Type 1 Insulin dosage

[Carl W]

Hi guys. Just a quick question, Firstly I’ve only been on insulin for about 2 months or so and I’m carb counting etc, and the dosage I’m using is 1unit for every 10g carbs, what I don’t get at the moment is if something is say something is 50g carbs of which 50g is sugars how would I dose that? I’m only asking because when I’ve eaten or drank something when the carbs match the sugars my blood reading 2 hours later is still quite high. TIA

 

[miahara]

Hi @Carl W . Forget the 'sugars' all you need to think about is 'carbs' as they are what you need to take into account as the 'sugars' are just a part of the overall carbohydrate intake.
You really need to keep a diary of your carb/insulin regimen to see how things are going as you'll find that your carb:insulin ratio can vary quite markedly during the day. I need very much more insulin per carb at breakfast than I do for my evening meal. From what you say it seems like you need to try upping your insulin a bit. The 1:10 ratio is just a ballpark generalisation and a starting point for further experimentation. Try upping insulin for a few days and see what happens.

 

[EllieM]

Hi @Carl W
As @miahara said, the 1 unit for 10g rule is the standard starting point for insulin dosing. Some people only need 1 unit for 20g, others might need 1 unit for 1g. It's very much a personal ratio that can vary by time of day and change over the years too. Most people try to get their basal dose right first and then (carefully) adjust their bolus ratio. (Because if your long acting insulin is wrong you can't tell whether you are going low or high because of it or because your short acting insulin).

I'd really really hope that at two months in you are still having frequent contact with your diabetic team so that they can help you work out how to adjust the ratios. If you up the insulin too much you can end up with hypos so it needs to be done very carefully. I'd strongly recommend talking to your team for advice.

Good luck

 

[In Response]

Hi @Carl W
The other thing to remember is that fast acting insulin is not that fast. It is still active after 4 hours. So, after 2 hours you still have fast acting insulin that is active in your body.
The advice to test 2 hours after eating us for people with Type 2. If you are using insulin, given the life of fast acting insulin, the 2 hour rule is less important.
Different food is digested at different rates but our insulin has a fixed profile. In an ideal world we would try to match the peak for carb digestion with the peak of the insulin profile. This is not easy unless you eat the same thing in the same environment every day. But you may find the BG peaks faster with high sugar content foods. You could overcome this by prebolusing earlier.
But after 2 months, I would say focus on the 4 hour level and don't get too hung up on spikes in between.

 

[Carl W]

Hi @Carl W
As @miahara said, the 1 unit for 10g rule is the standard starting point for insulin dosing. Some people only need 1 unit for 20g, others might need 1 unit for 1g. It's very much a personal ratio that can vary by time of day and change over the years too. Most people try to get their basal dose right first and then (carefully) adjust their bolus ratio. (Because if your long acting insulin is wrong you can't tell whether you are going low or high because of it or because your short acting insulin).

I'd really really hope that at two months in you are still having frequent contact with your diabetic team so that they can help you work out how to adjust the ratios. If you up the insulin too much you can end up with hypos so it needs to be done very carefully. I'd strongly recommend talking to your team for advice.

Good luck

Hi, thank you for replying, I’ve been diabetic for 3 years this month now (I think) but only been on insulin for the past 2-3 months, my team isn’t great I’m afraid, I have a phone appointment in about 3 weeks, but other than that I’ve had to google dosages etc myself, and at the moment it seems to be working for me, I check every 2 hours as I drive for a living and just want to keep tabs on it. And everything is recorded on the contour app too.
So maybe I may need to up my dosage again of the tresiba maybe? I’m currently taking 35/36 units at night before bed, but it’s depending on what my blood readings are beforehand.

 

[Carl W]

Thanks guys, you’ve all been very helpful. Thank you.

 

[EllieM]

So maybe I may need to up my dosage again of the tresiba maybe? I’m currently taking 35/36 units at night before bed, but it’s depending on what my blood readings are beforehand.

I haven't used it personally, but my understanding is that tresiba is very slow acting (several days) so changing it to try to change short term levels is counter productive. If your levels stay steady overnight then hopefully you're about right on the tresiba. (That's assuming you are going to bed without carbs or short acting insulin in your system). I have heard that you need to wait a few days to see how a changed dose of tresiba affects you.

The idea is that the tresiba holds you steady when you aren't doing anything else.

As for the blood testing, you could ask for a libre next time you visit your clinic, as they are theoretically now rolling them out for all T1s (but don't hold your breath).

 

[Carl W]

I haven't used it personally, but my understanding is that tresiba is very slow acting (several days) so changing it to try to change short term levels is counter productive. If your levels stay steady overnight then hopefully you're about right on the tresiba. (That's assuming you are going to bed without carbs or short acting insulin in your system). I have heard that you need to wait a few days to see how a changed dose of tresiba affects you.

The idea is that the tresiba holds you steady when you aren't doing anything else.

As for the blood testing, you could ask for a libre next time you visit your clinic, as they are theoretically now rolling them out for all T1s (but don't hold your breath).

Ok brilliant, thank you, I’ll ask about the libre, I don’t think my fingers can take anymore to be honest.

 

[becca59]

Hi @Carl W Your dosage of Tresiba should not be dictated by a blood test just before you take it. It is decided on by an overall picture of daily and night time levels. It is the most important aspect of Type 1 management and the trickiest to get correct. Basal testing is important, particularly overnight and is easiest done with Libre, but can be done without. By fasting over a certain time and taking blood glucose level readings. The plan being to stay as steady as possible. As Tresiba is such a long lasting insulin it can take 3 days to react to changes. As you are new to insulin, you really should be able to access support from your team.

 

[JaneC]

One other thing is to experiment with giving a bolus say 30 mins before eating, 50g of carbs which is mostly sugar is quite a big hit and the fast acting ( which really isn’t )doesn’t have enough time to get to peak reactive levels so a pre bolus might help.

 

[Carl W]

Hi @Carl W Your dosage of Tresiba should not be dictated by a blood test just before you take it. It is decided on by an overall picture of daily and night time levels. It is the most important aspect of Type 1 management and the trickiest to get correct. Basal testing is important, particularly overnight and is easiest done with Libre, but can be done without. By fasting over a certain time and taking blood glucose level readings. The plan being to stay as steady as possible. As Tresiba is such a long lasting insulin it can take 3 days to react to changes. As you are new to insulin, you really should be able to access support from your team.

Regarding the tresiba, I was upping my dosage every 3 days by one unit, I think I’ve finally found a good amount of units to inject each night which is 35/36 units, so far for the last week I’ve tested first thing in the morning before work etc and it’s been in a good range so far. I’ve recently asked about the libre and the diabetic nurse said she’d get someone to send a libre 2 out to me. Are they accurate?

 

[Carl W]

One other thing is to experiment with giving a bolus say 30 mins before eating, 50g of carbs which is mostly sugar is quite a big hit and the fast acting ( which really isn’t )doesn’t have enough time to get to peak reactive levels so a pre bolus might help.

My fast acting is fiasp and they’ve told me to take it right before I eat as it’s very fast acting, within 5 minutes they said and drops off after 2 hours, So I’ve been doing just that and so far had no real problems as such, except for the one or two readings that have been highish afterwards…. Thought I’d have to maybe inject a few more units if the sugars matched the carbs.