How many units?

[Robanny]

Hey everyone,
I have a few questions about units of insulin.

I've only just started caring about my diabetes after 10 years. I'm 19 and have suffered from depression since the age of approx' 11/12 (Though am happy to say that I've turned over a new leaf and am finally coming out of it), so just blocked everything out and ignored all the information given to me, etc. I want to get my diabetes under control and have finally decided that coming to a forum with other diabetics can help me.

I decided to start by asking this:
I am on Novo Rapid fast-acting insulin and Lantus long-acting insulin.

I was wondering if anybody could give me advice on how many units of insulin I should be doing in relation to my blood glucose reading?

For example:
How many units of novo rapid should I do if my blood sugar is... 9.0, 10.0, 11.0... etc, all the way up to being in the 30s 40s (which happens a lot due to my lack of control).
Is there a formula I could work with?
Like X amount of insulin units for X amount of 1.0s (cant think of a better name..) you want to reduce your sugars by? (For example: 1 unit of insulin to reduce my blood sugar by 1.5... or so on).

Also:
Is there a set amount of insulin to take after meals?
For example: If I had a normal sized plate of chips and pizza for dinner (though I don't usually, I'm quite a healthy veggie teenager! Ha-ha!) then is there an amount of insulin I should be taking? Is there a dose of insulin that would cover me for all normal-sized meals? And would this just be halved/quatered in relation to snacks, etc? Or am I going to have to start counting fat and carbohydrates etc in order to calculate every insulin dose? (See? I really have no idea! )

I've been working with blind knowledge for so long, I have no idea how much insulin to do in relation to my readings. I've always just guessed, and it's never helped as I've NEVER had constant, normal readings - they're almost always high or low.

I'm trying to start taking care of myself, and feel like I need this information to get started.

Any help would be appreciated!

Thanks a lot everybody,
Robyn
x

 

[dipsticky]

Come on you guys, 'bout time you was all up. This person needs some answers fast. Where's all you T1's ?

D.

 

[totsy]

hya robyn,
im glad u are starting to take control, im on the same meds, do u carb count?? if not it will help if u learn,
we are all different i inject 1 unit per 10g carb and as a correction dose if im say 8 or 9 b4 a meal i find if i take an extra unit it takes me down 3mmol, can u give me an idea what a days food and readings look like and i will try and help

 

[phoenix]

I think its incredibly difficult to get type 1 as a child. I'm not surprised that you've tried to ignore it and you're by no means the first. Now you've decided to face it you've taken the first step to controling it, rather than letting it control you.
I'll start with your last question
Its really useful to be count the carbohydrates in your meals, if you can do this it gives you a basis for adjusting your insulin, rather than just guesswork. There is an excellent NHS course called DAFNE, which teaches a lot about how to control type 1 in general and counting carbs/dose adjustment in particular.. It would great if you could go on this. Ask your doc if it (or a similar one is available in your area) In the meantime there is an online version of the carb counting part which could give you a good start.
http://www.bdec-e-learning.com/

There are formulas for working out correction doses and the amount of insulin to take to 'cover' so many carbohydrates, but since we vary a lot they may not work that well for everybody, I haven't found them to be that accurate for my own needs.
If you look at this website there are some tools that may help. Its an American site so blood glucose levels are given in mg/dl (you have to divide by 18 to get mmol)
As theres a lot on the site I've given you the the page about insulin, but theres a lot to explore(but as always you do need to talk with your medical team before making any drastic changes, and in any case change things gradually).
http://www.diabetesnet.com/diabetes_treatments/diabetes_insulins.php

 

[Dillinger]

Hi Robyn,

You should really be taking the novorapid just before you eat and it should be based on the amount of carbohyrdate in the meal; if you can do the DAFNE course that should give you some useful information to get going.

