insulin dose adjustment

[scotchpie]

Hi Guys!
I was diagnosed as T1 ealier this year and have'nt had much luck controlling it as yet. My quaterly meetings dont seem to be a lot of help as there is always so much to take in while being ushered from room to room and i am only allocated 10mins with my dietitian.
I've read bits about dose adjustment and have been having a crack at it by myself (without advice) as having a fixed dose for every meal was either to little or sending me straight into a hypo.
Most of what i've read seems very confusing and seems to use kilograms and other units of measurement that i'm no good at.
I've kinda gathered that i should take 1 unit of insulin for every 10 grams of carbs but thats all i know.
If there is'nt a carb listing on the packet i.e. if im making yorkshire puds or a lasagne or anything homemade i am clueless as to how i should work out the carb content for that meal, which has resulted in a keen cook eating more processed rubbish than ever before, purely so i can know what dose to take (roughly, lol).
Also when i was prescribed isulin in march i was advised to take 18 units of long acting per day which i have always found to be too high (nightime hypos, waking up with really low sugar levels ect) so have recently lowered my dose to 15 units and am waking up at a fairly constant 7. Is this ok?
I know you have probably been asked about all this before but if you could offer me some advice i would be really grateful. (even more so if you could avoid using kilos!)
I'm 37, approx 11 stone in weight and using lantus long acting and apidra fast acting insulin and have glucogon in the fridge.
Cheers much in advance,
Dave. :?

 

[kegstore]

Wow, where to start eh Dave?! There's definitely a lot for you to take in initially but well done for finding this place.

Dose adjustment: firstly weigh everything you eat, and with the help of a Collins Gem carb counter book (or equivalent/similar), work out how much carb you'll be eating. If you are preparing dishes from a recipe with multiple ingredients, you'll need to do this to add up all the carb components to work out the total. You'll probably need a calculator, I certainly do, but you can't get away from grams I'm afraid! This will soon become second nature to you.

A ratio of 1:10 is not a bad starting point for your insulin/carb ratio, but you may soon find that yours is slightly different, and that it may also vary throughout a 24 hour period: I have 3 different levels, 1:10 in the morning, 1:12 in the afternoon and 1:14 in the evening, which makes a significant difference to insulin requirements during a day.

Night time hypos: you could try splitting your Lantus dose so you take half every 12 hours instead of all every 24. Some have found this smooths things out a bit. You may want to discuss this with your healthcare team first. A waking level of 7 is not bad but it could also be better.

 

[iHs]

Hello

As Kegstore has said, although a 1:10 carb ratio is ok as a starting point, many people find by doing bg tests every 2-3hrs, making a note of how many grams of carb they ate, how much bolus insulin they injected, that they can then work out how much insulin to carb they need at different times of the day. That is the best way to figure it all out If you can, try to keep yourself eating food that you know the exact grams of carb content it has for a while until you can figure everything out. Don't worry if you find that you need a lot more bolus insulin to cover 10g of carb. A lot does depend on how much basal insulin you also inject and at what time. Using Levemir, my insulin to carb ratios are 1:3 at br, 1:5 lunch, and 1:3 evening meal. This is mainly due to how my body reacts to the effect that Levemir has as a background insulin. You might be different.

Although Kegs has mentioned splitting the Lantus dose into 2 amounts, you could try staying on one dose and give yourself an extra unit of Lantus. You might then be able to wake up in morning with a bg between 4-7 which would be better. You will learn as you do along - everyone does :wink:

 

[leggott]

Hi,

I had the same problem as you when my 2 kids were diagnosed. I always cooked home cooked foods but when they were diagnosed, it was so much easier to use convenience foods as it was all on the label. I spent enough time working out carb ratios and monitoring them let alone have to cook as well! After a few weeks when i got my head round it all I went back to cooking nutrious meals. If for instance you make a lasagne, just right down the total carb of everything you put in and then work out an individual serving ie. quarter, third etc. Once you have made it, just repeat the recipe each time so you won't keep on needing to work it out. I know it's a pain to start with but it does get easier. For a lasagne you will need to weigh/measure the flour and milk in the white sauce, the tinned tomatoes in the meat sauce and of course the lasagne sheets themselves (all of which should be on the packets). If you can't be bothered to do this then just use the carb value of a ready made one, as it is probably similar to your own. If you go to most supermarkets internet shopping web sites they have the nutritional values of all foods listed.

