Ratio

[grahamrb]

I dont know what a dexcom is.
The team have said it is too early to have a libre but we will get one; so its finger pricking until then.
The bertie course says every 3 months. the last reading was 70 something apparently the aim is to get it to 48

 

[EllieM]

I dont know what a dexcom is.
The team have said it is too early to have a libre but we will get one; so its finger pricking until then.
The bertie course says every 3 months. the last reading was 70 something apparently the aim is to get it to 48

Try to relax, though 48 is the aim I've been T1 for 51 years and rarely achieved it (mostly during pregnancies when I lost hypo awareness as a result). My team actually complain if mine goes that low because I have a record of hypo unawareness with too low hba1c. Though I'm sure I would be healthier if I hadn't been T1 for 51 years I still have no obvious T1 complications.

A dexcom is like a libre only possibly/probably better, I moved to it from the libre because the libre no longer worked for me (allergic reaction). It's twice the price so you'd only use it if the libre failed.

In your position I'd be stressing your wife's age to get a libre, I'd bet they don't have too many 78yo new T1s.

Lots of virtual hugs to both you and your wife.

 

[grahamrb]

I have worked pout the ratios as 5 to 1 etc and been advised by dietition that she worked it out by dividing 500 by 31 and got 16 to 1.

Where does this 500 come from? it seems to be plucked from thin air

 

[Deleted member 208503]

i had to totally learn and discover mine all by myself
none of the professionals even told me a thing
except how to inject
the first day i used rapid insulin i ate then was
hungry awhile later and i had no idea when
i could eat again so i called my drug store
and they told me the action time of the insulin
gracious it could have been so dangerous
what if i had of just eaten again and used more
insulin?
they had just told me 10 units when i eat
and i instinctively knew that was bad for just
eating a low carb vegetable meal
so anyway i discovered thru reading that a ratio was more
effective
and just used the 1 to 10 and tweaked it to a number
that have me the post meal results i wanted
which was 1 to 6
but now to get close to the results i want i have to
use 1 to 3
i aim for an 8 two hours post eating

 

[Hopeful34]

I have worked pout the ratios as 5 to 1 etc and been advised by dietition that she worked it out by dividing 500 by 31 and got 16 to 1.

Where does this 500 come from? it seems to be plucked from thin air

Maybe you could contact the dietician and ask her where the 500 came from. What sort of blood sugars is your wife getting, using the ratios you've worked out?

 

[grahamrb]

I did ask where the 500 comes from but didnt get an answer.

She said that we should start at 1 to 10 so that's what we are doing , doesn't make a scrap of difference.
still get silly readings. Both very frustrated.
Current insulin Lantus 14
Rapid 7, 6, 6
Does this mean we hgave to have 70 carbs in the morning and 60 at lunch and 60 at tea?

 

[Hopeful34]

If you're doing a ratio of 1:10 yes it would mean that.
Does your wife want to have the same amount of carbs every day like this, or is it just tha she's been told to take the same amount every day?
When do you next speak to the nurse? If you're getting silly readings, can you contact her earlier?
Sorry you're both frustrated, it takes a while for things to settle down after diagnosis.

 

[EllieM]

Does this mean we hgave to have 70 carbs in the morning and 60 at lunch and 60 at tea?

Yes and no. A lot of people take a bit more insulin in the morning to cover the dawn phenomena (liver pumps out glycogen/sugar to help you start the day). You're trying to match the insulin to the food not vice versa, so ideally you'd be adjusting the insulin doses/ratios after you find her going low or high after meals. (Hopefully she's got hypo awareness?) And some people have different insulin ratios at different times of day. In my opinion, the best thing to do is keep careful records and see what works.

 

[grahamrb]

We haven’t been told to eat that amount of carbs just told to take the prescribed insulin doses before each meal
All readings have been high today ranging from 10+to 14+
I think that we’ll just carry on recording the readings until we see the doc in a months time.
We were advised to do the Bertie course which has lot of good stuff in it, i started it and then told not to start the Bertie course until next May!!!
They would not tell me why.
I don’t think that they are used to people being proactive
Started counting carbs but now stopped since what do you do with the figures once you have got them
All too hard seems a complete waste of time when I did count the carbs and worked out a ratio I was told to ignore the figures and start at 1 to 10 but no explanation given

 

[Trevor vP]

I have worked pout the ratios as 5 to 1 etc and been advised by dietition that she worked it out by dividing 500 by 31 and got 16 to 1.

