[MinimedPumper07]

This **** has gone on long enough. I just can't figure them out. Mornings I am 6:1 and that seems to work OK but night time is a real pain. Sometimes 11:1 sends me low, but other times I go high. So I figured out that weekend nights I need 7:1. Even that sends me high sometimes. What is a good way to test? Could I just drink some OJ and bolus for it or would that not be sufficient? Also the 500 rule CAN'T work because I have a TDD of 35 and that means I need a 14:1 ratio which is much too little!

[Gary_W]

Sorry if this is a silly question, but have you done basal testing to establish that you are not rising or falling in the absence of food? How many units of basal do you put in per day vs how many (on average) units of bolus insulin?

Gary

[REDLAN]

It's that time of year again...

the one where people post aaaaargggh my regime isn't working anymore!!!!

<can't remember the name of the poster who noticed it - youngish guy by judging by his picture was always disagreeing with Bluesky>

I too have been struggling with basal rates, boluses, correction doses - nothing seems to be working - one day it's too much the next it's nowhere near enough.

<my hypothesis - impossible to prove and no-one would care because there isn't any money to be made pedalling a drug for it>

I'm convinced that it's because spring is here and our bodies are getting ready for summer. It's probably triggered by the longer days and warmer weather.

The gradual development of insulin resistance in order to lay down fat over the winter is no longer needed, and I guess we get days when it turns off in readiness for the summer, and then comes back on strong when we have a cold/wet snap.

so playing ping pong with the control - should sort itself out in a month or so.

[milfordj]

From a very long time Type I and very short time pumper (Animas 2020 -- with extended boluses to prevent stinging): I've been struggling to determine my I:C Ratio as well. I started with 15:1 based on pump book recommendation, and realized that wasn't nearly enough insulin to cover my carbs. I soon decided to start at a too-high dosage, beware hypos, test FREQUENTLY, and adjust as necessary. I began with 9:1, then 9.5:1 (this required intricate adjustments since Animas pump does not have fractional I:C Ratios), then 10:1, and am currently on 11:1. Haven't been on this ratio long enough to know if will need further adjustment. My technique (which may well be frowned-upon) is to establish a "Correct I:C Ratio" when NOT Excercising (to later adjust for ExCarbs). If I find this does not work (based on the fact that different foods / meals have very different effects on BG due to fat content, protein content, glycemic values, and probably numerous other variables), I'm going to use the one that works best for MOST Foods / meals, and then keep up with the amount of adjustment I need to make. Wenever I eat a very large meal, especially with high protein, I take the indicated I:C bolus, treating 50% of the protein as carbs, in Combo fashion -- slight gastropareisis and usually a very large dose that would definately hit me too soon. I also increase my Basal 200% for 4 hrs if a "Lunch-time" meal / and 100% if an evening meal, and retest, particularly at the 4 hr time, to see if I need to extend the Temp Basal Increase. My eve Basal increases from .40 to .60 at 3:00 AM, so I make sure the eve increase does not last beyond 3:00 AM to avoid morning lows. This has been working very well for me. Going through too much detail, and too much personal treatment parameters, but wanted to show how difficult it is to accurately determine the best treatment option for the individual -- no one way works best for everyone, or even for most. Getting back to my original attempts to determine the "Correct I:C Ratio", I've decided that if I don't find a single I:C Ratio that works for all foods / meals, I'll use the one that works best for MOST Foods / Meals and then, if certain foods or meals tend to require a 10%, 15%, or 20% INCREASED Carb Valuation to obtain the correct dosage (I:C Ratio), or certain foods / meals require a 10% to 20% DECREASED Carb Valuation (at least at my current 11.0 I:C Ratio), e.g. input 75 Carbs, vice 90 for my I:C Ratio. This has been working great for me. Much too long a reply to your post, but mainly wanted to suggest possible considerations which may be helpful to you. I should change my user name to "The Analyst", because I tend to Over-Analyze EVERYTHING. Best of luck.

