Increasing basal on low carb

What are your 2 hours post-meal readings like? If they're consistent with your next pre-meal reading, then it's probably your fast acting insulin that needs increasing. To find out if your basal is wrong, don't eat or inject at least 4 hours before bed and compare your before bed and before breakfast readings. If they differ by more than 1.6 mmol/l then adjust your basal by 10% for each 1.6 mmol/l change.

Not sure what you mean by "taking your novo 2-2.5 hours post meals"? Did you mean 'taking' BG?

To follow Spiker please explain taking your bolus 2 hours after your meal? If that's what you are doing that's quite strange; ordinarily one would take it before or with the food.

Other couple of thoughts; your morning ratios may be different to your evening? I need much less insulin to carb in the evening. Perhaps you could do with taking more bolus in the morning?

I assume that you are taking the bolus even for 'no carbs' foods like bacon and eggs? You'll need to; see Sam on the 'Chinese Restaurant Effect'.

Lantus never agreed with me; it certainly didn't last 24 hours; perhaps swap to Levimir and split the dose?

I'm a bit worried about you saying you don't have time to test a suspected hypo! That's crazy; if you may be hypoing that takes precedence over everything. You know; better safe than dead and all...

Lastly, it's unlikely to be a rebound high; those, if they happen at all would be very high (think 20's rather than 8's).

Best

Dillinger

Hi BellaBella!

I'm glad you're enjoying low-carbing. I've looked at your profile but can't see any detail about how long you've been diagnosed etc, so it's quite difficult to advise as I don't know your general exeperience with diabetes and dose-adjustment. However, I'm a little uneasy about some of what you've said in your post, so a couple of insulin-using low-carb principles:

1. Basal should normally be used to keep levels stable - not to try to cover meals. There are some good exceptions to this; notably some low-carbing LADAs who are still producing sufficient insulin to not need bolus insulin for low-carb meals. This group will often use the basal partially to supplement their own insulin production, but they are relying on the fact that their own insulin is strong enough. It is not an approach that would work well for full Type 1s. Another exception would be where your basal is an intermediate acting insulin such as Insuman or Insulatard - these have a strong 4 - 6 hour peak action which can be timed to cover or partially cover a low-carb meal - again, it tends to work well for certain LADAs or Type 2s who are supplementing rather than replacing their own insulin.

2. Rapid-acting needs to be taken with the meal generally. Your BG will start to rise just because you are eating - whatever you are eating - so you need to take some insulin to stop the rise. However, with some low-carb meals you might need to split the rapid-acting dose and take a small dose with the meal to counteract the immediate rise and a further small dose later to counteract a further rise at 4 or 5 hours post meal - that's trial and error I'm afraid.

3. Carb-counting is only part of the story for adjusting bolus doses for low-carb - it is a starting point. You need to add a bit for the protein and probably a small amount just for eating - at least I do! As long as the carb is low, with experience it is usually possible to 'guess' the amount of insulin needed by the size of your meal.

Obviously, as others have said, if you feel a hypo you must test.

Good luck

Smidge

I don't think you would need to take insulin for protein and fat on their own...........

some people calculate an additional value to add on to their meal time bolus.......

novo rapid is far too quick to actually deal with fat an protein.........

Lantus could mop up anything from the fat and protein.......

have you observed an effect from fat and protein....?

Hi Bellabella!

I can see where you're coming from on that and it might work.

The challenge we have as low-carb insulin-dependents, is that taking enough rapid-acting with the meal to cover the whole meal can make us hypo around the 1 - 2 hour mark before the protein releases it's glucose. Waiting to take the rapid-acting to cover the protein spike means we can miss the immediate carb/eating BG spike. The aim is to flatten out both spikes, not swap one for the other. With a normal-working pancreas, you would relese an initial surge of insulin in response to starting to eat and you would get another burst as required until your BGs normalise. Clearly, we can't do that.

I was concerned from your OP that you were taking a full dose with the meal and hypoing before the protein kickend in and then rising higher later when the protein kicked in.

I would suggest that if possible, you send a couple of days testing very frequently - maybe hourly or more if you can manage it - and eating the types of low-carb meals you eat regularly to try to build up a pattern of what your BG is doing. This might help you to match the insulin timings to your BG patterns.

Good luck.

Smidge