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Insulin dosages?

C

chocoholic

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United Kingdom
I know the answer might vary enormously but what ratio of insulin to carb. are Type 1 folk on, please?
Since changing from Novomix 30 to Novorapid and Lantus a fortnight ago, I've been put on 0.5 Novorapid for every 10g carb.(With 6 units of Lantus at night). Trouble is sometimes my intake of food seems to fall in the category of needing 1/2 measures and my pen doesn't do half measures. If you are in this situation do you up or down the dosage? I know the ratio seems small but it more or less matches insulin intake I was on before, so I thought it was spot on. First few days my fasting readings were in the 5's, now they've worked their way up to 8.1 this morning and last two pre-bed readings have been 10.7 and 11.1 which I'm not at all happy with. I wondered if the Lantus is not lasting the full 24 hours or if I just need to up the dose by two units. I'm going to sit tight to see how things pan out, as it's early days but my dietician says if morning reading is okay to try taking my Novorapid AFTER my evening meal, to see if that works. Does anyone else do this, as I've never heard of anyone taking insulin AFTER a meal?
I just wondered if my doses seem too low to others on the forum.I've been told to test 4 times a day.... before meals and bed but I want to test 2 hours after more too, to see what's happening and although my surgery has upped my test strips from 50 to 100, testing 7 or 8 times a day would use those up in no time. They gave me a box of 50 from the hospital pharmacy when I left but they were faulty and blood wouldn't seep onto strips properly. :roll:
Sorry to waffle.
 
Hi chocoholic,

A few things ocurred to me. You can now get pens for both Novorapid and Lantus which can deliver doses in half units (I've got them for Humalog and Lantus). They do seem to help with the fine tuning.
With Lantus I'd suggest you split the dose. It appears to have a variable half-life in individuals, but is often reported as lasting as little as 18-20 hours. Splitting the dose helped me too.
Taking Novorapid after you've eaten sounds plain nuts to me. Why did your dietician suggest that?

All the best,

fergus
 
Hello chocoholic,

My current novorapid/carb ratio is 1 unit for every 15g. People seem to vary quite a bit.

Your exact carb/insulin ratios may vary slightly throughout the day. If your lantus is tailing of
too soon, this effect can be exaggerated.

As Fergus said, lantus seems to work better in a split dose, 12 hours apart. You can also alter
the ratio of AM/PM lantus to what suits you best.

All the best,
timo.
 
Hi

Not really an expert on this but with me my ratios differ depending on the meal time, I am still trying to play around and work them out exactly. I have heard that they usually start people on a 10g to 1 unit. I have a spreadsheet on which I (rather sadly :roll: ) note my bg, carbs and insulin amount and then having found a rough pattern I calc my insulin using that particular meal time ratio and then add adjustment doses (or take a couple off if after exercise) It kind of seems to be working!

Louise
 
Hi Fergus,
Dietician suggested taking Novorapid after meal because of my double figure late night readings. For the life of me, I don't know why but that's why I thought I'd ask the question on here.
I did ask about splitting the Lantus and although she agreed some people do that she wanted me to try as above first.
 
Hi Troubr.Do you mean your ratio changes throughout the day or your dosage of insulin? Obviously my dosage varies throughout the day but the 0.5 to 10gm ratio I supposed to stay the same at all times.IYSWIM.
 
Hi Timo,
Missed your post before but I am confused now. It seems, like troubr, you are saying that your ratio(1 unit for every 15g) does indeed vary throughout the day. I had no idea about the ratio having to be changed at all and thought that was supposed to remain constant, unless upped or downed as a permanent adjustment. Sorry, I'm not explaining myself very well, am I?
I'm beginning to think it was easier on Novomix30!
 
Hello chocoholic,

Yes, your novorapid/carb ratio may well vary slightly between breakfast, lunch and dinner.
If your basal insulin isn't working evenly, the variation will be even more noticeable.

Regards,
timo.
 
I was told to take my Humalog directly AFTER a meal so I could calculate the dose for the meal I had eaten, because if you took your insulin BEFORE and for some reason did'nt eat all of the meal (didnt like it, was put off it etc) you may have taken too much and go hypo.......suppose theres logic in it somewhere...lol
 
Hi chocoholic. Your basal rate seems quite low to me. My little boy who is only 4 is on 4.5 units of levemir at night so your 6 units seems quite low in comparison. I have had to increase his levemir by a whole unit recently because he is coming out of his honeymoon period. Maybe your lantus needs to go up a bit if you morning BG's are a bit high. That is exactly the problem we had with Ben and it coursed the rest of his Bg's to be high throughout the day. Now finally getting back on track. Try increasing lantus slightly tonight and see what happens in the morning. By the way my son has all of his injections after eating. Makes it easier if he is having a picky day and therefore he won't hypo later on.
 
If you dont want to do another injection of Lantus in the morning you can compensate for Lantus's shortfall by increasing the Novorapid. By doing this, you will need a low dose Novo at BR, then at lunch you can increase the bolus up a bit and then for evening meal you will then have to increase the Novo up by a fair amount even though you might not be eating that much carb. This will then allow for Lantus's action to tail off from lunchtime onwards. You should be able to get fairly good control by doing this but it will make these insulin to carb ratios go a bit out of the window lol.
 
Thanks for all the advice folks.I thought I was doing so well after the first couple of days of changing over but now I'm just starting to get in a tizz again, as I don't know how the hell I'm meant to know if it's ratio or dosage to adjust.I suppose that's why the dietician has given me sheets to fill in, ready for HER to make adjustment but that's not until end of November. She's great at answering my emails but I suppose I'm just impatient. I want the near perfect readings I had up until a fortnight ago. I'm going away this weekend and am trying to pluck up the courage to take my new nutritional scales with me but hubby reckons they'll think I'm an inspector at the hotel, if I start weighing things at the table. I'll probably chicken out and just take my Collins little carb book instead. :lol:
 
It sounds to me very much as though your basal regime needs adjusting. If it was set correctly, you wouldn't expect to see your bs rising so high late in the day. If, like many people, you take only 1 dose of Lantus at bedtime, it has run out by the following evening and so your bs goes up.
If you decide to split your dose, it isn't necessary to separate them by 12 hours if that doesn't suit you. I split before bed and first thing in the morning and this seems to give good coverage over 24 hours.
I wouldn't recommend using short acting insulin to fill the gaps in basal coverage because you will run a much greater risk of hypoglycemia. Also, if you inject after you have eaten, your bs will rise abnormally high and the insulin will have to chase it down for hours afterwards - highs and lows, not a clever idea!

All the best,

fergus
 
I read elsewhere that a good split for Lantus is 40%/60%. Is that what you do, Fergus or do you do a 50%/50%? For instance If I split my dosage and have bedtime one at 11.00 and morning one at 8.00, will that last long enough through, one to the other? Sorry to ask so many questions.
 
Hi chocoholic,
I use 5 units of Humalog at bedtime and 3 the following morning, so I guess that's a 60/40 split? The smaller doses will last just as long as they do at present, but spread out over 24 hours you'll get much better coverage.
If you give it a try and it doesn't fix the problem you may need to use a slightly bigger dose in one of the splits, depending on which time of day is giving you a problem.

All the best,

fergus
 

I think you mean Lantus dont you Fergus??
 
D'oh! Quite right iHs, I'll go and stand in the corner!

All the best,

fergus
 
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