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Weird ratio change results

barrym

barrym

Well-Known Member
Messages
829
Location
North Wiltshire
Type of diabetes
LADA
Treatment type
Insulin
I have been using a Novorapid ratio of 1:20 for ages, and I had thought it generally accurate.

For the last few months I have been using Libre, and watching closely the spikes that certain foods give me. Cut out some stuff as a result.

As I scan and see current reading I may take an adjusting dose if I think it necessary. I suspect I have been over reacting and taking more adjustments than I should. Not just with Libre but previously too.

Anyway a couple of days ago looking at the LibreView reports I noticed one that showed total carbs per day (something I've always recorded) and also total insulin per day. Wow, that's quite revealing. If you make the assumption that my 1:20 dose plus adjustments levels out my estimated carb intake, which it really has to over time or I'd be dead! Cumulatively rising or falling otherwise.

So looking thru the total carbs and total insulin, the effective ratio that I have been taking is closer to 1:10!!! Yep, double what I thought. I did say I did a lot of tweaking.

So I decided I'd start taking 1:10 and see how it goes. Yeah I know it's a huge change, don't lecture me. I'm a grown up. I'm keeping a close eye on things.

Today I noticed another odd thing. Breakfast at 05:30 was a serving of Aldi Paleo Muesli. Including milk I estimate 15g carbs, so I took 1.5 units. Took the dog out and when I got back checked BG and the spike had been about 3.5 mmol, and was back where it started so 1.5 units looks good. Then I had a piece of toast, estimate 25g, and marmalade, 5g, a total of 30 so 3 units. Result within 2 hours was a much smaller rise, about 1.5 mmol, and BG heading south. Time for a quick jelly baby which seems to have resolved things.

Now finally a question, I have been at this long enough now to know there's little consistent in our struggle against this condition, but how do we explain why two reasonably similar carb types and the same ratio used don't spike the same. Twice as many carbs in the toast & marmalade doesn't rise as far as the cereal.

Not a thorough test I know. Might try toast for breakfast for a few days see if remains constant.
 
@barrym How long was the dog walk? That's some additional aerobic exercise that you've undertaken prior to eating, and aerobic exercise generally has a negative effect on blood glucose, especially with IOB - the normal advice is to bolus less after exercise...

You'd be better testing the toast and marmalade at 5.30am prior to taking the dog out to see whether the ratios are similar.
 
I have had the same routine for years, and realise the effect of exercise, particularly intensive, which the dog walk isn't. I used to do some semi serious cycling which did make a difference, but this walking is 45 minutes brisk pace.

The breakfast and snack were just examples. I have had plenty of these weird behaviour rises over the years. I just wondered if there was something I was unaware of.

I have adopted the new ratio and it does seem to be working, but I still had an odd occurrence with a pita yesterday. Getting a bit cocky, I thought this new dosing regime would easily handle the pita which I normally avoid, and BG went through the roof. Took 18 hours to get back on track.

It's a weird old disease ain't it?

Edit:

Ps. I did do toast and marmalade with low carb bread this morning and it behaved ok. Not a perfect comparison though.
 
If you were a type2 I'd explain that insulin resistance is worse on a morning. I know @Kristin251 is LADA and she can experience insulin resistance.
Is all your breakfast carbs giving higher need for insulin? Experiment safely but that extremely high reading after pita was it for breakfast?
Sounds like your libre is great for understanding your diabetes eh?
 
Pita was last evening, so no direct comparison there really. I tend to use the same ratio for all carbs at any time. A bit crude I accept. But as I've posted elsewhere I have never found anything repeatable or consistent enough to draw conclusions. Until that is the Libre report that pointed at a higher dose needed.

The Libre sure helps with seeing what happened. Whether I'm bright enough or disciplined enough to make good use of that to affect the future is another matter. I suppose to some degree I am. In the few months that I have been using it, I have improved my time in range noticeably and reduced the number of hypos quite considerably.

I should have posted more detail on my complications to make some of this more understandable, or rather explain why I may not be able to experiment in the same way as others. Here goes:

Five years ago I was diagnosed with esophageal cancer. Initial treatment was successful chemo/radio therapy and I had 4 more years of pretty normal digestion behaviour, so my diabetes management plodded along. Then at the end of last year abnormal pre-cancerous cells in the esophagus recurred and after much debating my consultant recommended a esophagectomy. This involves removing the esophagus and reshaping and reducing the size of the stomach and dragging it up through the chest cavity to the the top of where the esophagus was. Pretty major stuff!

