Help!!

[Raisen22]

Hello everyone!

Can someone see if I'm being silly here or what -

My consultants PA is calling me later but I needed to do an injection soonish and I'm unclear on what my consultant has said.

He changed my background doses and my ratios, my background doses have been reduced quite a bit and my ratios are now 1.5:1, 1:3 & 1:3.

So that means lunch and eve meals I'm doing 1 unit per 3 cps?? That can't be right surely, I'd have thought my ratio would increase if my BI has decreased, my blood has been high through the day so this doesn't make sense! But that's what he's written down, he must of meant 3:1, right??

Ahhhhhhh confused

 

[GrantGam]

Hello,

What insulins are you using and what is your background dose?

1:3 would suggest 1u:3g carbs.

Are you a fairly recent diabetic? If so, you may still have a partially functioning pancreas and this could account for why 1u will cover 30g of carbs. Otherwise, if it's 3:1 - this would suggest you are insulin resistant which is unlikely providing you are a recent T1D.

Regards,
Grant

 

[Raisen22]

Hiya, thanks for your reply.

No I'm not a recent, I've had it 20years this sept!

I take Humilin I and Novorapid.

Exactly, and this is what I don't understand, my blood had been higher during the day so I knew I'd some adjustments to my doses during the day, but decreasing my morning dose of background and then having 1u : 3cps seems really odd to me!! It'd make more sense if the ratio was 3u : 1cps?!

My background doses were reduced from a morning one of 21u to 16u at the appt today, and my evening dose stayed at 13u.

It's the ratios that have thrown me, seems odd!!

 

[GrantGam]

Yeah it seems a bit strange the way the ratios have been changed... What was your I:C before?

If it were me, I'd be increasing my morning basal insulin if I'm having consistently high day time BG, irrespective of what I'm eating. Have you tried a fasting basal test to fine tune your insulin needs?

https://mysugr.com/basal-rate-testing/

I find that my I:C barely changes at all, it tends to stay constant at around 1:12. I've only been T1D for 2 years so it's all still pretty new. Basal requirements on the other hand change dramatically depending on what I eat. Currently I'm on around 100g carbs per day and 8u AM/8u PM of basal. When I up my carb intake to 250g-300g I can be as much as 15u AM/15u PM. But 1u bolus insulin will still cover 10-12g carbs regardless.

Do you suffer from dawn phenomenon? This was the root cause of my daytime BG running high. 1-2u bolus insulin when I wake up seems to work. That may be completely off topic but you never know

Maybe someone will provide insight to your new dosages, but I can't see why these recent changes would help you any.

Cheers!
Grant

 

[azure]

I'd have read that as 1 unit to 30g carbs, but it could be 3g. However, that would be a lot of insulin per carbs.

Did he mean CP - carbohydrate portions? That would mean the 3 actually does equal 30g (10g to each CP)

I think the mix of grams and CPs in use is silly and confusing - as you've shown with your issues about what exactly was meant.

If in any doubt, take the smaller amount of insulin and correct later if necessary. Better that than a massive hypo.

 

[1abRat]

You don't seem very confident with dose adjustment. Have you ever done a DAFNE course? You might find it liberating as after 20 years I'm surprised you're not adjusting your own doses.

Your Diabetes nurse should be able to book you on to a course. what were your I:C ratios before your basal was reduced to 16 IU?

 

[azure]

What were your ratios before?

 

[Raisen22]

Thanks Grant!

Welcome to the diabetes club then! I'm an old timer, but as you can see things don't necessarily get easier the longer you have it!

Everything seems to affect my blood and I'm constantly changing backgrounds and quick acting!

I know I need to do some more work myself and see what's going on, I was just left more confused about what the consultant meant with a 1:3 ratio, seems bonkers to me! Hopefully they'll call shortly and I can have some clarity!

 

[Raisen22]

What were your ratios before?

They were all a 1:1

I'd have read that as 1 unit to 30g carbs, but it could be 3g. However, that would be a lot of insulin per carbs.

Did he mean CP - carbohydrate portions? That would mean the 3 actually does equal 30g (10g to each CP)

I think the mix of grams and CPs in use is silly and confusing - as you've shown with your issues about what exactly was meant.

If in any doubt, take the smaller amount of insulin and correct later if necessary. Better that than a massive hypo.

I have always read ratios as 1 unit : 1 cps which = 10g carbs, so I took his adjustment as 1 u per 3cps or 30g carbs - this seems crazy to me as that means if I have 6cps at lunch I'd only do 2u?!! And that's with my background insulin reduced from 21u to 16u... Less background and less quick acting at meals even though my blood has been higher during the day - I don't see how this is right!