Where does this 500 come from? it seems to be plucked from thin air

The 500 Rule is a calculation that is used to start working out for Type 1 diabetics to say how much will 1 Unit of Insulin cover the carbs. This is called the insulin-to-carb ratio or simply carb factor. The problem with it is the assumption that the average adult consumes 500 grams of carbs every day. The formula is flawed in so many ways firstly you presume the person will eat this many carbs (never assume), secondly you need to have a pretty good guess at what the Total daily insulin will be ( again never good to assume)

Presume you have your Basal right.

Always have your Hypo treatment on standby.

All I can say Test Test Test and document,
count the Carbs and test your Numbers before each meal and document it.

As a example I eat my dinner early so most Bolus out my system by bed. I take my Basal at 9 Pm I check my blood glucose same time and I want to be be within +\- 0.5 mmol/L when I test before breakfast . That way I know I am covered overnight and also if I am not dropping to much at night I know I need maybe 5 gram of carb before bed if I am going to bed a bit low to give me a safety margin.



Bolus Test before meal ,

Calc the Carbs and Document, Before Breakfast ,before lunch , before dinner you should have circa same Glucose if you got your Carb/ Insulin right on prior meal.

For Example I am 15 gram / 1 Unit in the morning but by 11:00 I am 10 gram / 1 Unit and that is from testing documenting and working out over time
That number might change over time as Circumstance change. Each person has there own numbers we are not all the same.

Last but not least If you are going to exercise that includes walking , a quick link worth a read on the % Insulin reduction required

Always take your fast acting hypo treatment with you, it is no good at home or in the car.


https://excarbs.sansum.org/adjusting-insulin/


I hope that helps.

 

[grahamrb]

Thanks Trevor
I went onto the link and I still have a lot to learn, the more I research the more there is to learn, didn’t expect this in my late 70,s

 

[grahamrb]

Woke up this morning with reading of 12.6 way above target
Worked out breakfast carbs as 44, did 7units insulin

reading before lunch was 12 way too high

Worked out lunch carbs as 45g, did 5 units insulin

reading before teatime was13.9 again way too high

Couple of hours later reading went up to 17.4 for no reason (no food,no exercise)
Wasn’t hungry so had salad of 23g of carbs did 6 units of insulin prior to salad

the evening reading is 19.3 !!?
What am I doing wrong?

I give up

perhaps I should be putting double the insulin

 

[KK123]

Just to respond to the initial question, in my opinion nobody can 'give' you your ratio as nobody knows. You can start off with the so called average ratio but from thereon in it is absolutely trial and error....mostly error at first! It also changes dependent on everything. It's good to have some idea of how it all works of course but test, test, test!

 

[EllieM]

What am I doing wrong?

I give up

perhaps I should be putting double the insulin

Remember there are 3 amounts/figures to worry about.
1) basal dose. Keeps you level when you are not eating. Should mean the morning reading is the same as the before bed one. If this is wrong it's very hard to deal with the rest.
2) Insulin to carb ratio.
3) Correction ratio. Are you adding any extra insulin to your amount for the meal so as to bring that before meal reading down?

When is the basal dose being taken? Morning/evening/both (split dose)?

 

[grahamrb]

Dear Ellie
Here are the answers to your questions
1) Morning reading is never the same as the previous evening eg last 7 evenings/mornings
15.4/12.6, 13.4/10.3, 6.6/10.4, 12.4/10.9, 6.3/5.1, 7.8/7.2, 12.9/ 8.3

2)ratio I instructed to do 10 to 1, so if we know that the meal is 40 carbs then should put in 4 units of insulin before the meal, if I followed that instruction it would be even worse.

3) correction ratio- I have read about this but professional team has not mentioned it at all

In answering your questions it has occurred to me that the correction factor could be the 40 carbs divided by 10 = 4, so I add the 4 units to the normal 6 units = 10 units of insulin, that would certainly bring the sugars down
Is that correct? I think that I will try this today

the basal dose is done the same time every morning about 8,30 am

thank you for your help

 

[EllieM]

In answering your questions it has occurred to me that the correction factor could be the 40 carbs divided by 10 = 4, so I add the 4 units to the normal 6 units = 10 units of insulin, that would certainly bring the sugars down
Is that correct? I think that I will try this today

The correction ratio is normally done by saying that 1 unit of insulin brings your bg down by so many units eg 1 unit of insulin brings you down by 3 mmol/L. So it's independent of the carbs taken in the meal. So total insulin before meal is correction dose plus insulin for carbs in meal. So if your correction ratio was eg 1 unit for 3mmol/L you'd probably inject an extra 2 units if your starting bg was 12 (thereby bringing it down to 6), and then add in insulin for the carbs in the meal. But remember that everyone's correction dose is different, so I'd start with a low amount of correction insulin rather than high.

