Type 2 - new to bolus

[LincolnLizzie]

Hi

I've been using Lantus with good results due to low carbing, but just occasionally it would be nice to be able to eat the same as everyone else! We are being treated to an afternoon tea by our son, so that was why I asked my DN if bolus would be the way to go to deal with that situation.

So here I am with my Novorapid, but not sure if I'm doing things right. I've used it a few times - she told me to use 1 unit to 10 carbs and underestimate rather than over.

My difficulty has been that my blood sugars continued to rise for a number of hours 12 after two hours, 13.6 after 3 hours, after the meal and it has taken me a week to get them back into the 5s, which is where I normally run.

I am doing so well with low carb, it is a very rare day for me to go over 30 carbs. So am I doing things right? Am I just going to have to wait out returning to my normal levels when I do want to eat something higher carb? Thank you.

 

[GrantGam]

Hi

I've been using Lantus with good results due to low carbing, but just occasionally it would be nice to be able to eat the same as everyone else! We are being treated to an afternoon tea by our son, so that was why I asked my DN if bolus would be the way to go to deal with that situation.

So here I am with my Novorapid, but not sure if I'm doing things right. I've used it a few times - she told me to use 1 unit to 10 carbs and underestimate rather than over.

My difficulty has been that my blood sugars continued to rise for a number of hours 12 after two hours, 13.6 after 3 hours, after the meal and it has taken me a week to get them back into the 5s, which is where I normally run.

I am doing so well with low carb, it is a very rare day for me to go over 30 carbs. So am I doing things right? Am I just going to have to wait out returning to my normal levels when I do want to eat something higher carb? Thank you.

What did you eat? It's notoriously difficult to estimate carbs when not cooking for yourself (weighing food, reading nutritional labels, etc).

1:10 is possibly a lot less insulin than you need. As a T2D, you may have a fair element of insulin resistance to work with. Your DSN was right to start you on a reserved I:C initially, as to avoid unnecessary hypos. You (if you feel comfortable) can adjust your own I:C ratio to keep your BG where it's meant to be.

Maybe you could try 1:5. Have a small amount of carbs (20g or so) with the amended bolus dose. Ensure that your BG is slightly higher than normal in case it ends up coming down a lot more than you anticipated.

Grant

 

[noblehead]

My difficulty has been that my blood sugars continued to rise for a number of hours 12 after two hours, 13.6 after 3 hours, after the meal and it has taken me a week to get them back into the 5s, which is where I normally run.

A week seems a long time to get your bg levels back to normal, however some very low-carbers like yourself do say they have a adverse reaction to carby meals when they deviate from their usual eating plan, perhaps you are one @LincolnLizzie

 

[Jaylee]

Hi

I've been using Lantus with good results due to low carbing, but just occasionally it would be nice to be able to eat the same as everyone else! We are being treated to an afternoon tea by our son, so that was why I asked my DN if bolus would be the way to go to deal with that situation.

So here I am with my Novorapid, but not sure if I'm doing things right. I've used it a few times - she told me to use 1 unit to 10 carbs and underestimate rather than over.

My difficulty has been that my blood sugars continued to rise for a number of hours 12 after two hours, 13.6 after 3 hours, after the meal and it has taken me a week to get them back into the 5s, which is where I normally run.

I am doing so well with low carb, it is a very rare day for me to go over 30 carbs. So am I doing things right? Am I just going to have to wait out returning to my normal levels when I do want to eat something higher carb? Thank you.

Hello,

Sounds like you have the right thing happening with the Lantus & low carb..
I agree with @GrantGam1337 that "insulin resistance" played a part. On this point.
But add personally.
Without knowing what was actually on your son's menu? It is safe to say from the the prolonged highs were down to a "reserved" estimation on the Novorapid. Unfortunately an estimated bolus is not a "magic bullet" for a meal, especially if it was something like a separate course style, prolonged social feast?? It needs a more cunning stratagem than just shoot first.. The questions will come later.! Lol
But I fully empathise a need to partake in these affairs with the "norms". From time to time!

