regimes and ratios

[scottishkate]

For me it's 4u Lantus in the morning, 4u Lantus at night.
Then 5u Novorapid bfast (no carbs)
3u Novorapid Lunch (few carbs)
4u Novorapid Dinner (veggie only carbs yum)

Katie.

 

[phoenix]

Normal basal between 11 and 13, (I use lots of temp basals)
Bolus about 13-16 units a day
breakfast about 3.5u
Lunch 4-6
Dinner 6-7

I find protein affects my BG hugely. Large amounts also take ages to 'work' .
If I eat a 'no' or low carbi n a meal I fnd it really difficult to estimate the amount of insulin to take.
The researchers behind the GI index started some preliminary work on an insulin index before they concentrated on carbs. Some protein foods were surprisingly high.

 

[fergus]

Hi pheonix,

Yeah, I think it was the University of Sydney which developed the insulin index, but only got as far as 38 foods on their list. They did notice certain foods, particulary dairy, had an insulin response much greater than their lack of carbohydrate would have predicted.
I guess this is why I don't find the GI terribly useful as it focuses on carbs so that some foods may score a 0, despite having a definite insulin response.
It was when totsy mentioned using no insulin for a negligable carb meal that I wondered whether there is even more individual variability in insulin index than glycemic index, or whether residual beta cell function is more of a factor?

fergus

 

[totsy]

hya fergus,
i too find it really interesting,i dont know about my beta cell function but it would be interesting to find out

 

[fergus]

I guess c-peptide would be the best way to find out. Unfortunately, my consultant refuses to do it for me because it would be 'pointless'. What he means of course is 'pricey'!

fergus

 

[totsy]

yep and my doctor wont do it either :twisted:

 

[lilibet]

Mixtard 30-pre-mix

5u am
4u pm
Could cut am if not snacking but am finding it hard to maintain weight so snacking it is!

Moderately low carb, still in honeymoon period ( I assume)

 

[jopar]

My regime is slight different to most as I use a insulin pump, so I don't use any background/long acting insulin.... But use humalog quick acting insluin

To deal with background basal requirements I have profiles set on my pump, each profile is a sectioned into 1 hours slots that I program to deliver a set amount of insulin over that hour...

Profile = basal, total amount of insulin delivered in 24 hours...

Profile 1 = 9.4 units standard non working day
Profile 2 = 7 units work day
profile 3 = 8.1 units non working day active

Bolus

1 unit =10g carbs

Correction

0.5 units = 6 mmol/l

Adverage daily total = 19 units

Fergus

I am surprised that you say that you need to bolus for non-carb meals, if I bolused for a non-carb meal I would hit the deck in a very short spam of time...

Could this because of the Basal side of things? Due to the limitations of long acting insulin to cover and flatten the basal line, so that it give a nice flat basal line to work from but leaves the basal line peaking and dipping slightly through out the day so that you are actually correcting the basal line rather than directly dealing with the protien?

 

[fergus]

Jopar, I don't believe that's the issue.
At weekends for example, I'm often very busy with the kids and simply skip lunch altogether. I find that my blood glucose is very stable throughout this time. That wouldn't happen unless the basal dose was correctly set.
If, however, I have 100g of mackerel, some mayo and a couple of celery sticks, I will need 2 units of Humalog. Negligable carb, therefore the insulin is mostly covering gluconeogenesis from protein.
A more likely explanation in your case might be that regular titration of fast acting insulin is able to cover the smallish demands of a low carb meal.
As others have already said, the UoS insulin index demonstrates that protein foods do have an insulin demand, and it's gotta come from somewhere!

fergus

 

[phoenix]

A more likely explanation in your case might be that regular titration of fast acting insulin is able to cover the smallish demands of a low carb meal.

again a question of ymmv, I also have a pump.
Earlier in the week I ate lunch out :duck, a very large breast came with green beans and what I thought was a potato gratin. I bolused, started eating but found that the gratin contained cauliflower not potato, stopped bolus at about 4.5u. At 2 hours BG was 4 mmol but at 5 hrs it was 6.1mmol ... higher than I would normally have been.

 

[totsy]

just moor proof we are all different

 

[derailleurs]

It's interesting that none of my doctors have ever said anything about my dosages.
I weigh 57kg and am normal weight, my weight's been stable for years so in that sense the dosage would seem to be correct.

I am not sure if I could do the low carb thing because of my kidney problems - I am supposed to be on a low protein diet. A little bit confused about everything now, I guess I'll have to go and search for some more information!

 

[jopar]

When I started on the pump, I had a fair idea where my problems lay...

