mrsgreensmith said:
pumppimp said:
Hi Cass,
I have always been taught to do trial and rotor with insulin, so we started with 10 units way back in 2010 and just upped it 2 or lowered it 2 depending on blood glucose levels last time I ate it till it came right, wouldn't really know where to start with carb counting to be honest!
What is .." taught to do trial and rotor with insulin"?
I haven't read all of this long and interesting seven page thread, but I would just like to offer some advise about carb counting, and calculating your Insulin-Carb ratio for each of your meals, since otherwise you may run into hypo type problems.
I have to say that I'm very impressed with the challenge you have set yourself, and I would judge that you WILL succeed since you appear to be well motivated and organised (just like me!). I have been Type 1 for 43 yrs and have had good HbA1c values all my life and as a consequence I'm very well controlled and have NO complications after this long time .... so I do know what I'm talking about. I'm on Lantus/Humalog regime.
Since you are on a basal/bolus regime with Levemir/Novarapid insulin, you must be very careful as you reduce your carbs and not 'just guess' about how much Novorpid by 'taking half the dose', unless you already know exactly what your Insulin-Carb ratio is for each meal.
These are the steps you should go through, but you may already have done some of these .....
1) You must 'carb count' exactly, which I suspect you are already doing. Download and read this booklet...
An introduction to carbohydrate counting and insulin dose adjustment
An excellent introductory document from Diabetes UK that covers all aspects of diabetes, and the method of carb counting, insulin adjustment and insulin-carb ratios is covered in Chapter 2 (Carbohydrates) and Chapter 3 (Insulin). Even if you are not doing carb counting, you should definitely read this!
https://shop.diabetes.org.uk/store/lite ... -book.aspx
2) Basal Testing … how to check your Lantus or Levemir dose is correct This is how to do that ...
In the absence of food, exercise and mealtime/bolus insulin, basal insulin should hold the blood sugar steady. Any significant rise or fall in blood sugar during a fasting basal test probably means that the basal rates need to be adjusted - even if the blood sugar winds up near normal by the end of the test. This is how to check it ….
http://www.diabetes-support.org.uk/info/?page_id=120
3) Adjusting your Insulin when results are too high or too low:
A detailed guide, with plenty of examples, to assist you in making required insulin adjustments. Download it and print it out so it is readily at hand after blood sugars have been made & recorded.
http://www.diabetes-scotland.org/ggc/do ... Change.pdf
4) Calculate accurately the Insulin-Carb ratio (Nova units to cover 10g carbs)
This must be done for EACH meal (breakfast, lunch and dinner), since this can vary during the day. The Ratio I use is defined as "(Nova units/Carbs)/10" needed to get good BG readings about 4 hours after the meal. e.g. Ratio = 5u / 15g / 10 = 3.3
Once you know this ratio for each meal, then it is quite easy to know how much Nova is needed to match the carbs for that meal. The ratio will not change much day to day but since you are planning on losing so much weight, then you will need to recalculate this since it should change (get lower I think) as you lose weight and hence less insulin needed.
5) Calculate the following ratios:
- Correction Factor: How much BG is REDUCED by 1u of Nova to reduce to target of BG = 6. This needs to be added to carbs Nova if BG is too high before meal.
- Hypo recovery: How many quick acting carbs needed to raise low BG up by 3mmol/L. I recommend Bassetts Jelly Babies - each one is 6g carb and for me raises BG by 1.1 within 10-15mins.
- So if BG is 3.5, 3 jelly babies takes me up to 6.8 (3.5 + 3 x 1.1)... with no overshoot. I used to use Tracker Bars or biscuits (easy to carry), since can't stand glucose tablets, but Jelly Babies in a small plastic bag can be taken easily when out etc, and work faster than biscuits and get no overshoot by taking too many when BG doesn't seem to be rising You may know much of this already, and of course it means testing, and recording, quite a lot in the early days, so hopefully you get testing sticks on prescription.
Best of luck and keep us posted on your progress and any other queries you have .....
Jonty