How much insulin is alot?

[richard67]

Hi I am a type 1 and have been injecting since around October.I am just learning how to adjust my insulin dose to cover what I have eaten(although I do my best to eat healthily anyway now) My diabetic nurse says to increase my dose if my blood sugar is high after certain meals.Anyway at present I take 3 fast acting doses of 12ml before meals and 22ml of slow release early evening.Is this a lot or a little amount of insulin?....I guess I am concerned about the amounts I am taking as they have been put up several times and I am worried I will have nowhere to turn if I just keep upping them.The amount I am taking still does not seem enough as my blood sugars are still higher than they should be and i still feel worn out constantly.Please excuse my ignorance and thanks in advance for any replies.
All the best Richard

 

[phoenix]

Hi,
The amount of insulin people need varies according to age, sex, weight, amount of insulin resistance, hormones, activity levels, sickness (and for some of us even the weather) As you are fairly recently diagnosed as T1 your needs may also be somewhat errartic.
This chart shows the types of amounts that are typical for basal needs in T1.
http://static.diabetesselfmanagement.com/pdfs/DSM0705_064.pdf
It's quite often suggested that basal should supply half of your total daily dose and bolus the other half. This is assuming a 'normal' carbohydrate intake.
However, those who are very active and those in the first five years after diagnosis of T1 may find that they use a lower proportion of basal.
People who eat very low carb diets, teenagers and people with insulin resistance may need a higher percentage of basal insulin.

It really varies a tremendous amount some people with LADA (a gradual onset T1) who still have some of their own insulin working may use only few units of basal at the start, some people with severe insulin resistance may end up on hundreds of units of basal.

The total bolus you use will, if you dose adjust vary from day to day according to your meals (crudely according to the carbs you eat but most people find that meals different amounts of fat/protein cause variation of bolus needs . You learn by experience what sort of dose the normal meals you eat require)
I found it invaluable to weigh foods contain starchy carbs and make good estimates of the carbs in other foods so that I could get an accurate carb count for the meal. I kept good records of meals/time/glucose levels/insulin doses. It's a faff and nine years later I don't keep such detailed records (still weigh starchy carbs at home though). The faff was well worth while as it really helped me to understand how to use insulin effectively to control my diabetes.


( How much is a lot?
There some people with a rare genetic condition that makes them very insulin resistant and very thin because they can't store fat. These people have been known in the past to require 2000 units a day to control glucose levels : now that's a lot! Fortunately these people now have other treatments that can help)

 

[mo1905]

I'm not too sure what you would consider a lot as there are many factors to consider, mainly what foo you eat and how much. It's probably better to think of it as ratio's. DAFNE educators assume the average ratio is 1 unit of insulin per every 10g of carbs. There will be some that use less or more but I wouldd say this is the avg though.


Sent from the Diabetes Forum App

 

[Daibell]

I agree with the other posters. Your number of units are somewhere in the 'middle' i.e I have seen other posters taking very large units. This tends to happen more if you are overweight and insulin resistant; if so reduce the carbs you have. BTW your nurse, quite correctly, is suggesting you modify your dose depending on the meal content. This is called 'carb-counting'. So as you get used to the injections you should vary the 12 unit dose to keep the after meal blood sugar in the right range. Make changes in small steps and use the meter to guide you. Talk to the DN if not sure. Taking too much insulin can result in a hypo as you probably know but won't in itself do harm.

 

[noblehead]

As ever a great reply from Phoenix.

As Mo says you inject insulin according to the carbs in your food and the starting ratio is usually 1 unit to 10g of carbs, so if this was your ratio throughout the day at each meal-time you could reduce your carbs slightly for each meal which in turn would reduce your insulin doses. Say you eat 70g a carbs for breakfast, 80g for lunch and the same again for your evening meal, by cutting back 20g from each meal would mean your reducing your insulin by 2 units, which would be 6 less units a day.

Another good tip is to keep active, exercise makes us very sensitive to the insulin that we inject and exercising after a meal can reduce insulin doses by as much as a half, I walk my dog for an hour every evening and inject half the amount of insulin than I would otherwise if I was sat watching tv (but do ask your DSN about reducing insulin for exercise beforehand) so this also might be something you may want to consider if your concerned about increasing insulin needs.

As everyone says it's early days yet Richard and I wouldn't be too concerned until things settle down, once your bg is stabilised I would enquire about a carb counting course such as DAFNE, there's also an on-line version of it here which you might want to look at:

http://www.bdec-e-learning.com/