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What happened? (carb counting / insulin dose failure.. hypo)

carl0s

carl0s

Member
Messages
24
Location
Manchester
Type of diabetes
Type 1
Treatment type
Insulin
Hi.
I started on novorapid & lantus on Saturday, after initially starting on novomix over the xmas period. I'm a late onset type 1, probably.

I am trying to figure out my doses. Nurse told me to start on 3u with each meal, and 10u of the basal each night. Firstly, I think I am finding the basal is too low because I am generally high all the time (9 - 10 more often than not), and have on one or two occasions added an extra 2 - 4u of Lantus in the evening.

I thought my evening I:C ratio was about 1:7, as that worked well yesterday, and also it seems to be working well for breakfast, at least with the Lantus in the background anyway.

Today I did the same, and 1hr after eating, I was at 3.3. I panicked a bit and had a sip of lucozade, then quickly went up to 3.7, so I had another sip, and then a small piece (from mini loaf) of brown bread with peanut butter (4% carb peanut butter, and I had hardly any of it). That was about 20 mins ago and I'm at 5.7 now.

I am wondering if I should have perhaps not counted the carbs in my veg? I'm wondering if I read something about that ?

I was at 7.8 before evening meal, and the meal was:

1x chicken kiev (16g carb)
30gr brown rice (10g carb)
130g mixed veg (6g carbs) (brocolli, cauli, carrots, from frozen, microwaved)
2x poached eggs
bit of reggae reggae sauce.

which I logged as 32gr carbs, and so took 5gr insulin 5 minutes before starting to eat.

Right after eating, I had a weight watchers yogurt to make up the difference, which is 8.6g of carbs.

Then an hour later I was at 3.3, although I felt fine, until I panicked a bit.

Any tips, other than to try a higher ratio (1:8) next time ?

I am intending to try 14U lantus tonight instead of just 10. The other night I took an extra 4 U 1hr before main meal and things looked better that night. Last night (actually 3:53 this morning) I took an extra 2U of the lantus and as said before, I have been generally high all the time.

My full log is here: http://www.internetsomething.com/export.pdf (and attached below, but remember I only started on basal/bolus on Saturday 2nd). Yes I know I shouldn't have had chips with lunch today, it was the first time in months!

Thanks,
Carl
 

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Hi. I can only give you some suggestions as I can't try to diagnose you remotely and as an amateur. First, the Lantus (Basal) is normally adjusted to get the morning fasting blood sugar to be between 5 and 7mmol and you should get this right before trying to get the rapid (Bolus) right. You may need to do this gradually over several days. Your rapid looks like it's slightly high and I was told to start at a ratio of 1:10. I assume you mean 5 units when you say 5gm? So try to get the Lantus right and expect to reduce the rapid a bit?
 
I agree with Daibell, a starting ration of QA insulin of 1:7 seems on the high side. Keep a detailed diary of food eaten, carbs, BG levels and insulin taken for a week and take to your DSN. Still early days so I'm sure there will be more dose adjustment in the future.
 
Thanks guys. Yes I did mean 5 units of the bolus!

I am keeping a good diary. I found 1:10 wasn't covering it but I will try again, or maybe 1:9 and see how that looks for a bit.

My morning fasting since starting the Lantus has been 8 - 10, and that's with me taking 14u one night, 12u another night, and the prescribed 10u on the first night. I think I might take 13u tonight once I'm sure I'm steady again, and see how that looks for a few days.
 
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the lantaus lasts for upto 3 days in your body so needs time to adjust. By adding correction doses and altering your dose your just confusing things more. I would go with 10u for 3 days and record everything. review. are all 3 mornings after higher than you want? yes? then add 1u (11 u total) for 3 days. this takes time dont try and rush it - thats what the rest of your life is for.
 
OK cheers - I will give it time then. I took 13U Lantus last night and will carry on with that. My average over the prior 3 days was 12U anyway (10, then 14, then 12 the next night). I used a 1:9 I:C ratio today and have had a good day. Spikes 1hr after meal up to 12mmol/l, but then dropping back to 4.9 - 7 for the rest of the day right up 'til teatime. Best numbers I've ever seen so far, and much better than the novomix which sent me into a hypo if I didn't eat on schedule every day.
 
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