Ratio advice

I know it sounds stupid but could you have lunch a bit later - that is a hell of a gap between lunch and dinner QA...

Not sure if its just me being old skool tbh, its how i was broght up that dinner at 7 is 'late'.

Hi Hale!

I have the same issue sometimes - it's bizarre how the numbers can spike with the same food and insulin that's normally OK. There's a couple of things that I've put it down to over the years I've dealt with it, but i don't have any evidence.

1. Something is making you more insulin-resistant than usual so your insulin isn't work properly - for me, that's usually the week before my period. I have to increase doses, but that does cause the odd hypo which I stave off with a strategically-timed finger of dark chocolate kit kat (about 7g carb). For some reason, around this time, my Apidra seems to work more slowly - but it does work in the end!

2. Some kind of cold/bug/virus/infection/pain etc is on its way - usually a migraine about to start for me - although to be fair, that might be connected with point 1 above!

3. Your insulin has been out of the fridge for a fairly long period of time (basal or bolus) and needs chucking away and a fresh one using. I use fairly small doses and my cartridges last the full 30 days they are allowed to be in the pen - most people's don't. So, after a couple of these types of episodes, I took the decision to discard insulin when it's been in the pen for more than 20 days and start new cartridges. I think it loses its potency and/or changes its absorption abilities, although I have no evidence.

4. Your pen isn't working properly - I don't think the pens are as accurate on very low doses and any slight issues with them are more noticeable. I guess if you are injecting a sizeable dose, the force of the liquid forces the dose out through any minor blockages, but I only use 1.5 units with my lunch and that's the one i seem to have more problems with. That might just be a load of rubbish though LOL.

Anyway, you get my drift - so many reasons it could be happening. Try changing one of the things you can e.g. the insulin or the pen and see if it makes any difference.

Smidge

It's not uncommon to have different ratios for certain meals/times of the day. It may be whilst waiting for a proper honeymoon you're finally coming out of your old one ;-)


Sent from the Diabetes Forum App

Seems like your insulin requirements certainly increasing. You gonna do a basal test first ?


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Hi Hale,

It looks like the problem is with your rapid-acting to me. The first thing to try under the circumstances is to change the cartridge and see if it stops the issue. I know what you mean about waste, but it's no good if it's past its best - throw it away! LOL

Incidentally, you should always have spares in your fridge - you should not have to go to the pharmacy to get a spare!

Seriously, it looks to me like your insulin isn't bringing you to the right levels after a meal, so you're still high at the next meal. When your BGs are high, your ratio can change - more insulin to carb is usually needed. A unit of insulin drops me further from a starting 5 than from a starting 10.

Smidge

hale710 said:

Today

7.30am 7.9, 40g so 2.5u
9.30 am 13.7

11.30am 9.3, 55g so 4.5u+0.5u correction
2pm 11.7
4pm 12.1/11.0 depending on the meter you use lol

All around not chuffed with the outcome one bit. Something needs done

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Definitely looks like your honeymoon period is coming to a end, time to rethink those insulin ratio's me thinks!

hale710 said:

Smidge, tell me to check my fridge closer in future. I have THREE cartridges in there. THREE. As of Saturday I'll have EIGHT.

Must learn to count....


Blogging at drivendiabetic.wordpress.com

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Ha ha. I've done that before - ended up with 3 boxes of Apidra in the fridge which is about 9 months supply for me! Having said that, I always like to have at least two different batches in the fridge in case I have a bad batch! Actually, there was a manufacturing fault with Apidra cartridges a couple of years ago and you couldn't get any for about 6 months - many people had to change to novorapid or humalog. The thought of changing from an insulin that works for me really freaked me out, but with my 9 months supply I was able to last until new stocks arrived! LOL

Smidge

hale710 said:

Today

7.30am 7.9, 40g so 2.5u
9.30 am 13.7

11.30am 9.3, 55g so 4.5u+0.5u correction
2pm 11.7
4pm 12.1/11.0 depending on the meter you use lol

All around not chuffed with the outcome one bit. Something needs done



Blogging at drivendiabetic.wordpress.com

Click to expand...

On a bg level of 7.9 I would have given myself a correction to get target of 6mmol and then done the bolus. On the 7.9 with no correction, after 2hrs the bg of 13.7 would be about right, also Novo's action is about 5hrs which can more or less be seen with the 2pm bg of 11.7 (dropped 2ml 2hrs after the lunch bolus with the tiny correction)

hale710 said:

Smidge, tell me to check my fridge closer in future. I have THREE cartridges in there. THREE. As of Saturday I'll have EIGHT.

Must learn to count....


Blogging at drivendiabetic.wordpress.com

Click to expand...

and you're an engineer right?

I've found that I need to be much more accurate with some foods than others, bread being one of them. I've been going by the rule 10g carbs per inch of baguette. That worked OK for me on Tuesday (or would have if i'd listened to myself instead of the book - ended up at 9.4 after lunch).


I wouldn't worry at all about long gaps between meals, I often eat after 8pm with lunch at 12. Think about it, that's a good indication of basal dose as more than 5 hours allows all the QA to be aout of your system, so you shoudl be back to your background level by te next meal. Having say breakfast at 8am, lunch at 12noon and dinner at 4pm means you've always got some QA hanging around and obscuring things.

Looking at your numbers I think you need to do a series of really good basal tests throughought the day, so on different days have a carb free b'fast, lunch, dinner etc. Get that right first - if you look at yesterday you never got back down to your waking level.