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Novorapid 120 units prior each meal (120 x 3 times aday ) !!! Help me please !!

Discussion in 'Type 1 Diabetes' started by Khalifa, Apr 2, 2014.

  1. Khalifa

    Khalifa Type 1 · Member

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    Dear All ,

    I'm 30 years old . I have Type 1 diabetes when I was 18 years old . my doses are
    too high as I am taking 120 units per meal 3 times a day of Novorapid and take 70 units of Lantus at bedtime. I'm taking these large amounts of basal and bolus insulins because my BG is too high either before or after the meals . I'm one of who eat alot of carbs without any carbs counting or caring from my self.
    But I decided from 2 weeks ago that I will change this to the better healthy life in eating , in exercises like walking or running and in every things So I have taken some of actions:-
    1. Change my bad habits food and to Increase the healthy foods.
    2. Reduction of carbohydrates in eat.
    3. Applying of a diet 2,000 calories while " MyfitnessPal " helps me in that program.
    4. walking about 3-6 Km a day or at least (4 times a week )
    I have applied above for one week and the results are very good except that had hypo coubles of time after the walking or during my sleep. I had hypo maybe 4 times during this week .
    I need your help as I face some difficulty to specify exact my ICR and and I need some tips to better carbs counting . I have some questions but I will postponed them after I read you comments.
    Sorry all for my poor English language :) I'm trying to improve it. :p

    your help is highly appriciated
    Khalifa
     
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  2. Donna1

    Donna1 Type 1 · Well-Known Member

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    Download the carbs n cals app on your phone it tells u exactly how many carbs are in certain things n if u know ur ratio u can work it out bit better, ive jus started properly carb countin as not long diagnosed so not had the appropriate dafne training! U seem to be morivated for the change! Well done keep it up!


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  3. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    First things first is your basal............the Lantus, you need to test this dose out with carb free meal times to make sure your dose is holding you steady.......

    you may need this much insulin but you should be looking to take a larger dose of Lantus, and then smaller novorapid doses for your meals.....

    how much do you weigh?
     
  4. Spiker

    Spiker Type 1 · Well-Known Member

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    Khalifa, you've made a great decision to put behind you excessive amounts of carbs and really excessive levels of insulin to try to manage them.

    Hypos will be the main challenge as you adapt your lifestyle so test regularly, particularly after exercise and maybe set an alarm during the night for a test since you have had night hypos. Correct hypos gently with just around 12g of Gkucotabs or similar. Over correction leads to swings.

    Keep in mind your Lantus level will also come down. Ideally you would figure out your correct basal rate first before figuring out your correct Insulin : Carb Ratio (ICR) and insulin sensitivity factor (ISF) for corrections. Realistically you need at least a guesstimate so figure out how many carbs in your typical big meal from last week and divide by 120 as a first estimate. Monitor thus number and change it based on the evidence of your meter. While you are figuring out your basal rate, ICR and ISF, weigh your food, use packaging labels, or failing that use Carbs n Cals (less accurate but better than total guesswork).

    You've made a great decision.
     
  5. Khalifa

    Khalifa Type 1 · Member

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    Thanks Donna1 for your fast response ..

    This is my problem in this week I dont know my ratio .. I tried to fixed it as (1unit:10g ) but readings of BG were high I will post down some of reading for last two days and you or any one can help me to calculate my exact ratio ..

    in 01/04/2014 :-
    Before Lunch it was : 5.2mmol\L
    CHO was about : 108g
    Novorapid was : 60
    After 2 hours it was : 9.2mmol\L ( my target is around 7mmol\L ) need to correct so I assumed that I need to take 75 not 60 to keep it in 7mmol\L

    Before Dinner it was : 4.0mmol\L
    CHO was about : 67
    Novorapid was : 45
    After 2 hours it was : 10.7mmol\L ( my target is around 7mmol\L ) need to correct so I assumed that I need to take 71 not 45 to keep it in 7mmol\L

    Today 2/4/2014
    Before Breakfast it was : 7.3mmol\L
    CHO was about : 46
    Novorapid was : 23
    After 2 hours it was : 11.0mmol\L ( my target is around 7mmol\L ) need to correct so I assumed that I need to take 50 not 23 to keep it in 7mmol\L

