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Help with insulin/carb ratio

Discussion in 'Type 1 Diabetes' started by samantha13, Mar 2, 2013.

  1. donnellysdogs

    donnellysdogs Type 1 · Master

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    So Samantha

    I take it that all your bolus's yesterday were for the food only.. That you didn't try to give extra bolus to correct?
     
  2. donnellysdogs

    donnellysdogs Type 1 · Master

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    Good that your night checks were so level..
    Will see if iHs is around for advice now...
     
  3. donnellysdogs

    donnellysdogs Type 1 · Master

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    What time(s) was your basal insulin given?
     
  4. alisoningold

    alisoningold Type 1 · Active Member

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    Hello:)

    You're jut like me dose wise! I used to correct like that all the time. More levemir at night, adjust by two units about every 4 days as required. Take less short acting as you're probably like me, used to corrective doses! Good luck.


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  5. donnellysdogs

    donnellysdogs Type 1 · Master

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    I think the same. Your meal rises arent too bad, but your drop at night before bed a concern... It could be a couple things to improve that.. Less bolus with evening meal or altering time(s) of basal insulin.. Depends on time you taking it though. Would definitely increase your basal.. Brilliant that you so good at monitoring for the day!!
     
  6. samantha13

    samantha13 · Well-Known Member

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    Yes donnellysdogs I stuck solely to my ratio of 2u to 10g and left out the correction doses. I noticed that my readings wernt that diff to when I was correcting is that due to my body being used to them?

    I take 18u levimer at 8pm

    So determined to get on top of this as I have abused my body long enough. Currently studying Gary scheiners think like a pancreas at the recommendation of Robert.

    I was thinking the low reading at bedtime as my body not used to going so long without food. I used to eat like a bin! Enjoying making these small steps to a healthier life though.

    Also thank you Alison for your advice. I think I will have my meal around 7pm tonight and increase my levimer and continue the readings for the next few days. Xx


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  7. donnellysdogs

    donnellysdogs Type 1 · Master

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  8. iHs

    iHs · Well-Known Member

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    Sam

    You have two options to get your bg levels a bit better. One option is to increase the basal up by probably 2u and leave the time you inject as it is. The other option is to leave the basal at the remaining dose until you go to bed and adjust your insulin to carb ratios for your meals upwards if necessary until your bg levels start to behave. Dont worry at this point if you need to use 2.5 or 3.0u for 10g carb. Everything can be adjusted as you go along. Do look at the 100 rule to determine your correction factor and correct pre meal with the bolus dose....
     
  9. samantha13

    samantha13 · Well-Known Member

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  10. Paulasensio

    Paulasensio · Member

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    Hi there. I too use Levemir as my basal. Some observations:

    1. 9.1 to 13.8 without eating anything on the morning of your 'normal day' account - it seems that without any input carb-wise you are going up. Also, even with a double ratio bolus you are still rising (which bolus are you on?)
    2. 13.3 to 8.4 at 2am night-time reading. The posts by donnelysdogs and Robert72 about you probably having corrected the 'before bed reading' which probably took you too low is really important. What was the correction given?
    3. All your first of the day readings are too high - this is a basal issue. This then puts you out the rest of the day.
    4. 200 ml and 2 digestives on a reading of 4. Given your high readings you were probably starting to feel a hypo at 4. Although this is getting on the low side you over-compensated on carbs. A small swig of lucozade (better than orange) and 1 digestive would suffice. You'll find as you get better readings you will start feeling hypos at a lower 2.5 to 3.5 say which is fine (as long as you are sensitive to them - don't take your average readings too low or you will only become aware when your blood glucose is too low - if at all). Always having readings at 4 for example is actual a bad thing. Aim for 5 to 7.
    5. Your correction boluses don't seem to be very effective at all. Not that I'm saying you will be the same as me (obviously test one step at a time) but I need 1 unit to every 1 mmol/L I am over. As an example, once you were on 13.8 and gave yourself a correction of 2 units. I would have given 6 or 7 using Humalog. You asked if your body was used to them as when you went without there was no real difference... You're just not taking enough. I made this error for a long time. A correction needs to pull it right down to 6 or 7.
    6. You are taking Levemir as one dose but you rightly say it lasts 18 hours.

    I would say you need more basal given twice a day (I take two lots of 27 units a day) - when you get up and when you go to bed. I would say increase by 2 units every couple of days until you get those morning readings right down. When they are fine tinker with your bolus - you might find a ratio of 2 is fine but you might find 1.5 is ok given your basal is now higher. Also be aware that your ratio can change during the day. You might need a ratio of 2 during the day and 1 at night for example.

    Increase those correction boluses. Test this one at a time increasing them until you get good corrections. The good thing is your measuring is frequent.

    Good luck!


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  11. donnellysdogs

    donnellysdogs Type 1 · Master

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    Yes, agree with Paula ref splitting doses.. Nut the most importsnt thing that Paula mentioned is that your carb ratio may/will change if giving yourself more basal... Paula has **** good advice here...
     
