Need help

Hi and welcome. I can only guess that you are having too many carbs? This will casue weight gain, insulin resistance and less stable insulin units. If you aren't already keeping the carbs down I would set a daily limit of less than 200gm and possibly quite a bit less. Use the meter to see how you are doing and you may need to reduce your insulin to avoid hypos. Yes, you need to seek guidance from your GP/DN. My DN told me to adjust my once-daily Levemir to have a fasting blood sugar level of between 5 - 7 mmol. There are more accurate ways of adjusting but I find this is good enough for me. I think you will find your rapid carb ratio has to be determined by trail and error starting at 1 unit to 10gm. Adjust it slightly and see what the meter says after 2 -3 hours for a few meals. Some people find it varies during the day possibly due to the Basal not lasting for 24 hours? The 'correction dose' formula should provide a guide to the blood sugar reduction for 1 shot of rapid. I can't remember the formula but you should find it on this website or Google it

Can you give us an idea how much total insulin you are having altogether in dsy for your bolus, corrections and basal please?

Hi @Ben_Eaton

welcome to the forum

i was speaking to another member a few days ago on the subject of insulin ratios and wrote the below response -- i have copied and pasted it
as @Daibell said it is important to speak with your D care team
you do need to start by getting your basal right first -- this is done by not eating ( sorry) and not taking fast acting for an extended period of time - there are topics on the forum on this subject
normally the medical peeps do start you off at 1 unit per 10 CHO and to make adjustments you need to employ your carb counting skills and trial and error
i have put an example of a meal below and the differing amounts of insulin that would be taken depending on ratios
also your Pre meal BG matters in case a bit high and you need to factor in a correction as well


i will now bore ( or enlighten ) you with an example

meal as follows
chicken curry and rice with the following ingredients

chicken portion 150 grams ( 0 CHO ) mushrooms 75 grams cooked weight ( 2 CHO) onions 50 gram cooked( 7 CHO) cauliflower 55 grams cooked ( 2 CHO) sauce - bought from jar values 200grams ( 17.5 CHO) basmati rice 150 grams cooked ( 47.4 CHO)
total CHO = 75.9
so @ 1u per 10CHO this = 7.59 u if you had a 1/2 u pen 7.5 u
@ 1u per 15CHO this = 5.06u
@ 1u per 7.5CHO this = 10.12u
@1u per 5CHO this = 15.18u

as you eat this meal and test at 1 hour , 2 hour , 3 hour , 4 hour , and 5 hour post bolus you will see what your blood sugar does
through much trial and error over the years on MDI my ratios are about 2.4u per 10CHO in the morning , 2.5u per 10CHO at lunch , and 2.2u per 10CHO at tea time.

my lantus is 30u at 6:30 pm

Welcome to the forum Ben

Hopefully your diabetes team will get back in touch and advise you accordingly, but if you want help in trying to make sense of basal testing then have a read of the following:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

To help with your carb counting skills and to work out how to adjust your insulin to the food you eat do take a look at the BDEC Diabetes Learning Programme, it's an on-line carb counting course similar to that what is taught on the DAFNE course:

http://www.bdec-e-learning.com/

Hi Ben
thanks for the fairly detailed spread sheet -- that is extremely useful as it tells me quite a bit.

1 -- i think you need to start at the beginning at basal test - when changing basal a change must be accompanied by 3 days of checking results before adjusting basal again
2 - your ratios @ 1u per 10CHO don't look spot on but basal must be done first
3 - ratios -they can change during the day
4 - as for carb counting are you confident and precise or adequate ?? honest answers please -- LOL

a handy book for carb counting available on amazon link found here
http://www.amazon.co.uk/gp/offer-li...r?ie=UTF8&condition=new&sr=1-6&qid=1421930890

and by the way -- higher blood sugar readings will leave you feeling lethargic and tired

Ben_Eaton said:

E.g. Pre-dinner my blood sugar was 7.4
I had 90g of carbs, so I actually took a few extra units and injected 12 rapid units
Dinner was just after 8pm.
My blood sugar at 10pm was 11.6
A bit p!ssed off, I injected my Lantus and then also did 2 units of Rapid to counteract the hyper sugar.
I tested this morning, for it to be a whopping 18.3.