    With reference to the above BG I would to guess that my ratio is

    in Breakfast = (13 unit:10g)
    in Lunch = (7:10)
    in Dinner = (11:10)

    I don't know if I have a mistake or misunderstand so I'm seeking to know more from each one of you :)
     
  6. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

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    That is great that you've seen an improvement already Hhalifa, keep it up and I'm sure in time your insulin requirements will reduce, if they don't then I would discuss the possibilities of changing insulins with your consultant, some find this resolves insulin resistance and taking a drug called Metformin is also said to help.

    There's an on-line carb counting course that will help teach you about insulin-to-carb ratio's, you do have to register first but by all accounts it's worth it:

    http://www.bdec-e-learning.com/
     
  7. Donna1

    Donna1 Type 1 · Well-Known Member

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    If its 1:10you have took a couple of units short in each meal which is keeping it bit higher but then u dont want hypos. Im still trying to work mine out so dont have great deal experience but ive had a few hypos doin the 1:10 so thinkin mine might be 1:/12/14 g! All depends on yr weight to! Dont want to be cheeky n ask but sone of the more experienced knowledgable guys on here will be able to help if know that too!


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  8. Khalifa

    Khalifa Type 1 · Member

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    Thanks novorapidboi26 ,

    yes my basal is Lantus I'm taking 70 units every day in same time with the pre-dinner . I read this test here in some posts and I will do it soon .
    I'm 97 Kg - 172 cm - about 32 BMI
     
  9. mbudzi

    mbudzi · Well-Known Member

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    I'm hoping to learn on this thread too but don't quite understand your second para Spiker - sorry - I'm not familiar with all the terms.

    "Figure out your correct basal first" - any advice how to do this please? I've got it stable at the minute but by luck and it would be good to know how to tackle it next time it goes out of whack.

    How do you figure out ICR? - I've tried eating the same foods on different days/meals and varying the insulin until I get a reading that brings me back to my starting BG after 2 hours, but this is rarely the same twice so I must be getting something else wrong.

    What is ISF - how do you calculate it/vary it?

    Why are you dividing carbs by 120 - what is this magic number and what is it telling me?

    Sorry for all the questions - I'm very out of my depth with things how the honeymoon is over. I know that things aren't well managed but my diabetic team disagree I need to do anything and consequently aren't too helpful in providing the answers.
     
  10. Khalifa

    Khalifa Type 1 · Member

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    For all I will reply on each comment but be noted that I do not use " pump" or any other machine only meter and I visit my doctor once each 4 months . This visit does not exceed a 30 min without any advice or tips new interest me .. just read the results and give medicine to next 3 months
     
    #10 Khalifa, Apr 2, 2014 at 12:48 PM
    Last edited by a moderator: Apr 2, 2014
  11. Donna1

    Donna1 Type 1 · Well-Known Member

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    So your takin the lantus and novorapid before dinner! I was told not to take them together by my nurse that it had to be a few hours apart? Does it matter?


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  12. Khalifa

    Khalifa Type 1 · Member

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    Thanks Spiker ,

    Good tips . I use APP " MyfitnessPal " to figure out the calories and also to calculate the carbs .. But the qustion now in specifying the my ratio does only carbs include inside this calculation ?? what about others like sugars , protines , fat .. etc ??? Does these out of calculating the ICR and ISF ??
     
  13. Spiker

    Spiker Type 1 · Well-Known Member

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    Hi Khalifa

    120 isn't a magic number :) It's the amount of Novorapid you said you were taking with each meal. You basically have the right approach which is to figure out how much it takes to get you back down to your pre-meal BG. The main thing I would say is not to test after 2 hours. Test after 4. Any decisions you make about ICR or ISF should be made 4 or even 5 hrs after injection. Before 4-5 hours your Novorapid is still working and still reducing your blood sugar.