It's difficult to be specific about how much insulin you need to lower blood sugar in general as there are quite a lot of different variables; your weight, your metabolism, what you've eaten etc., etc., but I would say start low and test a lot and try to get a handle on what works - for insulin for meals the Novorapid will be dependent on how much carbohyrade is in the meal. It's been a while since I've eaten much carbohydrate but I used to do about 50 grams of carbohyrdate a meal and would take about 12-14 units of short acting to cope with that; that was me though; you will probably be very different. Trial and error is the way to go, and keep in mind that even Novorapid takes a while to kick in and peaks at about 2 hours after taking and then dimishes but is still working after 6 hours - http://www.novonordisk.com/diabetes/hcp ... rofile.asp

I've found that when my blood sugar has been particularly high that a lot of extra insulin would be needed; but you need to be careful about that as obviously going from very high to hypo won't help and you'll probably get a blood sugar bump after the hypo as well.

One of the things that you can do to bring your blood sugars under control is to do as much exercise as you can manage and to stay clear of all sugary and sweet things.

I find that once my bloods are stable then it's much easier to keep them stable, and similarly if things are swinging from high to low, it's hard to break out of that and get stability.

Welcome to the forum by the way - it's a very helpful place; I wish I had had something like this twenty years ago!

All the best

Dillinger

 

[phoenix]

Dillinger is right to spot that about the Novo, taking it before meals, it starts working very quickly but so does the increase in glucose levels.
His amount of insulin just demonstrates individual differences. (and why you need to be very careful), For 50g g of carbs, starting from a normal blood glucose at lunchtime I'm about to bolus 4.1u, his dose would send me into hypoland.
(I have an insulin pump so can dose in tenths of a unit, the pump helps do the calculation).

 

[LittleSue]

Well done for taking responsibility for controlling your diabetes.

As others have said, everyone's different and it takes trial and error to find out your personal needs. But its worth the effort.

The DAFNE way is to start with 1 unit of NovoRapid for each 10 carbs, then adjust from there according to need. Test before each meal and before bed. If the dose was right and your Lantus dose is right, bs should go back to the same reading. If bs too high, correct by 1 unit to reduce bs by 2 or 3 mmol. If consistently needing corrections, then increase your mealtime dose (ratio) to 1.5 units for each 10 carbs and repeat the process. Snacks are usually dosed at 1 unit for 10 carbs regardless of meal ratios, seems illogical if you need more with main meals, but there tends to be some overlap with the previous meal dose. Write things down as you go, and note if you weren't sure of the carbs, or anything else that might interfere.

So you need to count carbs! Including the carbs in veg, gravy, nuts, sauces etc.

You may need different ratios of NovoRapid at different times of day. It's clearer if you stick to consistent carb amounts for each meal to start with. Ratios can vary over time and with illness or menstrual cycle,so you'll need to regularly review whats happening. If you write your mealtime doses as (for example) 4 + 1 which would mean 4 units for the food, plus 1 unit to correct a high, then its easier to see how you calculated the dose when you look back.

If you're on small doses, half-unit pens are a big help and avoid having to 'round up' to the next unit of insulin.

 

[iHs]

Hello Robyn

In addition to what has already been mentioned, to help you out a tiny bit it is said that most people will need approx 0.5 - 1.0 units of insulin per day per kg of body weight. So if you weigh for example 50kg you will need approx 25 - 50 units per day (this includes the basal and your bolus added together). As you wont know exactly how much you really need, go for middle of the two calculations and call it 38 units. Divide half the dose for your basal - 19 units and have a go at splitting that between morning and bedtime so that your background insulin control is a bit more evened out. Use the other 19 units to take care of your breakfast, lunch and eve meal. Once you have been able to roughley guess what your TDD is (total daily dose) you can then use Sue's advice about adjusting your insulin to suit the amount of carb you eat a bit more easily.

Although I have used a 50/50 approach to using the bolus and basal, some people get good control using a 45/55 or 40/60 percentage. So anything can go really.