Most of the evening readings are slightly higher than the morning ones, but not drastically so. How often are you able to consult your team about the readings? (It's awesome that you are keeping such good records.)

Edited to add, just been playing with the numbers in this example and made a lot of changes. Editing now over.

 

[Trevor vP]

Dear Ellie
Here are the answers to your questions
1) Morning reading is never the same as the previous evening eg last 7 evenings/mornings
15.4/12.6, 13.4/10.3, 6.6/10.4, 12.4/10.9, 6.3/5.1, 7.8/7.2, 12.9/ 8.3

2)ratio I instructed to do 10 to 1, so if we know that the meal is 40 carbs then should put in 4 units of insulin before the meal, if I followed that instruction it would be even worse.

3) correction ratio- I have read about this but professional team has not mentioned it at all

In answering your questions it has occurred to me that the correction factor could be the 40 carbs divided by 10 = 4, so I add the 4 units to the normal 6 units = 10 units of insulin, that would certainly bring the sugars down
Is that correct? I think that I will try this today

the basal dose is done the same time every morning about 8,30 am

thank you for your help

I see the 6.3/5.1 and 7.8/7.2 do you know what and when you ate exactly those days and dosage for the two meals before and reading before and the dosage of Insulin the reason for the question may sound stupid.

But there is some logics sometimes with high fat and high protein meals the insulin timing is off (We call it the "Pizza" effect )

What I am thinking try replicate those two days food etc.. Are you getting your Carb Count right not always easy unless you weigh everything and put in in Carb and Calc.

Are you drinking any tea or coffee with Milk between meals.. Milk has Carbs and some people spike from that.


Do not give up, you can sort this ,
we have all been through this and by keeping accurate record you can contact your doctor or diabetics nurse and be very precise with what you ate and the exact timing and exact insulin and that helps a lot.

Remember as type 1's we are trying to do a very complex task that a very clever organ the pancreas does all day every day for everyone else. So we just need to learn and learning is document and adjust .

 

[grahamrb]

Dear all
We have kept records of all carbs, food eaten, insulin doses, times of eating and blood glucose levels.
Now that we have that information what do we do with it?
There is no pattern apart from the last 12 or so readings being high ie between 12 and 18 we have increased the insulin but it makes no difference
We know what to do if there is a hypo and that is drink some coke or have jelly babies but what do you do if the readings are high
No one seems to know
There is no correlation between the readings and what you eat
None of it makes sense

any ideas anyone?

 

[grahamrb]

I haven’t contributed to the forum for some time
Recently saw a nurse who clearly knew what she was talking about, what a difference!
Increased morning insulin to 16
Rapid insulin to a range of 8, 9, or 10
Stopped worrying about ratios, mainly playing by ear.
Range of readings 1.6 to 20
The 20 was because we forgot to do the insulin
No idea why it went to 1.6 which was at 2am in the night, fortunately when it gets low like that it wakes you up.
Took extra insulin before Christmas lunch and reading afterwards was only 14 which we were very happy with.
Going on a course in January so hopefully learn a lot more
People say that it doesn’t change your life clearly rubbish, you always have to think “can I do that or what happens if do that “
So still very frustrated
Simple things like ironing, hoovering affects sugar levels so you have to plan everything,you can never do anything when you want to
Type 1 completely changes your life
Let’s see what happens after the course which is every Wednesday for 4 weeks

 

[grahamrb]

2 Things

1 - Invited to join Twitter by Diabetescouk, so I joined; so far seen only inane nonsense by complete starangers which is of no interest so will discontinue with Twitter. Who really wants to know that someone the other side of the world had a tiring day or had egg and bacon for breakfast?
It confirms my belief that it is not for me, and I am surprised that the organisation would even suggest such a product. I am however open to suggestions, can any say why Twitter is good for Type 1 people.

2 - Type 1 means you have to plan,plan,plan and you cannot do anything spontaneously for fear of Hypo or Hyper.
ps Current range this week 1.4 to 20! we know why 20 but havent a clue why it went down to 1.4.