    The ICR is then just the number of grams of carbs on the meal, divided by the number of units of insulin needed to get you back to the pre-meal BG. In your case it looks like 108 gch / 120 Novorapid, or just below 1:1. That's a very high ratio. While everyone is different, 1:10 is more typical. Your ratios will all probably come down as you switch to a healthier lifestyle. If you are in the UK, request a DAFNE course. Or try the online carb counting course suggested above.

    Just want to check if you are using 100u per ml insulin? Some countries use 1000u per ml insulin.
     
  14. Spiker

    Spiker Type 1 · Well-Known Member

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    You only need to count carbs for the purpose of insulin doses and ratios. Fats have no insulin requirements, and proteins have only a small requirement that is only a factor if you are on a low carb diet.

    ISF is purely about how much insulin you need to correct high BG. You can check this anytime you have a high BG. Take a corrective dose, eat nothing (and don't exercise much) for 4-5 hours. Then test again. Divide the reduction in BG by the units of insulin you injected for the correction. That's your ISF. So if you injected 2 units and your BG dropped 5 mmol/L, your insulin sensitivity factor is 2.5. Probably at the moment yours will be a lot lower, maybe around 1?

    Other terms get used apart from ICR and ISF but the concept is the same.
     
  15. Spiker

    Spiker Type 1 · Well-Known Member

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    To figure out your correct basal rate you need a day of fasting. If you were still eating a lot of carbs I would even lay off the evening meal the night before, certainly no late night meal.

    Check your BG frequently during the day, every 2 hours probably. You are looking to see if your BG is rising (or falling) without food and without [bolus] insulin. I would guess that with your high basal dose of 70 and high carb / calorie intake, you may find your BG drops, suggesting your basal is too high - just guessing.

    It helps if you know your ISF as you can then guess how much to increase or decrease your basal rate by.
     
    #15 Spiker, Apr 2, 2014 at 1:48 PM
    Last edited by a moderator: Apr 2, 2014
  16. monkeynuts

    monkeynuts Type 1 · Active Member

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    That is a significant amount of insulin. There are many different insulin regimes that may be better suited to you and your lifestyle. Some form of mixtard may be a more practical solution. For example Humulin M3.


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  17. Spiker

    Spiker Type 1 · Well-Known Member

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    @Khalifa, I would suggest your target of 7 mmol/L for 2 hours after injection is much too tight, particularly if you are eating a lot of carbs. You will need to "walk before you run".

    Also, 2 hour tests are good for learning which foods we react to, but as far as I've been taught anyway, we should never make a treatment decision (injection, or ratio change) based on a 2 hr reading. That should only done based on a reading 4 hrs after injection when the quick acting insulin is nearly or fully expended.
     
  18. Jkm2010

    Jkm2010 Type 1 · Well-Known Member

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    I would recommend the DAFNE course. You can book it via your nurse. When I was on it a lady was taking 60 basal units 95 and bolus units a day, by the end of the week she was carb counting and got to 50 basal and 45 bolus. after 3 months she was on 25 basal, and 30 bolus. I know everyone is different but it's a great course. It's 5 days, a real pain, but it's also good to talk to other people with type 1 in the same boat.

    He it helps.


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  19. Julie1471

    Julie1471 Type 1 · Well-Known Member

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    Novorapid should be taken before meals or as a correction dose, to lower a high BG, but do not take before bed. Lantus is normally taken in the evening. But be aware you may have a false hypo(feeling) that you feel low, but in actual fact your blood sugar is in range, but body and your brain are trying to fool you, into taking more sugar, when you don't need it, but your body craves it, as your blood sugars have been high before. Don't give into the sugar crave, test when you feel it, to confirm you need a boost.
     
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  20. Omar101

    Omar101 Type 1 · Well-Known Member

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    Hi Khalifa, since you are tracking your food everyday could you tell me what your macronutrient numbers for the day look like(protein,carbs,fats).
    I know when I was eating 200g of fat +200g of protein a day my insulin became very ineffective; it was like injecting water.

    Also spiker mentioned above, you should be calculating your novorapid dose with respect to your levels 4 hours after eating as thats when all the insulin from that dose is gone. Your 2 hour levels have more to do with what particular foods you are eating and how many carbs you are having in one sitting.
     
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