  12. samantha13

    samantha13 · Well-Known Member

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    Great advice! Thank u so much. All about trial and error but I WILL get there :)


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  13. 1905

    1905 Type 1 · Member

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    Hello Samantha, Have you been on a DAFNE course? this is the sort of thing they teach you on the course (how to adjust your levels of Insulin to how much 'physically challenging' work you are doing). You need to talk to a Specialist Diabetes Nurse who will give you the right information on how your OWN body reacts to Insulin.
    If you havent done the course I would say it is worth a week of your time to do it.

    Cheers,
    Ian.
     
  14. iHs

    iHs · Well-Known Member

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    Hi Sam

    Until you get to go on a carb counting course, does your total bodyweight equal the amount of insulin you are using? It is thought that as a starting guide 1u of insulin will be needed for every 1kg of bodyweight. Whatever the amount equals, it is then divided 50/50 between daily basal dose and bolus over 3 injections as a starter.
     
  15. samantha13

    samantha13 · Well-Known Member

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    Ther is a 3year waiting list for DAFNE in my area I have been told. I would give my right arm to get on the course. My DSN is offering very little help. When I told her my readings she said 'you should know better after 2.5 years'. A lot of sighing and tut tuts from her but little advice other than to increase my basal. I openly admit I havnt treated my condition as I should but I now want to turn things around. This forum has been fantastic.

    In regards to splitting my basal do I wait until I see a decrease in my readings and get my carb/bolus ratio right first?

    iHs my body weight is 85.7kg. Am 5ft 8ins. That would mean 42.5 am I right? Seems an awful lot.

    Today I am continuing with 2hourly readings, sticking to around 70g carbs and leaving out the correction doses. I increased my levimer bolus from 18u to 20u at 8pm last night.




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  16. Paulasensio

    Paulasensio · Member

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    I went straight into carb counting so can't comment on your other question. I would say 42.5 isn't a huge amount - I take 54 each day and I know people who take much more than that.

    I would say get your basal right first as your ratio will then slot into place. You need to get rid of the morning highs. Start today with 10 tonight and 10 tomorrow morning - although given your readings - I would imagine you will need to increase by 2 a few more times - but do take it slowly and see... as you are already doing.
     
  17. iHs

    iHs · Well-Known Member

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    Hi Sam

    The calculation is based on someone eating about 150g carb per day (I think). Its only a very rough guideline but it does look from your msgs as though your basal dose is not right and you should increase it and keep testing your bg levels.
     
  18. robert72

    robert72 Type 1 · Well-Known Member

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    Hi Samantha

    If you're only eating 70g carbs then you might not need quite as much insulin as in the formula, although obviously you're not having enough at the moment. But as Paul says, you need to get the basal set right before you can work out your carb ratios.
     
  19. Dillinger

    Dillinger Type 1 · Well-Known Member

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    Hello Samantha,

    You are getting some good advice here I'm a Type 1 as well and would just say you need to think about 3 things and tinker with them;

    1. Your insulin to carb ratio by time of day; you are saying at the moment you take 1 unit for 5 grams of carb.
    2. Your correction dose; you haven't said what dose you are using; you need to get a figure for how much 1 unit of insulin reduces your blood sugar.
    3. You need to know how much 5 grams of carbohydrate raises your blood sugar levels (for hypo management).

    You also need to know how long your short acting insulin lasts (for correction doses if nothing else).

    Once you have a handle on those you can really start fine tuning; I change my insulin/carb ratio and insulin correction dose by time of day.

    I would suggest that you address the short acting insulin first; your blood sugars are high but that seems related to the carbs/insulin ratio you are on; whilst high these readings are pretty steady.

    I think that you should increase your short acting insulin ratio to 1 unit for 3 grams of carb. Once you get this ratio right all the others will fall into place.

    Once the short acting is right I think that you should start a correction dose at say 1 unit to lower your blood sugar by say 3 mmol/l and test to see that that is correct (ideally without eating when you start seeing if that is correct).

    Obviously I'm guessing; and you need to do things safely and carefully so my figures could well be out, but you need to start somewhere and change until it's right.

    I agree that splitting Levemir (50/50) is the way to go.

    The problem with the overnight reading is that you are clearly showing normal liver dumps going on in the early morning; if you increase your bolus at night you will hype at around 2:00 am (dependent on when you take it) and then between 4:00 and 7:00 your blood sugar will rise because your liver is releasing glucose as part of its normal routine.

    You should do a correction dose as soon as you get up if you cannot eat breakfast then and then when you have breakfast later take the normal amount of insulin for the carbs.

    Best

    Dillinger
     
  20. samantha13

    samantha13 · Well-Known Member

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    Hi Dillinger. Thank you do much for the advice. That's quite clear I should be able to work it out by your directions. One thing I'm confused about is should I wait until I get my basal dose correct before adjusting my carb/insulin ratio?


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