Insulin to Carb Ratios at Different Times of Day

[Cheryl]

I am aware that some people use different insulin to carb ratios for different meals, but have always understood that the general rule is that one is likely to need more insulin per 10 grammes of carb in the morning than at other times.

I am on a pump & have spent a lot of time & effort trying to get my basal rates right, but seem to be high & need to have a correction bolus most nights a few hours after dinner.

My current ratio is 1u insulin for every 12 grammes of carb & this seems to be right for breakfast & lunch. I have analysed my night time readings & the correction boluses that I have had to reduce my BG & on almost every occasion, had I used a ratio of 1u per 10 grammes of carb, that would equal the exact amount of my meal bolus + the later correction.

I'm used to not fitting the mould of a "normal" diabetic as the DSNs are always telling me to do things that just don't work for me.

My question is: Does anyone else use a higher insulin to carb ratio in the evening that at other times?

ps I work normal 9-5 hours, so my body clock should be on standard time.

 

[Snodger]

yes, kind of. I need less insulin in the morning (very unusual); the same carbs at midday need an extra 2 units of insulin; in the evening I'm inbetween the two.
That's the problem with diabetes, what is 'normal' for the general population is quite often irrelevant when it comes to your own personal control. It's so variable.

 

[Cheryl]

I've pretty much decided to change my ratio for my evening meal, the worst that can happen will be a series of early hours hypos & I revert back.

I sometimes wonder where the DSNs get their normal diabetics from; they seem pretty few & far between.

I'm used to bucking the trend as far as how I react to changes in my medication, but at least I'm not alone in perhaps needing less insulin at breakfast than in the evening.

 

[FindingNemo]

I need half the insulin for my evening meal than lunch or breakfast.

 

[Snodger]

I sometimes wonder where the DSNs get their normal diabetics from; they seem pretty few & far between.

yeah... when you read the textbooks about what is supposed to happen, it feels as if it's describing a different disease altogether sometimes.

 

[Cheryl]

Two interesting things happened yesterday.

Firstly, after thinking all morning about changing my ratio for dinner, I applied a ratio of 1u/10grc at lunch time by mistake. This meant that I had 1u more of insulin than I would normally for the carb in my meal. I was hypo 5 hours after my lunch, which experience tells me is about the extent of the active insulin time for me. I then applied the same 1u/10grc at dinner time & was 6.4 at 00:45, pretty good & lower than most nights when I've been 9 or 10 & having a correction dose at that time.

I know it's only one day, but maybe a positive change. I shall soldier on (& try to remember that it's still 1:12 at lunch time!

 

[donnellysdogs]

I was always told by my consultant that bolus's were responsible for highs or lows at 2-3 hours after a meal....and this helped me enormously to watch and time my carb ratios correctly....

I always need more bolus at night because I am then sat on my bum and not so much physically active and the same goes for my basal rates (except the dawn phenomenen)...during the day my ratios are either 1to 10 or 122 but at teatime are 1 to 9.

Quite honest I haven't spoken or met to any pumper yet that has the same rate of carb ratio or correction does for each time period. Although, I guess that someone may now come along and say they do!!!!

 

[iHs]

Most of my basal rates are different for each hour. Only a few are the same... I appear to need a higher basal from 6pm to 11pm and then have a reduced one from midnight to 4am so that I don't go hypo.

My carb ratios are 1u:10g breakfast, 1.2u:10g lunch, 1.1u:8g eve meal

 

[Cheryl]

I know where you are coming from Donnellysdogs, 2-3 hours is the peak time of activity for human analogs (I use Humalog) but when you look at the activity graphs for it they show that it starts working after about 10 mins, hits peak performance at about 60 mins, stays there for the next 2 hours then trails off over hour 3 to 4, but still has some effect, though only a little for another 2 hours. It doesn't leave one's system fully until about 6 hours from infusion. (data from Ely Lilly's own site)

For me, peak hypo risk always seems to be 4-5 hours after a bolus. Different people absorb at different rates of course & I am somewhat atypical (as usual) as I appear to absorb quite slowly. Pumps with bolus wizards allow one to set one's own insulin curve (for the pump's insulin on board calculation) in recognition of this I assume.

I also have to bolus, if possible, at least 30 mins before a meal to try to stop big spikes afterwards. I still spike into double figures every meal, but if I have more insulin, I'm hypo 4-5 hours after my meal.

Thanks for your input, it's useful to know that I'm not alone in being the opposite of what the HCPs tell me is normal...again!

 

[iHs]

I know where you are coming from Donnellysdogs, 2-3 hours is the peak time of activity for human analogs (I use Humalog) but when you look at the activity graphs for it they show that it starts working after about 10 mins, hits peak performance at about 60 mins, stays there for the next 2 hours then trails off over hour 3 to 4, but still has some effect, though only a little for another 2 hours. It doesn't leave one's system fully until about 6 hours from infusion. (data from Ely Lilly's own site)

For me, peak hypo risk always seems to be 4-5 hours after a bolus. Different people absorb at different rates of course & I am somewhat atypical (as usual) as I appear to absorb quite slowly. Pumps with bolus wizards allow one to set one's own insulin curve (for the pump's insulin on board calculation) in recognition of this I assume.

I also have to bolus, if possible, at least 30 mins before a meal to try to stop big spikes afterwards. I still spike into double figures every meal, but if I have more insulin, I'm hypo 4-5 hours after my meal.

Thanks for your input, it's useful to know that I'm not alone in being the opposite of what the HCPs tell me is normal...again!

Cheryl

Although this might mess up your 'true basal rate' on the pump, can you not just increase your bolus insulin and then reduce your basal rates down from the 2 or 3hr mark after you have eaten? This would save you from needing to bolus insulin early in order to prevent the spike that you get later and also prevent the hypo that you get. It just means remembering to eat at set times....... You could also use a reduced TBR and just remember to activate it instead of altering the basal rates.

 

[donnellysdogs]

AAAh, I see where you are coming from...however...to get your double figures away after meals, it may be that you need to have a higher carb ratio>>>HOWEVER>>>>>>lower your basals for prior to the time when you get the hypo's 4/5 hours later. That is what I used to experience the same as you.....but this is what I had to do to over come it. As you say though, what works for 1 doesn't necessarily work for another.

Have you checked what your basal/bolus ratio is working out to be???

 

[Cheryl]

An interesting thought from both of you. I am making/considering a number of changes at the moment & that one may just be a step too far just now, but I will bear it in mind for the future. My life is very varied & I don't think that I could do it on a permanent basal change basis as I find itdifficult to predict when I will eat day to day. I travel for work frequently, get stuck late in the office & mmy weekend routine is non-existent. But perhaps I could try upping the insulin to carb ratio & then setting the alarm clock on my pump to reduce my basal after 2 hours for 2 hours maybe. Hmmm, food for thought.