If you haven't got one already, then a little pocket carb counting book is a must. You can get them for only a few quid and they give all carb values of most food.

Happy cooking!

 

[Celtic.Piskie]

The pocket books are a godsend.

Personally, i don't walk around with a caculator. With natural oods especialy the individual vegetables can vary a lot in their content, so working it out too much is pointless, as one carrot is different to another.
The books have a good average. One lasagne isn't goint to be that much different to another, so cook one and use the values in the book.

You'll soon learn what carb ratio you need during the day. Trial and error is the only way, so dont worry too much about it while you're getting to grips with it.

Good luck.

 

[CiaraJansonFan]

The pocket books are a godsend.

Personally, i don't walk around with a caculator. With natural oods especialy the individual vegetables can vary a lot in their content, so working it out too much is pointless, as one carrot is different to another.
The books have a good average. One lasagne isn't goint to be that much different to another, so cook one and use the values in the book.

You'll soon learn what carb ratio you need during the day. Trial and error is the only way, so dont worry too much about it while you're getting to grips with it.

Good luck.

According to my dietitian, the ONLY vegetables you should take into account are potatoes. She showed me a food chart and asked which foods I was injecting for - I too was using insulin to cover other veg, but she told me that was wrong and gave me the DAFNE CPs book which doesn't list any veg except potatoes!

Just thought I would comment

 

[cugila]

What sort of idiot would tell people to ignore Carbs in Vegetables...... :shock:

Just take a look in any carb counting book you care to name and check out the carb content of the individual portions of Veg.

It ranges from nil to 68.6g carbs per 100g weight. It all depends on the Veg you choose. If like me you have two or three veg then the carb count adds up considerably, so any calculation you may have made goes out the window if you ignore the carbs in Veg. Simple !!

 

[Celtic.Piskie]

Carbs are found in most veggies, and fruits.

A decent carb conting book should have all of them listed.
Personally, i eat a lot of yam / squash / root veggies.

There are carbs, you do have to take them into account......
I'd love to speak to that dietician and ask her about the magical non-carby carbs

 

[CiaraJansonFan]

Hmm, what do they tell you on the DAFNE course about veg? :?

 

[cugila]

I have no idea....does anybody here know...... :?:

 

[CiaraJansonFan]

What sort of idiot would tell people to ignore Carbs in Vegetables...... :shock:

Just take a look in any carb counting book you care to name and check out the carb content of the individual portions of Veg.

It ranges from nil to 68.6g carbs per 100g weight. It all depends on the Veg you choose. If like me you have two or three veg then the carb count adds up considerably, so any calculation you may have made goes out the window if you ignore the carbs in Veg. Simple !!

Well she seemed to know her stuff to me! Who told you to include ALL veg?!!?

OK then, from my Collins Gem Carb Counter, which I was using before I saw her last month (when she gave me the DAFNE Carb Portion List book):

Carrots: 80g, boiled - 3.5g carbs
Cauli: 100g, boiled - 2.1g carbs
Leeks: 100g, boiled - 2.6g carbs

I don't understand why you would inject ANY QA insulin for the above?!!? :shock:

So which veg has 68.6g per 100g? Potatoes (100g boiled) only have 17.8g carbs...

Don't get me wrong, this is all fairly new to me, but I really don't see where you're coming from - sorry! :?

Steven

 

[CiaraJansonFan]

Carbs are found in most veggies, and fruits.

A decent carb conting book should have all of them listed.
Personally, i eat a lot of yam / squash / root veggies.

There are carbs, you do have to take them into account......
I'd love to speak to that dietician and ask her about the magical non-carby carbs

Well yam, yes - my DAFNE book DOES include that - 100g, raw, 3 CP i.e. 30g

Squash though - 1.2g carbs per 75g boiled (Collins book) - why would that need insulin? If you're using a 'standard' ratio of 1 unit:1 CP, you wouldn't inject any QA for less than 10g carbs would you!

Steven

 

[cugila]

Hi Steven.

It is not the individual portion it is the TOTAL amount of carbs you are going to eat which is on your plate !! That is the amount you should be using to make your calculation.

A meal could total something like 30+ carbs. You MUST include all the carbs you will consume.