It's been intersting to see how my body reacts to different things, in the main I have pretty much sort (for the time being) a good profile, that tends to keep me pretty satble throught the day but need to work out my night time basal a bit better...

As I know that until 2 in the morning, my levels remain stable, then between 2am and 3am I hve a constant 3mmol/l increase in my levels and then from 4am to 6am then drop back by 3mmol/ so it's now again to adjust the setting around these times to settle futher..

Interestingly, when I used MDI I actually used several carb/insulin ratios not only for meals but also for different time of the day for correction purposes, but with the pump I seem to be able to have one ratio to cover most things?

 

[JimmyD]

My daughter has 5.5 units of Levemir at bed time around 7pm and we are using 1 unit of novarapid to 10g carbs. She has around 15 units of novarapid a day. Correction is 1 unit for 5 mmol above 7 mmol.

 

[Rach79]

Amazing how little Lantus you all seem to take compared to me. I take 14 in the morning and 14 at night. I used to take 12 morning and night but my blood sugar levels were high constantly.

Novorapid pretty much 10-12 units before every meal.

I'm normal weight and exercise daily.

Hi derailleurs - how weird. I can't believe you have to take so much insulin - it does actually sound like insulin resistance of some sort. Are there any forms of medication you might be taking which could contribute to this?

As for no / low carbing.... didn't realise you could have a meal with no carbs whatsoever... sometimes I just feel like I want a piece of fruit for breakfast or a meal without carbs but didn't realise I could do this... gonna speak to the clinic about it. Although my next "proper" appointment is in July 2009. On 20th December I go to get a blinking blood sugar monitor inserted and attached to me which I'm going to mention they've had four months to do this and it is very ill timing (over Xmas and New Year). Hopefully they will allow me to have this after New year :| Must pester them to get on the DAFNE programme where some kind soul from this site informed me about once :!:

 

[phoenix]

As for no / low carbing.... didn't realise you could have a meal with no carbs whatsoever... sometimes I just feel like I want a piece of fruit for breakfast or a meal without carbs but didn't realise I could do this... gonna speak to the clinic about it.

Speak to your clinic, I do sometimes miss meals but my doctor still stresses that regular meal patterns helps keep control. If you are using a basal bolus regime and your basal is right then its fine, you shouldn't go low. In fact you test your basal by missing meals (and associated bolus). Fruit of course has carbs so it wouldn't be a no carb meal

 

[LittleSue]

Levemir 4 units 7am, 3.5 units 10pm, both vary during the month
Humalog b'fast 1 unit to 10 carbs (1.5 units part of month), lunch 1 per 10, evening a bit less.

According to DAFNE most people need 2-3 units for 10 carbs at b'fast, 1-2 units rest of day... I've never understood why they insist on 1 unit per 10 carbs for snacks regardless of time of day.

For protein, does anyone know an easy way of working out how much it'll raise bs? Such as X grams of protein will raise bs as much as Y carbs?

 

[Red_5]

I honestly can't believe it! I've just realised my control is terrible! Prepare for a shock, heres mine.

I've just received a letter about this DAFNE course and I don't count carbs like most people here nor do I record my results in my diary!

14 NOVORapid for breakfast

18 NOVORapid for lunch

24 for dinner

36 Lantus in the evening.

The high dosages are most likely a combination of insulin resistance and poor control .
I've only started to get better results even though i've had it for 14 years. Still, i'll check this DAFNE course out and hopefully i can get it lower.

Thanks for all your dosages though, quite an inspiration and motivation to get my diabetes in control.

 

[jopar]

Red_5

I have been on the DAFNE course and highly reccomend it...

The template is based around carbohydrates, types, reactions and counting.... But you will get a wealth of information different factors that can effect diabetic control... And if you ever wondered why a DSN suggests that you change your regimes at xxx point, and when you look at your monitoring data and think how the earth did they come to that conculsion? You find out why and how you can interpreatate your own data... You learn the ratio's of your insulins, how to work out that you background insulin is correct, how to determin when a change might be needed in any of the ratios etc... Even the sick day rules...

 

[lou]

Hey Im feeling pretty bad after reading all that too! Here's mine for my sins:

Am - novorapid -10units
Lunch - novorapid - 10+ (depending how high I am)
Dinner - novorapid - 14+ (give or take depending on high / low)
Before bed - Levemir - 50units!!

I am wondering how Lantus is different from levemir because everyones doses seem much lower...? But then they also seem much more in control!

I went on a carb counting course maybe 2years ago and try to keep to the principles. But it seems that stress has a huge effect on me and the more stress I get the more out of control things are! Is DAFNE the same principle?
Thanks
Lou