[Gary_W]

Originally Posted by REDLAN

<can't remember the name of the poster who noticed it - youngish guy by judging by his picture was always disagreeing with Bluesky>

That would be Deus Ex

[grace girl]

Have you done basal testing? You have to do that first, or you will NEVER get it right. Once you know your basals are set right, then you should be able to determine your carb ratio.

I will add that there are two things to keep in mind:
1. I can't say that it affects everyone, but I find myself changing things when Spring comes, and then again when Fall comes. I usually take less insulin in spring/summer than in fall/winter.
2. Daytime activity (for ME) is a major player in how the evening is going to progress bs-wise. My point is, even when you learn what your ratio's are, there will be some fluctuations, but with time you'll learn to recognize them.

[MinimedPumper07]

i will do basal testing next week over my break. but does anyone have any idea why the 500 rule is so off for me? I mean i should be 14:1 but i need twice as much !!!

[grace girl]

Originally Posted by MinimedPumper07

i will do basal testing next week over my break. but does anyone have any idea why the 500 rule is so off for me? I mean i should be 14:1 but i need twice as much !!!

The only way I can explain it is that the 500 rule is a general guideline and that everyone is different. I can't explain why lantus injections can drop me like a rock when it PLAINLY states in the package info that it's a flat insulin. It's just different for everyone and you have to find what works for YOU.
I promise you, once you do some basal testing and get all of your basals and carb ratios dialed in, the 500 factor's accuracy won't matter to you one bit!

[BlueSky]

I also find that the 500 rule is way off for me. I need much bigger boluses. And I have never been able to work out consistently reliable I:C ratios. I am amazed that many people are in fact able to do this. There are just so many independent variables. The main ones are blood glucose volatility, activity levels, stress levels, insulin absorption rates, insulin action, state of health, and the weather .

Looking back on it, I think blood glucose volatility is the biggest confounding factor. If blood glucose is always on the move, getting the desired effect from bolusing becomes very difficult. Difficulty with accurate bolusing is one of the reasons I eat low-carb. Not having to cover large amounts of carbs means that the problem just goes away. This is particularly useful in the mornings, when we tend to be more sensitive to carbohydrates.

[JediSkipdogg]

The 500 rule is the most useless thing in the world. It is based on an average and that everyone has the same body and reaction to carbs.

I have an odd thing happen with regards to my dinner ratio. It depends on how long prior to dinner I had eaten. If I go longer than 4 hours without food then my ratios generally double for the next meal. I have no idea why that's how it works, but it's what I've come to figure out on my own study and it just puzzles my doctor and she doesn't think it's true, but it'st he closest I've come to figuring it out.

[Gary_W]

Originally Posted by MinimedPumper07

i will do basal testing next week over my break. but does anyone have any idea why the 500 rule is so off for me? I mean i should be 14:1 but i need twice as much !!!

IMO, it should be called the 500 ballpark as opposed to the 500 rule. You have to start somewhere and these things are useful in giving guidance of where some people may be close to. But as we are all different we all have to tweak from there.

As we all vary in terms of insulin resistance / sensitivity / diet / activity etc then what you need is what you need. If you know the right amount to squirt in and it keeps you on an even keel then the book can respectfully go and take a running jump...

You can test your ratios, but until you've established that your basal is correct then you can't really rely on the result.

Gary

[RLK]

Originally Posted by MinimedPumper07

i will do basal testing next week over my break. but does anyone have any idea why the 500 rule is so off for me? I mean i should be 14:1 but i need twice as much !!!

Basal testing is a great idea, and I'm glad to hear that you're going to try it. Keep in mind though that your activity level will most certainly influence your results, so testing during a break may cause your results to be a little off, and you may want to repeat the tests once you return to classes. In my case, I perform basal tests while I'm at work and in the office (instead of the field), because that's a "typical" day for me. (Oh how I wish that weekends were "typical" days )

Good luck with the basal tests, and let us all know how you do with them

[shabbie]

i didnt manage to nail my I:C ratios until i had tested various basals out first.
the 500 rule suggest i should be on 11:1
but daytime i need 18:1 (6am to 6pm)
and nightime i need 10:1...although thats still being tested out!