Hi everyone I am 64 years old and have had type 1 for 43yrs now and somehow have stumbled through it without any complications that I know of and until the last 5 years in all honestly I acted as though I did not have it the only things I did was limit my carbs and nothing sweet but then I lost my hypo awareness my consultant who I very rarely had any contact with told me to run high for a couple of months and it worked that was what made me start testing which I had not done for that long I did not remember how to do it, I live in the Medway area of Kent UK and I also attended there MINTE course which gave me a reasonable understanding of what was going on but I am still very much in the dark with it, so thought I would give this a try, I am taking 16 units of Levimir in the mornings and 12 in the evening and am running a ratio of 1 unit of Novorapid to every 10g of carbs that I eat but for some reason my readings are pretty high and sometimes hypos happen, can anyone offer me some useful advice as how to control it better, I think one of my problems may be that on the MINTE course they told me I could eat whatever I like as long as I counteract it with the Novorapid but I think my problem is not judging the values and weight correctly as it is impossible to weigh everything I use the Carb and Calorie counter book like a bible but it is still going wrong so any help or advice would be gratefully appreciated many thanks Chris
Hi everyone 43yrs type 1
- Thread starter chrisf-1
- Start Date
kaylz91
Well-Known Member
- Messages
- 1,090
- Type of diabetes
- Type 1
- Treatment type
- Insulin
Why do you find it impossible to weigh everything? I do it, it is time consuming but I want to get this right so therefore I do what I think is best which is to weigh everything I eat, when do the hypos usually happen? x
Three things come to mind:
1. Inaccurate carb counting. I am completely in agreement with you that it is not always possible to weigh everything, find out the ingredients and calculate the carbs before you eat everything unless you only eat pre-packaged food or make everything from scratch. I overcome this with some guestimation (which improve over time) followed by BG checks after 2 hours and do a correction bolus if necessary. Correction boluses any earlier are unlikely to take into consideration any insulin on board (IOB)
2. The rate of absorption of carbs. When I attended the DAFNE-like, it was taught as if all carbs were equal: count how many there are, apply your ratio and inject. Unfortunately, it is a little more complicated than this. If I was to count the carbs for something carby and fatty like a pizza and inject in one go, I would hypo because the fat reduce the absorption rate of the carbs so my insulin would work before the sugars reached my blood and then go high as the carbs start to hit the blood later. The way around this is a double bolus - half before eating and half 90 minutes later (or something like this - trial and error will help you find what is right for you).
3. Your ratio changes. Another area where the course simplifies diabetes is to propose a single ratio for all times of the day. For many, this is fine. However, some people find their ratios are different at different times of the day. So if you find you often hypo in the afternoons, reduce your insulin ratio for the afternoon food.
1. Inaccurate carb counting. I am completely in agreement with you that it is not always possible to weigh everything, find out the ingredients and calculate the carbs before you eat everything unless you only eat pre-packaged food or make everything from scratch. I overcome this with some guestimation (which improve over time) followed by BG checks after 2 hours and do a correction bolus if necessary. Correction boluses any earlier are unlikely to take into consideration any insulin on board (IOB)
2. The rate of absorption of carbs. When I attended the DAFNE-like, it was taught as if all carbs were equal: count how many there are, apply your ratio and inject. Unfortunately, it is a little more complicated than this. If I was to count the carbs for something carby and fatty like a pizza and inject in one go, I would hypo because the fat reduce the absorption rate of the carbs so my insulin would work before the sugars reached my blood and then go high as the carbs start to hit the blood later. The way around this is a double bolus - half before eating and half 90 minutes later (or something like this - trial and error will help you find what is right for you).
3. Your ratio changes. Another area where the course simplifies diabetes is to propose a single ratio for all times of the day. For many, this is fine. However, some people find their ratios are different at different times of the day. So if you find you often hypo in the afternoons, reduce your insulin ratio for the afternoon food.
I went to bed last night with a BG of 8.9 not good but passable I awoke this morning with 12.1 for breakfast I had 2 thick white slices of toast =60g and had my usual 6 novorapid and 16 levimir this was at 6.53 am at 11.12 am I was at 14.7 this just does not make sense to me I have taken +2 novorapid to bring it down but I have had this situation before and know any more correction will send me hypo
paulliljeros
Well-Known Member
- Messages
- 417
- Type of diabetes
- Other
- Treatment type
- Other
Firstly, have you done a basal test, to work out if your basal dose is correct? Also, whilst it sounds unlikely in this scenario, should you have a hypo overnight, you may well see a jump in BG the following morning, Additionally, Dawn phenomenon is a common problem for many, and this is worth monitoring. Hopefully a few things for you to consider?
I have just done another BM and the time is now 12.30 and it has gone up again to 13.8 and I have ingested nothing apart the 2 toast and a couple of cups of tea, I do not not how to do or what a basal test is but this just seems to defy logic I will take another 2 novorapid but am frightened to do more because of hypo Chris
paulliljeros
Well-Known Member
- Messages
- 417
- Type of diabetes
- Other
- Treatment type
- Other
A basal test is something that is done over a couple of days, but you can read up on it here https://mysugr.com/basal-rate-testing/
If correction doses are not bringing BG down, you should consider changing your insulin, and injection sites. There is a chance the insulin has lost its potency if it is older, has been kept too warm, too cold, or just happens to be a bad batch, so always worth checking that first. I guess you already know this, but be cautious of multiple correction doses, for most people, bolus has a lifespan of up to 5 hours, so may still be working in your body. If you ate fat (butter or cream for example) with your toast, this may also be slowing down the absorption of the carbs, meaning they are still raising BG many hours after eating.