As I said, I am requesting an appointment today, as I am obviously doing something wrong here!

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Ben, these BGs aren't good for you. I would really recommend reducing your carb intake. Initially to 150g/day to avoid any drastic results, but after that definitely down to max 100g/day and perhaps 70 or 60.

It's easier to get control with lower carbs, because the wild factor - insulin - is less wild in smaller doses.

As or if you reduce carbs, though, you'll need to monitor and reduce your insulin doses. The one will shrink the other. So you have to do that slowly and carefully. Slowly, like allow at least four days between each basal insulin dose change.

So many people have been thro this. Things that may help:

The Diet Doctor: a slightly zany Swedish doc who runs a good website and is very encouraging. What he says is reliable, and apparently he answers emails. http://www.dietdoctor.com/

A web page called Blood Sugar 101, run by Jenny Ruhl, who reliably summarises the available technical literature and presents it. She is reliable. Here is her nutritional calculator, which I keep droning on about but because it has saved me. You enter your vital statistix, then try out various levels of carb and see what that would mean for the rest of your diet, then see if any of it attracts you. http://www.phlaunt.com/diabetes/33614154.php

Her whole website is good. (Despite the awful look of the layout.)

And read Think Like a Pancreas. It's available on Kindle also for downloading to iPads etc, even if you don't have a Kindle. It's reliable, written in ordinary English, and superb.
http://www.amazon.co.uk/Think-Like-...1932575&sr=1-1&keywords=think+like+a+pancreas

There are answers to all of your problems. You just need some information.

Good luck, of course.

The other thing to bear in mind is the food you are eating in the evening. The majority of T1s on here will testify that high carb/high protein/hghi fat in combination has the effect on your glucose levels of pushing them up much later than you anticipate, so while you may be bolussing for the initial glucose spike, you tend to get a delayed action as well.

I'm with the others on undertaking a basal test though. As mentioned in another thread, when it all starts to fall apart, treat it systematically. Start with your basal and once that's good you can reassess your bolus.

himtoo said:

a handy book for carb counting available on amazon link found here
http://www.amazon.co.uk/gp/offer-li...r?ie=UTF8&condition=new&sr=1-6&qid=1421930890

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Carbs & Cals is a great smartphone app. I didn't fancy carrying a physical book around with me and I use this all the time. I got the paying version. I customised mine by adding various foods/dishes etc under My Foods. I'm a pedant, so I put in lots of foods from the US Dept of Agriculture food database . That database has American measurements, so you subtract the fibre from the carbohydrate to give what a UK source would say was the carbohydrate content.

Have a play with it. People also mention myFitnessPal, but I didn't like it.

Good on you for climbing back on the wagon again.
If your diabetes team run a DAFNE or similar course, ask if you can do it. I found it a huge help to me after trying for too long to get a handle on things myself.
It can feel overwhelming at times looking at results and wondering where it all went wrong. Look for trends in your overall results, certain areas of the day where things are swinging higher or lower. As others have said, basal testing first off to help get that sorted, then moving on to boluses should help iron things out. And if in doubt about anything, ring your DSN, they are there to help.

Good luck!

Hi Ben sorry about the book recommendation -- i keep forgetting about modern technology -LOL
been doing it for 42 years

that is a fair jump in 90 minutes but it is also important to test at 4 hours after bolus and 5 hours as well as that is how long the fast acting will be around in your system.

good that you have an appt with DN

Ben_Eaton said:

Thanks again, all.

I was going to download the Carbs & Cals app, as recommended by one of my DN's. There was numerous bad reviews, recently so I held off paying for it.
I agree, much easier than having a book. Plus the app will be updated, whereas book will not.

My blood was 7.1 before lunch, and I had 77g of carbs. Based on NOW using 1.5 Units : 10g Carbs, I took 12 units (Rounded up).
I don't think that was an overly high amount of carbs.. yet my blood in an hour and half has over doubled to 15.

I have a confirmed appointment with my DN tomorrow, and she is aware I am having trouble.. She has said "DONT PANIC, WE'LL SORT IT TOMORROW". So fingers crossed, I get even more guidance tomorrow.

Really impressed with the responses so quickly. I will be sticking to this forum. Thanks again.

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Please let us know how you get on with your DN..

indeed -- do keep us posted !!