Anyway, I have made a pretty good physical recovery, but my capacity for food is greatly reduced, and digestion is a bit fickle. The recommendation is to eat little and often. Easy for a non-diabetic, but for a diabetic a bit difficult to fin a post-prandial time to test! By getting up early I squeeze in a snack after the dog walk, but afternoons are too short. If I have a snack I don't want tea so it is self defeating. Digestion isn't predictable. Sometimes I feel full and nothing seems to be 'going down' and other times it can 'dump' and all act a bit too quickly if you get my meaning;-)

Anyway, it adds to the fun and games we have to deal with. I try not to be too obsessive, but I am! My consultant was worried about me getting Libre as she knew that more data was going to mean more questions. And as we all know there are more questions than answers:-)

That's enough now.

Sorry for the long post.
 
Yeah it sounds like the Libre has "livened things up" because it gives you more to look at. Myself I've rarely been one to measure a blood sugar 2 hours after eating. Only before eating, at bedtime, upon arising (is that sort of a British phrase I hope?). But I do tend to take less bolus when I consume lower glycemic index carbs (which I favor for obvious reasons). My rule of thumb is 1:12. Your customary 1:20 is/was pretty unusual IMO. Last weekend for lunch I ate 2 small enchiladas and a small/medium bowl of tortilla chips with salsa and took 11U. It came out about right before dinner.
 
(I'm lada or type 2, on tresiba and fiasp, in case that's relevant) I have the impression I need way more insulin for the first carbs of the day then for the carbs later on, regardless of the time. I also get a rise right after getting up (again, regardless of the time), for which I take insulin right after waking up (take about as much as for a slice of bread, whithout eating). These are both things that could play a part in what you're seeing. For a late night snack I need less than half of the insulin I need for the same food for breakfast (for instance: a single cheese sandwich for breakfast is 6-7 units of insulin, a double cheese sandwich before bed is 5 -6 units of insulin) Diabetes is weird.
 
barrym said:
Blimey! I have never, ever, ever, taken 11u in one go! Awesome.
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That's very rare for me too. I probably do about 50-60g carbs/meal. Like I said a 1:20 ratio sounds pretty high. What I see around here is more like 1:10 1:12. How much basal do you take?
 
Antje77 said:
(I'm lada or type 2, on tresiba and fiasp, in case that's relevant) I have the impression I need way more insulin for the first carbs of the day then for the carbs later on, regardless of the time. I also get a rise right after getting up (again, regardless of the time), for which I take insulin right after waking up (take about as much as for a slice of bread, whithout eating). These are both things that could play a part in what you're seeing. For a late night snack I need less than half of the insulin I need for the same food for breakfast (for instance: a single cheese sandwich for breakfast is 6-7 units of insulin, a double cheese sandwich before bed is 5 -6 units of insulin) Diabetes is weird.
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That's the opposite to how I have always thought I worked. Being more active in the day and fairly sedantry at night I've always taken heavier doses then.

Will give it some thought though see how it might work.

Oddly I have a request into my DSN to switch to fiasp. I reckon that'll help.
 
barrym said:
Blimey! I have never, ever, ever, taken 11u in one go! Awesome.
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Keep an eye on these larger doses. (I am sure you are.)
I have heard and read a few times that our bodies have a maximum insulin dose they can take on board in one go. For me this is around about 10u. Anything more is wasted and I need a correction dose later.
 
Antje77 said:
(I'm lada or type 2, on tresiba and fiasp, in case that's relevant) I have the impression I need way more insulin for the first carbs of the day then for the carbs later on, regardless of the time. I also get a rise right after getting up (again, regardless of the time), for which I take insulin right after waking up (take about as much as for a slice of bread, whithout eating). These are both things that could play a part in what you're seeing. For a late night snack I need less than half of the insulin I need for the same food for breakfast (for instance: a single cheese sandwich for breakfast is 6-7 units of insulin, a double cheese sandwich before bed is 5 -6 units of insulin) Diabetes is weird.
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I think adrenalin and cortisol are the monkeys responsible to get us moving. At evening time our bodies need less. Unless we are shift workers, of course. I'm led to believe.
 
ickihun said:
I think adrenalin and cortisol are the monkeys responsible to get us moving. At evening time our bodies need less. Unless we are shift workers, of course. I'm led to believe.
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That makes some sense to me. For instance the highest blood pressure people get is the first one in the morning after they wake up, after a restful night during which the BP is usually at its lowest. Which is why I tell people to take their BP meds as soon as they get up. Maybe insulin's the same way. I take my Lantus right when I get up.
 
TheBigNewt said:
That makes some sense to me. For instance the highest blood pressure people get is the first one in the morning after they wake up, after a restful night during which the BP is usually at its lowest. Which is why I tell people to take their BP meds as soon as they get up. Maybe insulin's the same way. I take my Lantus right when I get up.
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I think the early worm.....combating the morning rise helps with my hba1c, for sure.
 
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