T1 for 38 years switching to new insulin :-(

Hi Chris,

Insulin to carb ratios are very personal. Yours may well be different to others on this forum, that's nothing to worry about - you just need to work out your own ratios. They might be different at different times of the day - many people find they need more insulin in the mornings (e.g. my morning ratio is 1 unit for about 5g carbs; later in the day it's one unit per 7g). This just takes time, experimentation and careful monitoring. Your relatively high carb intake means you inject a relatively large amount of insulin, which may be making you slightly insulin resistant - you might find that if you move to eating fewer carbs, your ratios change slightly over the course of a few weeks or months - again, this is something you'll just need to monitor and adjust for.

The way I determined my ratios was to simply have a period of fasting to make sure I had the correct basal dose; a day without eating anything at all and testing my blood to make sure it was fairly stable. Repeat as necessary to refine the basal dose. I then had further days (not necessarily straight after the fast!) where I'd eat a single meal, take what I thought was a reasonable amount of insulin, and test for a few hours afterwards to check whether I was right or not; this let me find my early morning, daytime, and evening ratios. It wasn't really pleasant to do this, but it worked for me; this plus a low-carb paleo diet have taken my A1C's from 7.6 (a typical result over the past 10 years, I'd never had anything better than 6.9) to 6.2 in under three months, and I expect my next result to be five-point-something.

Your comments about the speed of Novorapid are interesting - I also find that Novorapid takes a fair while to kick in. I haven't used Humalog or Apidra so I can't compare it, but with the Novorapid it seems to take an hour before I get any affect at all, then it works over the following 2 - 2.5 hours (e.g. if I wake with a high BG it won't even start to lowerin the first hour; after 2 hours it'll have dropped slightly; after 3 - 3.5 hours it'll be down where I want it). I counteract this by injecting early where I can, but for times where that isn't possible (e.g. an unexpected high or waking up high), it's a pain that it takes so long to work for me.

I'll be interested in what others might have to say about this, I may have to have a medication review and give Apidra or something a try...