If correction doses are not bringing BG down, you should consider changing your insulin, and injection sites. There is a chance the insulin has lost its potency if it is older, has been kept too warm, too cold, or just happens to be a bad batch, so always worth checking that first. I guess you already know this, but be cautious of multiple correction doses, for most people, bolus has a lifespan of up to 5 hours, so may still be working in your body. If you ate fat (butter or cream for example) with your toast, this may also be slowing down the absorption of the carbs, meaning they are still raising BG many hours after eating.
Hi @chrisf-1 I can relate to this - I'm 55 and have been living with type 1 for 51 years. Like yourself I've been complication free and a few years ago kind of slacked off on my diabetes management. Once my kids were born and growing I thought I better take better care of myself so I started to explore ways of doing that. That was about 22 years ago and carb counting was relatively new if it existed at all - don;t know. I ended up taking notice on what foods would spike my BGs and which foods would not and as a result my diet radically changed. As well so did my insulin consumption - I ended up dropping my Basil by 20 units and I dropped my daily consumption of my fast acting by 15 units while my A1Cs went down. I still don't carb count but am much more aware of what foods I eat.
All the best!
Odin004
Well-Known Member
- Messages
- 165
- Type of diabetes
- Type 1
- Treatment type
- Insulin
Hi @chrisf-1,
Firstly, you say you hadn't tested your sugars for some time - so it's probably the case that you had highs and lows before, without realising it - it's just that now, you're testing, and you've become more aware of them.
Secondly, your previous strategy was to limit your carbs and to eat "nothing sweet" - and in your course, you were told to "eat whatever you like a long as you counteract it with the Novorapid" - I have to say, I completely disagree with the advice that you should eat "whatever you like" - advising an insulin-dependent diabetic to do this, is simply wreckless. Your previous approach of limiting your carbs, is much better, and if you can, I would suggest going back to doing this.
It is not surprising to hear that you've had highs and lows if you've been eating anything you want - this is exactly what happens when you have a high carb diet (it's unavoidable)! There's an intrinsic margin of error in dosing insulin - we can't get it 100% right - but that margin of error is more significant in real terms, when there's a higher amount of insulin in your system; for example, a 30% error on a 9 unit dose, is clearly much more dangerous than a 30% error on a 3 unit dose.
Having a lower carb diet, and therefore less insulin in your system, is much safer - as it means that any error should have less of an actual effect on your sugars; it also reduces the inevitable swing in blood sugars.
From what you say, you've clearly been doing something right all these years - and long may it continue!
Firstly, you say you hadn't tested your sugars for some time - so it's probably the case that you had highs and lows before, without realising it - it's just that now, you're testing, and you've become more aware of them.
Secondly, your previous strategy was to limit your carbs and to eat "nothing sweet" - and in your course, you were told to "eat whatever you like a long as you counteract it with the Novorapid" - I have to say, I completely disagree with the advice that you should eat "whatever you like" - advising an insulin-dependent diabetic to do this, is simply wreckless. Your previous approach of limiting your carbs, is much better, and if you can, I would suggest going back to doing this.
It is not surprising to hear that you've had highs and lows if you've been eating anything you want - this is exactly what happens when you have a high carb diet (it's unavoidable)! There's an intrinsic margin of error in dosing insulin - we can't get it 100% right - but that margin of error is more significant in real terms, when there's a higher amount of insulin in your system; for example, a 30% error on a 9 unit dose, is clearly much more dangerous than a 30% error on a 3 unit dose.
Having a lower carb diet, and therefore less insulin in your system, is much safer - as it means that any error should have less of an actual effect on your sugars; it also reduces the inevitable swing in blood sugars.
From what you say, you've clearly been doing something right all these years - and long may it continue!
There's a few things which might be going on there:
12 is high so if you're on 1 to 10, 6 u for 60g has no correction adjustment built in. I'd have been inclined to add more on so the 6u is working on the toast and the correction is working on lowering the 12. Without a correction dose the 6 plus toast would do nothing to get you out of the 12 to 14 range.
You're going into the meal at 12.1 which is fairly high - it's often the case that insulin is less effective when levels are higher i.e. takes a bit more to lower from higher levels compared to if levels were lower to start with, so the 6u might not have been working as well compared to if you'd had the same meal, same dose starting from say 6 or 7.
"Foot on floor" is fairly common - my levels will easily rise from say 5 to 8 or 9 just by getting up and moving around in the morning, so I usually pin that with 2 or so units. So, it might be that if you were bolusing just for the meal based on the carb count, maybe there was a bit of foot on floor kicking in to throw things out.
Many find that usual ratios don't work that great in the morning. It's quite common for people to up it a bit from 1 to 10 to say 1.5 to 10 for breakfast. None of these figures are set in stone, takes a bit of experimentation.