Yea I can't be getting to the point where I may hypo really bad as i only had a baby 4months ago and I need to be on full alert hahaha!

 

[GrantGam]

Thanks Grant!

Welcome to the diabetes club then! I'm an old timer, but as you can see things don't necessarily get easier the longer you have it!

Everything seems to affect my blood and I'm constantly changing backgrounds and quick acting!

I know I need to do some more work myself and see what's going on, I was just left more confused about what the consultant meant with a 1:3 ratio, seems bonkers to me! Hopefully they'll call shortly and I can have some clarity!

That's no problem, I'm sure you'll get to the bottom of your query through this forum

If you could let us know what your previous I:C was (in grams) then that will help @azure and others try to clarify matters for you and let you know if your recent adjustments have any logic to them

Grant

EDIT - just read your reply with I:C information.

To put it simply, it makes absolutely no sense changing your I:C to 1:30. The only reason this would help you manage your diabetes is if you were having constant post meal hypos. Apart from that it's completely pointless. I'd be questioning your Dr's reasoning for this adjustment.

Good luck
Grant

 

[Raisen22]

You don't seem very confident with dose adjustment. Have you ever done a DAFNE course? You might find it liberating as after 20 years I'm surprised you're not adjusting your own doses.

Your Diabetes nurse should be able to book you on to a course. what were your I:C ratios before your basal was reduced to 16 IU?

I did Dafne back in 2010...

I am more than capable of changing and adjusting but the problem is I don't get what the consultant has written down.

I've only had a baby 4months ago and my usual perfect bloods have gone completely off the wall and I've made so many adjustments, waited, adjusted, waited - you know the drill - but nothing seems to work so I need someone who hasn't got baby brains and isn't exhausted from a tiny baby and a three year old to look at it and help me out!!

I think I'm having a burnout too, it's overwhelming having a screaming baby and another one who is going through the tantrum stages and I have literally no head space to think haha!

My ratios were all 1:1 and I was taking 21u AM and 14u PM of Humilin I.

Bit odd that my Basal had reduced and so has bolus even though my blood has been horrendous through the daytime!

Arrggh another headache I could do without!!

 

[GrantGam]

I did Dafne back in 2010...

I am more than capable of changing and adjusting but the problem is I don't get what the consultant has written down.

I've only had a baby 4months ago and my usual perfect bloods have gone completely off the wall and I've made so many adjustments, waited, adjusted, waited - you know the drill - but nothing seems to work so I need someone who hasn't got baby brains and isn't exhausted from a tiny baby and a three year old to look at it and help me out!!

I think I'm having a burnout too, it's overwhelming having a screaming baby and another one who is going through the tantrum stages and I have literally no head space to think haha!

My ratios were all 1:1 and I was taking 21u AM and 14u PM of Humilin I.

Bit odd that my Basal had reduced and so has bolus even though my blood has been horrendous through the daytime!

Arrggh another headache I could do without!!

I guess there may be some post pregnancy reasons for your dose adjustments?

From my understanding though, your insulin needs typically increase gradually through the 9 months and then significantly decrease after delivery. Unless you've been having hypos then I still don't get the reduced basal and increased bolus approach...

Grant

 

[azure]

They were all a 1:1



I have always read ratios as 1 unit : 1 cps which = 10g carbs, so I took his adjustment as 1 u per 3cps or 30g carbs - this seems crazy to me as that means if I have 6cps at lunch I'd only do 2u?!! And that's with my background insulin reduced from 21u to 16u... Less background and less quick acting at meals even though my blood has been higher during the day - I don't see how this is right!

Yea I can't be getting to the point where I may hypo really bad as i only had a baby 4months ago and I need to be on full alert hahaha!

Ok - so 1 unit to one CP ie 10g previously. That's fine but what confuses me is why your basal has been reduced if you're having highs. Did your consultant say anything to give you a clue? Was the advice passed on by somebody else without you speaking to the consultant?

For example, did they suggest you were having too much basal but not enough bolus? Sorry to keep asking questions, but I'm trying to understand how there could be so much confusion and lack of information.

 

[azure]

I have a baby and I found my BS was going lower than normal for months, but yes, it is hard to think when you have young children!

As I said, err on the side of caution - take the smaller amount. When you speak to the secretary, ask questions (write them down so you don't forget) Don't let them leave you with anything less than full understanding of the amounts and the reasons for them.
And if it doesn't make sense, don't be afraid to tell them!