 

[mist]

My bloods rise for hours after I eat too, regardless of what it is. I think it's stress in my case. Maybe you have some insulin resistance!

 

[Daibell]

Hi. Do you have excess weight? You appear to need the insulin even though having low carbs and you go high easily and stay there. I wonder whether you could even be Late onset T1 and not T2?

 

[LincolnLizzie]

What did you eat? It's notoriously difficult to estimate carbs when not cooking for yourself (weighing food, reading nutritional labels, etc).

1:10 is possibly a lot less insulin than you need. As a T2D, you may have a fair element of insulin resistance to work with. Your DSN was right to start you on a reserved I:C initially, as to avoid unnecessary hypos. You (if you feel comfortable) can adjust your own I:C ratio to keep your BG where it's meant to be.

Maybe you could try 1:5. Have a small amount of carbs (20g or so) with the amended bolus dose. Ensure that your BG is slightly higher than normal in case it ends up coming down a lot more than you anticipated.

Grant

I was so naughty! Sponge syrup pudding with custard! Fabulous treat.

Thank you, I'll consider upping the dose a bit and ensure I start from a higher BG.

 

[LincolnLizzie]

Hi. Do you have excess weight? You appear to need the insulin even though having low carbs and you go high easily and stay there. I wonder whether you could even be Late onset T1 and not T2?

Yes, I do have excess weight, I've lost nearly two stone, but another two to go. Difficult on insulin but getting there. I'm definitely T2, I discussed it with my DN. I only need insulin if I eat other than low carb. I'm only on 16 units of Lantus daily, so not a huge amount. I am making some insulin, just not much, otherwise I think my levels would not drop albeit slowly.

 

[GrantGam]

I was so naughty! Sponge syrup pudding with custard! Fabulous treat.

Thank you, I'll consider upping the dose a bit and ensure I start from a higher BG.

Syrup sponge, amazing!

Another question for you. When you said that it took you nearly a week to get your BG back to normal, did you use your QA insulin at all to help? As in, administer any correction doses?

 

[LincolnLizzie]

I'm not sure what you mean by QA insulin, so assuming you mean the Novorapid, then no, I didn't. Just upped my bolus by 2 units and actually, looking back at my diary, it took 5 days. Interestingly, even though I did two bike rides, the exercise didn't help at all.

 

[GrantGam]

I'm not sure what you mean by QA insulin, so assuming you mean the Novorapid, then no, I didn't. Just upped my bolus by 2 units and actually, looking back at my diary, it took 5 days. Interestingly, even though I did two bike rides, the exercise didn't help at all.

Sorry QA insulin (quick acting) will be your Novorapid.

You may want to discuss correction doses with your DSN in order to get your bloods back on track when not following your carb restricted diet.

A rule of thumb (for T1D's anyhow) is that 1u of quick acting insulin will reduce BG by 2-3mmol/L. This value is entirely individual so you may find you need slightly more to reduce your BG. Equally, you may require less but that's something only you will be able to find out.

Maybe some other T2's on insulin can advise with their own personal experience.

 

[Mep]

It's possibly from sticking to the 1:10 ratio. For me I think my ratio is more like 6:10 depending on the carb... but that's an average.... sometimes just under that ratio with carbs like potato. Like I just ate 125g of basmati rice tonight which is almost 32g of carbs. I bolus'd 18 units of apidra which is the bolus insulin I use. I apparently do still produce a small amount of insulin (not sure how much but I was told it's not very much) so I often wonder if I get a bit more of my own sometimes than others... I don't know. I just think I react differently to different carb types and also with whatever else is affecting my sugar levels aside from food. I hope you figure out the right dosage... also I agree it's hard to figure out if you've not prepared the food.

 

[LincolnLizzie]

Thanks for your help x