Try to get your target bg to be no higher than 4-6 before a main meal and then no higher than 8 2.5hrs later. You will learn as you test your bg levels so write down in a record book all your bg results, the amount of carb that you eat for each meal and the amount of bolus insulin you had. Dont worry, its all trial and error but you will be able to sort yourself out, so GOOD LUCK

 

[rogbert]

You don't say when you were given the insulin and by whom I work closely with a nurse attached to the diabetic clinic at my hospital its mainly on trial and error considering many factors as mentioned in previous replys I now use a novamix slow and fast acting and take three doses a day of 60 units per dose this has taken me ten years to work out.At my last hospital checkup a reading of 7.00. for last 6 months .

 

[Pinson]

Robanny,

I think what I wanted to tell you regarding the answers to your questions have been all writen by other people, so I will not duplicate.

One thing that I want to tell you is that I was so touch to hear that you are 19, that you have T1D AND you want to take care of your own health after suffering from depression. This is a GIANT step, and you did it yourselve...

You are simply fan-tas-tic and wonderful. Just you remember it!

If you feel like, let us know how you are going

 

[chris.reed3]

Hi Robyn,

I no you wrote this thread a while back, but i'm very similar to you when it comes to my diabetes. Got it at a early age and just rebelled against it all. Its only recently i've started to take control of it and am actually finding it very interesting now.

I look at your thread as i was sitting here at home and i started to realise my blood sugar was really high. In fact it was 33!! I had dinner and all my insulin but lately i've been really stressed with work and a few other things. So i thought i'd ask the internet the question - If my blood sugar is 30, how much Novo Rapid insulin should i take to reduce it?? This is when i stumbled upon your thread.

Well it definitely helped but now i'm just sitting here waiting for the effects. I'm now on my second bowl of shreddies cos to tell you the truth i'm a little scared to sleep. You see i live by myself and don't really have many people to turn to at the moment. Sorry to babble on about things, but if you need someone to talk to, who seems to be in the same boat. Give me a shout.

My email address is [email protected]

Hope you have things under control now, i'm nearly there.

Thanks again

Chris

 

[noblehead]

Chris,

I would advise you to speak with your diabetes team asap, they will tell you how to manage your diabetes better and advise on reducing elevated bg.

Nigel

 

[andrianna1]

I have just joined the forum too,i find it really helpful hearing from others who actually have diabetes themselves.best people to ask i say.i too am lost by carb counting and figuring out my doses so have learned a bit more just by reading through these comments.I was diagnosed at 21. and 10 years on am only just realising and accepting the truth of my condition.i suffer with neuropathy and have no warning signs of hypos.which means i need a constant babysitter. i would advise you to go and see a dietition.this is what i have done.she has got me on the waiting list for the carb counting course.and has given me a lot of helpful advice and homework to do.just like what has been suggested already write down everything you eat and look at the labels to see what total carbs are in your food and try and work out the unit of insulin you need.i still struggle with my sugar levels but am now on the right path to one day be in control of my life again

 

[Gates]

Hi Robyn,

I no you wrote this thread a while back, but i'm very similar to you when it comes to my diabetes. Got it at a early age and just rebelled against it all. Its only recently i've started to take control of it and am actually finding it very interesting now.

I look at your thread as i was sitting here at home and i started to realise my blood sugar was really high. In fact it was 33!! I had dinner and all my insulin but lately i've been really stressed with work and a few other things. So i thought i'd ask the internet the question - If my blood sugar is 30, how much Novo Rapid insulin should i take to reduce it?? This is when i stumbled upon your thread.

Well it definitely helped but now i'm just sitting here waiting for the effects. I'm now on my second bowl of shreddies cos to tell you the truth i'm a little scared to sleep. You see i live by myself and don't really have many people to turn to at the moment. Sorry to babble on about things, but if you need someone to talk to, who seems to be in the same boat. Give me a shout.

My email address is [email protected]

Hope you have things under control now, i'm nearly there.

Thanks again

Chris[/QUOT
Pleased to meet a gentleman. Nice one Chris..

 

[@so_sweet_its_killing_me]

It all depends on what your carb:insulin ratio is