T2 carb counting and adjusting insulin doses

[meenahoque]

Hi everyone
I am a type 2 diabetic with tablets and both types of injections. I take 2 metformins in the morning and 1 dapaflozin and 30 units of lantus..
Midday I have 20 units of Novorapid.
In the evening I have 20 units of Novo Rapid and 30 units of lantus along with 2 metformins.
I have been a diabetic for many years but never understood how the blood sugar changes so much even after eating same food,treatment and exercise.
My hba1c was over 90. I am insulin resistant hence the high doses of insulin is prescribed fir me.
I am under st thomas hospital now but I was treated very badly at initial stage of my diagnosis by the community speacialist.
To cut the story short I have retinopathy in both eyes and had vitrotectomy inthe left eye and suffering with the right eye now. Had laser and injections and eye sight is detioratting. So please take care of your eyes.
I can’t contribute much in the forum but I can read and this forum has given me so much knowledge about the management of diabetics.
I would love to have a discussion on the counting of carbs and the flexibility of changing the insulin units accordingly.
Best wishes.

 

[Antje77]

Hi @meenahoque , I've moved your post to this thread.
Just let me know if you'd like the title changed!

 

[meenahoque]

Thank you.

 

[EllieM]

I would love to have a discussion on the counting of carbs and the flexibility of changing the insulin units accordingly.

What's your diet/regime like at the moment? Are you on fixed amounts of carbs per meal? At fixed times? I'm a little puzzled in that you don't seem to be taking fast acting insulin first thing in the morning, as many of us need extra insulin then as our blood sugars go up because our livers pump out sugar to aid in the getting up process.

As a T1 on a basal (eg lantus) bolus (fast acting insulin eg novorapid) regime, my basal is meant to carry me through the day and night when I don't eat and then my bolus counteracts any meals and sometimes acts as a correction dose. (eg I gave myself 4 units of my bolus at 5 am this morning when I could see my blood sugar rising with dawn phenomena, and then went back to sleep. Not recommended to do unless you know this agrees with your body and its reaction to insulin, because you don't want to go hypo when asleep.)

My (very limited) understanding of T2s and insulin is that insulin resistance is a massive issue. Plus you may not know whether you are still producing much insulin of your own? But .if you want to go on a basal/bolus regime I would suggest that you talk to your diabetic team. I was on fixed doses throughout my T1 childhood (pre glucometer so it was pretty well all guesswork apart from the odd urine test) and found it very liberating when I moved to a basal/bolus regime in my twenties (and got my first glucometer).

As a child I rapidly memorised lists of carb values of proprietary food, now I go by a lot of experience and guesswork, though I still get out my kitchen scales occasionally. Modern prepared food in supermarkets tends to have carb values on it which makes things must easier.

So, in theory, once your basal dose is right, you need an insulin ratio from your diabetic team to calculate your bolus for meals/snacks. Typically they start at 1 unit for 10g of carbs, but it's likely that if you're insulin resistant you'll need more than that (eg I need 1 unit for 3g of carbs as I'm a bit insulin resistant thanks to the genes from my T2 dad). If your ratio is 1 unit for X g you just divide the total carbs for your meal by X to get the needed insulin. (Then add in a correction dose if your before meal blood sugar is too high.) But the whole point of the basal/bolus regime is that you should be able to have the meals when you like (including skipping them or having a midnight snack).

Having said all that, not entirely sure on the effect that your other medication has on the whole thing.

Hopefully you'll get some more responses soon. Good luck.

 

[meenahoque]

Thank you so much for your reply with so much information. I think I will have to ask the diabetic team to really teach me about the diet and it’s carb contents.
At the moment I am not on any diet which is on particular carb measure.
I have developed a diet from my own experience and sticking to a fairly healthy diet as far as possible. It all depends on my sugar level in the morning .
If my sugar level is between 6 and 7 then I will have porridge with oat milk and an poached egg.one cup of tea.
Lunch tend to be sandwich with homemade roast chicken or grilled fish and or roasted veg.I have some fruits and little yogurt. Very small portion.
Dinner is mostly home made chicken or lamb or fish curry with rice or 1 chappati.
Boiled veg and potatoes with grilled chicken or lamb chops.
Some evening we will have spaghetti or noodles with veg and chicken.
Dessert is for special treat only . I have Alpro yogurt most night.
I don’t have anything after 8 pm unless my sugar is below 8 at 10 pm.
Trying to lose more weight as I am 10 stone now .would like to go down to 9 stone gradually!!!
Personally I don’t think I have bad diet but it needs to be more measured to understand the carb content . I feel my treatment is complex with insulin and tablets and I need to get background insulin right and then the fast acting insulin for the meal time.
My last hba1c is 63 and I need to get it down to 55 to avoid more complications with the hammorage in the eye.
I will have an appointment with the diabetic Team soon and will discuss all these issues.

Thanks for you help.
Best wishes.