It's hard to basal test with a baby, but I went back to the same basal I had before pregnancy. That's worked pretty well with the odd tweak as the months have gone by. My ratios were less insulin to carbs but that has very gradually increased until I'm now pretty much back to pre-pregnancy ratios even though I'm still breastfeeding ( I just eat extra top ups when necessary).

You may find a DSN more helpful as they'll probably have more time to discuss things.

 

[1abRat]

Sympathies for the baby brain, I'm sure its making it all 100x harder than usual. Get your consultant to write down the details and explain themselves properly if stuff doesn't make sense to you because they're not infallible and sometimes aren't very good at explaining themselves.

If you're having highs in the day it seems really odd that they've reduced your basal. Were you having problems with hypos too?

The only thing that would make sense in that context is that they meant 1 unit of insulin for every 3g of carbs but this is a big increase from 1:10g but then 1:30g is an equally huge shift.

It seems counterintuitve to me that they've made huge alterations to both basal and bolus as it makes it very difficult to see if one change is working or not when both have been mucked about with.

Hopefully your consultant gets back to you ASAP because I think we're all confused now!

 

[azure]

@Raisen22 Just had a thought - you said "from what he's written down". Some doctors have bad writing - could the "3" actually be an "8"?

That means a change from 1 unit to 10g to 1 unit to 8g, and that would make sense if you're going high.

 

[Raisen22]

I have a baby and I found my BS was going lower than normal for months, but yes, it is hard to think when you have young children!

As I said, err on the side of caution - take the smaller amount. When you speak to the secretary, ask questions (write them down so you don't forget) Don't let them leave you with anything less than full understanding of the amounts and the reasons for them.
And if it doesn't make sense, don't be afraid to tell them!

It's hard to basal test with a baby, but I went back to the same basal I had before pregnancy. That's worked pretty well with the odd tweak as the months have gone by. My ratios were less insulin to carbs but that has very gradually increased until I'm now pretty much back to pre-pregnancy ratios even though I'm still breastfeeding ( I just eat extra top ups when necessary).

You may find a DSN more helpful as they'll probably have more time to discuss things.

I'm so gutted, my blood and hba1c was perfect and it's now all a mess!

Yea see mine goes the total opposite, it gradually gets higher and higher, so annoying! Congrats on your baby by the way!

I've always preferred DSN's actually, much more easier and you can actually have a good chat about everything. Thanks for your replies!

 

[Raisen22]

Sympathies for the baby brain, I'm sure its making it all 100x harder than usual. Get your consultant to write down the details and explain themselves properly if stuff doesn't make sense to you because they're not infallible and sometimes aren't very good at explaining themselves.

If you're having highs in the day it seems really odd that they've reduced your basal. Were you having problems with hypos too?

The only thing that would make sense in that context is that they meant 1 unit of insulin for every 3g of carbs but this is a big increase from 1:10g but then 1:30g is an equally huge shift.

It seems counterintuitve to me that they've made huge alterations to both basal and bolus as it makes it very difficult to see if one change is working or not when both have been mucked about with.

Hopefully your consultant gets back to you ASAP because I think we're all confused now!

Haha thank you! You know what it really didn't help as he only had 10mins to see me as clinic was running really behind, and this is the first follow up since I've had the baby!

Exactly, it does right!? All too huge a change for my liking and understanding!

This is today's riddle for everyone to solve haha, good luck everyone!

I do hope I get a call soon, everyone is baffled!!

I shall update you all when I get clarification!

And thanks to you too, for your replies

 

[Raisen22]

@Raisen22 Just had a thought - you said "from what he's written down". Some doctors have bad writing - could the "3" actually be an "8"?

That means a change from 1 unit to 10g to 1 unit to 8g, and that would make sense if you're going high.

Totally right with the handwriting, how does their poor secretaries understand what the hell they've written to type up any letters!

That would make more sense but it's definitely a 3..

The mystery continues

 

[azure]

Totally right with the handwriting, how does their poor secretaries understand what the hell they've written to type up any letters!

That would make more sense but it's definitely a 3..

The mystery continues

D*mn! I thought I'd cracked it then!

Seriously, every time a med person speaks to you, make them say it in full - "1 unit to 15grams of carbohydrate" or "1 unit to 2 carbohydrate portions". It makes a huge difference and I think sometimes people make assumptions and just say things without being clear.

My top tip for post-baby carb/insulin is to keep it very simple. I have the same breakfast every day and pretty much the same lunch. That's two meals I know will work ok. I also test lots and adjust as necessary - that is, either correct or eat a bite extra if going lower than normal.

Thank you - and congratulations on your baby too Diabetes and a baby is much harder than people realise unless they've done it!