Type 1 diabetes and ratios

[Diabeticmum1982]

Hi, I have recently been experiencing problems with high blood sugar levels after my evening meal, I am doing the carb counting and all proper calculations but for some reason the units of insulin I take is not enough for my food, even though I have weighed all my carbs, and done the proper calculations to see the amount of units I'm supposed to take, I was just wondering if my ratio could be different for my evening meal? Even though all other meals of the day including any correction doses all work on the 1 to 3 ratio, so is there anyone on different ratios that could give me some advice

 

[catapillar]

Yes it's possible you could need a different ratio for different meals.

It would however by fairly unusual to be significantly more insulin resistant in the evening than the rest of the day, there's no circadian/hormonal reason to cause insulin resistance in the evening like there is in the morning, unless:

1. Your basal insulin is running out in the evening. If you take lantus even though it says it lasts 24hrs in reality it probably lasts more like 18 hrs so you might have a period of the day when your basal coverage has worn out. If your basal has worn out, you'll need a higher ratio as the bolus is going to have to do some of the work for the missing basal. Many people get around thus by taking one basal shot in the evening and one in the morning. You can do some evening basal testing to see if your basal might be contributing.
2. Your evening meal is high in fat. High fat food can make you temporarily insulin resistant and require a larger dosage. So what kind of thing are you eating? If you think it's high fat food it might be worth doing some experiments with non high fat foods just so you know if it's an evening ratio thing or a fat ratio thing.

 

[Diabeticmum1982]

Yes it's possible you could need a different ratio for different meals.

It would however by fairly unusual to be significantly more insulin resistant in the evening than the rest of the day, there's no circadian/hormonal reason to cause insulin resistance in the evening like there is in the morning, unless:

1. Your basal insulin is running out in the evening. If you take lantus even though it says it lasts 24hrs in reality it probably lasts more like 18 hrs so you might have a period of the day when your basal coverage has worn out. If your basal has worn out, you'll need a higher ratio as the bolus is going to have to do some of the work for the missing basal. Many people get around thus by taking one basal shot in the evening and one in the morning. You can do some evening basal testing to see if your basal might be contributing.
2. Your evening meal is high in fat. High fat food can make you temporarily insulin resistant and require a larger dosage. So what kind of thing are you eating? If you think it's high fat food it might be worth doing some experiments with non high fat foods just so you know if it's an evening ratio thing or a fat ratio thing.

Thanks catapillar, I'm going to try by putting my morning levimer up and see how I get on

 

[Kristin251]

Thanks catapillar, I'm going to try by putting my morning levimer up and see how I get on

The timing of your bolus can make a huge difference. When are you taking it compared to when you start eating? My humalog doesn't some in to effect for about 20 min so I wait 20 min until I eat. Works like a charm.

Should be noted I'm ultra low carb sonyojr timing might be different but no insulin works immediately so getting your insulin there at the same time as your food is key. It you eat before insulin is there you'll spike. It your insulin gets there before your food you'll hypo.

What bolus are you on?

 

[catapillar]

Thanks catapillar, I'm going to try by putting my morning levimer up and see how I get on

It might be a bit hasty to just increase your am levemir without basal testing. This page has a good guide on how to basal test - https://mysugr.com/basal-rate-testing/

Levemir lasts ~12 hours. Do you not take am levemir, or do you take it am and pm? It might not be a question of the dose being too low, more that it just stops working after a certain period, taking more won't make it last longer. If you're only taking an am dose then that might explain post dinner highs - the levemir will have run out 12 hrs after taking it so your dinner time bolus is having to fight against no basal on board. You don't solve this by taking more am levemir, that will just make you more insulin sensitive while the levemir is working but it won't make the levemir action time extend. You tackle it by splitting your levemir dose and taking some in the morning and some in the evening, might want to think about a 70/30 am/pm split to start with and then some basal testing to see how that covers you.

But I wouldn't even consider splitting the levemir until you've investigated whether you actually need to with some basal testing. Or at least considering what your bedtime numbers look like in comparison to the waking up numbers. If your wake up numbers are always significantly higher than bedtime that suggested you need to split your levemir.