If you don't want to take the advice, feel free. I am not going to change what I tell you. Neither am I going to answer every indivuidual point about carb values of vegetables. It is in the carb counter book, look it up ! :roll:

 

[CiaraJansonFan]

Hi Steven.

It is not the individual portion it is the TOTAL amount of carbs you are going to eat which is on your plate !! That is the amount you should be using to make your calculation.

A meal could total something like 30+ carbs. You MUST include all the carbs you will consume.

If you don't want to take the advice, feel free. I am not going to change what I tell you. Neither am I going to answer every indivuidual point about carb values of vegetables. It is in the carb counter book, look it up ! :roll:

I can't look up carrots in the DAFNE book - it doesn't exist! Neither does most veg, the exceptions are potatoes, yam - well that's about it actually! I think I need someone who has been on the DAFNE course to tell me what they say. I'm going to ask to be put on the waiting list but it might be a while

I'm seeing her again on Thursday - I'll tell her you think she's an idiot and see what she has to say :lol:

Seriously though, that's what I USED to do - add up potatoes, carrots, cauliflower etc. - until she told me that was wrong. She's a professional who works for the NHS, who am I to argue?!!?

So is that what your dietitian told you, add up everything?

Cheers

 

[CiaraJansonFan]

Hi Steven.

It is not the individual portion it is the TOTAL amount of carbs you are going to eat which is on your plate !! That is the amount you should be using to make your calculation.

A meal could total something like 30+ carbs. You MUST include all the carbs you will consume.

If you don't want to take the advice, feel free. I am not going to change what I tell you. Neither am I going to answer every indivuidual point about carb values of vegetables. It is in the carb counter book, look it up ! :roll:

I can't look up carrots in the DAFNE book - it doesn't exist! Neither does most veg, the exceptions are potatoes, yam - well that's about it actually! I think I need someone who has been on the DAFNE course to tell me what they say. I'm going to ask to be put on the waiting list but it might be a while

I'm seeing her again on Thursday - I'll tell her you think she's an idiot and see what she has to say :lol:

Seriously though, that's what I USED to do - add up potatoes, carrots, cauliflower etc. - until she told me that was wrong. She's a professional who works for the NHS, who am I to argue?!!?

So is that what your dietitian told you, add up everything?

Cheers

 

[cugila]

Steven.

Tell your dietician what you like. I'm off down the pub for a Pint of Guinness.... :twisted:

 

[sugarless sue]

( Moderators now having nervous breakdown!!! :? :? :? We have gone to lie down in darkened room ,please do not disturb for several days!!)

 

[scotchpie]

Oh my good gravy i've started a war over carbs :lol: :shock:
I went on a fact finding mission to a local frozen food store this avo and as many of you said, veggies do contain carbs in varying degrees. I think that as frozen veg is apparently every bit as good for you as fresh and it has the carbs per 100g on the back of the packet i'll settle for them in the future! :wink:
I had a bit more luck working out my insulin-carb ratio for dinner tonight, it seemed to work well but does a ratio of 1-13 sound rediculously low to anyone? :?:

 

[CiaraJansonFan]

Oh my good gravy i've started a war over carbs :lol: :shock:
I went on a fact finding mission to a local frozen food store this avo and as many of you said, veggies do contain carbs in varying degrees. I think that as frozen veg is apparently every bit as good for you as fresh and it has the carbs per 100g on the back of the packet i'll settle for them in the future! :wink:
I had a bit more luck working out my insulin-carb ratio for dinner tonight, it seemed to work well but does a ratio of 1-13 sound rediculously low to anyone? :?:

Not really - I'm currently using 1:15 at breakfast and lunch/dinner, 1:10 at tea time (yes I'm from up North! )

Of course I could be completely wrong about that too, but so far it seems to be working OK :lol:

 

[kegstore]

Don't worry scotchpie, the war is never-ending, this is just another battle!!!

As someone who obsesses about carb counting (because I have to), it is worth listening to cugila's advice about the total carbs you're eating in one sitting, because he's absolutely right. There are few vegetables that don't have ANY carb content and it all adds up, even the small numbers. I know this partly from reading, but also by weighing, eating and testing blood glucose levels repeatedly.

If you're not worried about incorrectly estimating carb intake by 10-15g a sitting, you really shouldn't be worrying about a minor thing like good glycemic control. For some people (oh yes and me actually), 15g of carb can mean the difference between 5 and 8mmol/l. I know where I'd rather be...