advance of any help xx



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[donnellysdogs]

Hi Sam

Well done first off for starting to take control.

Initially my thoughts are that you need more basal and less bolus.

My 2nd thoughts are.. Your bolus doses need to be less.

My third thoughts are thst giving youself 3units of correction insulin would be normally quite a high dosage at a level of 9... But this is probably you just wanting to get lower...

First off Samantha.. Please do a couple of 2-3am checks of your blood.. Then you can adjust your basal up slightly.. This is what I would do.....

All your day levels are out.... But you have to start from a safe point.... Nights are the best to get right,, then you'll be starting good for your waking hours to fine tune your bolus and corrections....

Your levelscould get balanced within a fortnight or sooner...they need tweaking.. But not major...may seem like it.. But honest.. You can be much more balanced quite quickly..

 

[samantha13]

Hi donellysdogs thanks for replying! I did a couple night time tests and my readings were 11pm 13.3
2am 8.4
4am 10.1
730am 11.6

Someone on another post had suggested that as my morning reading was only a few points off my bedtime reading that my bolus dose was possibly correct but I see your point as my readings remain high.

Would it be worth a try increasing my bolus to 20u and leaving out any correcting doses the following day?

Obviously I take any advice at my own risk knowing this is not a medical site. But still think the advice here is way better than any dsn or consultant iv seen :-/


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[samantha13]

*sorry meant to say my basal dose correct


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[donnellysdogs]

My worrying thought is..... If you were a 'normal' 7 before bed instrmead of the 11 and you dropped line you did on the example you just gave... Then you would be in hypoland at 2-3 am.... And not in a good place....

So you need to stop your levels dropping and then rising overnight.....as odd as this seems there is a few ways to do this...

One would be to eat a snack before bed... But you would have to do that constantly... And me... I could not do that..

The second choice to try would be to LOWER your basal by perhaps 2 units, but to increase your bolus with your evening eating. Now, this depends on a couple things too... What time you last bolus...and what your current readings are for tea time, 2 hours after and bedtime.... But this would personally be my choice to take.

You will see some day levels go up... But this can be stopped by increasing your bolus's.

I would advise though that I personally would not advise you to raise your basals if you are drifting downward at 2-3am....

 

[samantha13]

Ok I like the second option. I will try that and hopefully get things stabilised with a few tweaks. Thanks for taking the time to advise me xx


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[robert72]

Hi Samantha

I'd be curious to know if you did several nights of night testing and if they all followed the same pattern (I seem to recall that you'd done a correction bolus on the particular evening above). It could be that the low in the above example was a one off in which case you might be able to increase your basal. Just a thought.

 

[donnellysdogs]

If you dropping like a doughnut at 2am due to correction then Robert may well be right.
To test what happens at night you really need to go to bed without a correction, and eating no later than 8pm latest... As much coffee n tea though.

You must be specific with eating and testing whilst tweaking.... Be prepared for daytime levels to go up slightly.. As you will have less basal in you...
Dont get put off... Or panic and overdose on corrections... The best thing to do when tweaking is to do gradually and to stop the large swings that you are currently having...

Others may have better ideas... But mine would be to get your nights right first... As this is the starting point to day doses....Let us know how you get on...

 

[samantha13]

Thanks guys. I am going out for dinner and couple of drinks tonight so maybe not the best night for middle of night readings but tomo I will have my tea at 6pm and try my readings then. Fingers crossed I get on top of this. I jus don't seem to b able to retain any information to work this out xx


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[robert72]

Hi Samantha

A couple of books that will really help you with all of this are:
Think like a pancreas by Gary Scheiner
Using Insulin by John Walsh

 

[samantha13]

Thank you Robert on amazon as we speak!


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[iHs]

Hello Sam

I think maybe you will have far better control if you were to inject Levemir twice per day instead of just the once.

I used to use Lantus once a day at night and then switched to Levemir. Initially I tried to use Levemir once a day at night like the Lantus but quickly found out that my bg levels were going fairly high during the day so then started to inject Levemir in the morning and evening and sorted my bg levels out a lot better..........

 

[samantha13]

So with this do u jus split the doses? For example I wuld then take 9u at 8am and 9u at 8pm? I'd b a bit weary of making this change but at the moment I feel I will try anything to get my sugars down. Thanks for the suggestion I'll give it a wee think xx


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[samantha13]

Have jus searched this splitting doses idea in the forum and see levimer actually only covers you for around 18hours. It wuld jus be a matter now of working out what amount to give am and pm but I feel this might make a diff. Thanks for the suggestion xx


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[robert72]

Hi Samantha

Be careful not to change more than one thing at a time. Do a few nights of testing first to see what the data shows, then you'll be in a position to make adjustments.

 

[samantha13]

I think I'm jus wanting to see lower results too quickly. Your right I should be patient and try some night testing. It's frustrating from the drastic changes iv made to my carb intake I jus feel I'm getting no where.

Tomorrow would u advise I have my 3meals 4-5 hours apart, eat no later than 7pm and then carry out my night testing? Also should I continue with correction doses tomo as donnellysdogs suggested I could be taking too much bolus and too little basal?

Sorry I feel I'm getting such great advice from you guys but letting you and myself down by not achieving the results xx


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[Thundercat]

If I don' t have a snack after lantus I go very low even if night time ns is a bit elevated. Tried adjusting doses basal and bolus but snack works best. I don't always feel like eating but it is worth it to keep levels even and avoid hypos

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[robert72]

Samantha, that's a good plan re the meals. Main thing is to get your basal level right before calculating your bolus ratios. The most important part of the basal is night time as you don't want to drop too low during the night.

 

[iHs]

Samantha, that's a good plan re the meals. Main thing is to get your basal level right before calculating your bolus ratios. The most important part of the basal is night time as you don't want to drop too low during the night.

Also, Sam

Get your evening meal insulin to carb bolus to be ok so that when you go to bed, your bg levels will be about 7-8mmol and then start the overnight basal test. The 80/20 split with Levemir is a good starting point but as always everything can be adjusted to suit the two insulins actions on your bg levels....

 

[samantha13]

So yesterday...

730am 10.1 porridge 30g carbs 6u
930am 14.2
1130am 13.9

I was working though and as I find the morns very stressful I always have raised bg at this time.

130pm 12.7 salad sandwhich with low carb bread. Small pear 35g 7u

330pm 15.3

6pm 11.4 soup/yoghurt/small apple/4crackers 65g 13u

8pm 8.7

1030pm 4.0 200ml orange juice/2digestives
1045pm 7.7
11pm 10.1

Was really disappointed that I went low before bed. Had been trying to aim for a 7 which would have hopefully meant I woke up with an 8 or so making readings today a bit lower. I panic when my bg is low and prob took too many carbs but havnt quite worked out what amount I need to bring me up without being to high.

During the night...
2am 9.8
4am 9.2
6am 10.2


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