this insulin thing is tricky business

[Ategeler]

After running high on higher carb meals I was given the okay to start using Novolog 1-2 units depending on how heavy the meal. Well, I have yet to get this right! Last night I thought I finally got it- checked my sugars at an hour after finishing eating to make sure I wasn't going too low to quick- 83 okay. Checked again at 1 1/2 hours- 100-hmmm it is going up but still in good range? Checked again at 3 hours- 173- Yikes! My fasting was 131 this morning which is on the high side too for me. I took 2 units which is a lot for me as I am very insulin sensitive too. I don't think I could have taken 3 units and gotten away with it...

Any ideas on why it initially went down but then way up again hours later.

[NoraWI]

Fat in the meal.

[Ategeler]

Ah- fat. I will say that the sauce was cream based. Probably lots of fat in it. I was so fixated on the carbs I wasn't thinking as much about the fat! Sheesh! Back to the drawing board I guess!

By the way, like the name Nora- it is my daughter's name as well. I might be a bit biased :-).

[lorilei]

def dependent on what you ate as mentioned above...r u just tossing 1-2 units or do you have a carb ratio? seriously, carb ratios make it so much less of a blind folded dart game ...still may not end up with a bullseye, but a much better chance of hitting the board...

[Ategeler]

Funny you should ask about the carb ratio Lori. My Endo recommended 1/25 but I think that is way to high for me. I thought it might be closer to 1/40 or maybe even 1/50. I was going off of the 1/500 rule. How do you configure it?

I tried the 1/25 ratio the first time I ate and I ended up low within a half hour after eating... I have to admit I am rather skiddish about going low so I tend to be more conservative!

[Subby]

Funny you should ask about the carb ratio Lori. My Endo recommended 1/25 but I think that is way to high for me. I thought it might be closer to 1/40 or maybe even 1/50. I was going off of the 1/500 rule. How do you configure it?

I tried the 1/25 ratio the first time I ate and I ended up low within a half hour after eating... I have to admit I am rather skiddish about going low so I tend to be more conservative!

When dealing with insulin, it helps to always remember these two points:

Given a certain meal (it's a bit simplistic, but lets say given a certain amount of carbs)
- there always is a dose that is too high
- there always is a dose that is too low

That's the way insulin works. An inadequate dose won't do the job, and there will always be "too much" insulin, it doesn't peak out like other medication might.

So your job is to find the bit in the middle, the dose that is just right. Unfortunately there is nothing that can inform this better than just... trying things out and seeing.

Using I:C ratios is brilliant, as you can find an I:C ratio and it will deal with this question across so many meals, rather than either working out the equation many times over, or just putting up with lousy control, or severely limiting the variety of your food. In general, and I'd say especially with your sensitivity, guessing with units is just going to be many times the work, and is not going to deliver, compared to working with I:C ratios.

Back to the work of discovering a good dose for you: you have some information: you have some evidence that 1:25 is too much insulin. You suspect 1:40 might be more ballpark. So, go forth and try out your assumption. Personally, I'd probably go for about 1:33 next, as a fair logical step to test.

[lorilei]

if you are that sensitive, you must be eating 40-80 carbs per meal? does that sound right? I'd go with a typical meal, known carbs and try the 1:40...you will quickly know if you are in the ball park
get your pre and post Bg for your rise and drop

[Ategeler]

Subby- I couldn't agree with you more regarding the IC ratio. I just have to figure out which one works best for me. Thanks for the words of wisdom.

[Ategeler]

Lori-you are right about the 40-80. I try and stay on the low side of that but if we go out to dinner it can be on the upper end instead.

[Subby]

Subby- I couldn't agree with you more regarding the IC ratio. I just have to figure out which one works best for me. Thanks for the words of wisdom.

No problem - I dunno about words of wisdom, it's just a straightforward and hands on approach that tends to work best - and that can elude people a bit who are coming to insulin gradually (more stereotypical type 1's are kind of dunked in the deep end, and are more likely to sink or swim pretty quickly). Only you can find your best I:C, and the only way is to treat yourself like a testing subject. :)

[networkguy]

As others have said, establishing a good carb ratio is your best bet. It may take you a few days of experimenting (along with the highs and lows that go along with that) but once you get it, youre golden.

Im wondering why if you were 131 fasting why you would shoot 2u? Im a bit insulin resistant and 2u at 131 would put me into serious trouble...

[lorilei]

april..in addition to getting your insulin to carb ratio, you will need to see how much a unit drops you...this is your correction factor...take 1 unit when you are higher and take a couple of tests before and after to see how low your bg drops from 1 unit

the above post is correct..at 131 I would do a unit as it drops me 40..so would put me at 91 my i:C is about 1:15 depending on the time of day and the meal....i roughly can anticipate a 5 pt raise per carb....2 units at 131 would most likely bottom me out unless some other factor was already pushing my bg up..most likely a hidden carb or a miscalculation

knowing how many BG points raise from a caeb also makes correcting a low easier..if I eat a 5 gm candy I can expect a 25 point rise...no need to overeat and end up high ..



whoever said math is useless wasn't a diabetic

[jenb]

I've found that I need a little extra bolus about 1hr 45mins after I eat a lot of fat...about 1 unit /30 grams of fat in fact. More stats to keep track of. Diabetes is fun!

Jen

[Russell A.]

April:

Going out for a meal is always a tough one. Have you considered keeping a log? Try to eat the same thing for breakfast and Lunch for a few days. Write down what your bs was and the amount of insuin you took, than check according after you eat.

After a several years of pumping that was the only way I could hammer out the correct bolus for simple/common meals. Same thing with commons foods like pizza and pasta. (the forbidden carbs):)

Russell

[Ategeler]

Network guy- my I shot 2 units for dinner the night before. The fasting of 131 was a layover from the previous evening. I am on 4 units of Levemir AM as well.

[Ategeler]

Lori-
This is helpful info. Fortunately, I don't generally need novolog for breakfast or lunch. I tend to eat conservatively for those meals and my body can make enough on its own. It is the dinnertimes where I run high and need to supplement. I am always afraid to correct with novolog since the peak can be delayed. I am always afraid it is going to drop me too low while I am sleeping. But I know I need to start doing that with my numbers so high. My body used to correct itself for me but I am finding now that even in the morning, that isn't the case. Fear of the unkown I suppose!

BTW- Does anyone do half units? My endo initially said she didn't think I would need to half it and that it is more of a juvenile pen that does half units. But I am wondering if that would be more helpful since I am so insulin sensitive anyway.

[Ategeler]

Russell- we are on the same wavelength! I am keeping a log with what I eat and insulin I use. I am hoping this will be key in my "cracking the code" to my insulin/carbratio!

[Ategeler]

JenB- This fat thing is the wildcard for me. And here I was worried about carbs! That is good to know that bolus might be necessary to offset the effect of fat in the diet. Sheesh! So much to learn. I am getting saturated as we speak (no pun intended ;)

[lorilei]

yes..when I first started I used 1/2 units more ftequently..the luxura pen from humalog does 1/2 units..my friend's dtr is on novolog and she does 1/2 units but by syringe...so you'd have to check out their particulars

[mazea]

Yes it could be fat in that cream sauce.
If I have over 20g fat in a meal, and if I don't have extra novorapid my blood sugar rises about 7mmol. If I have over 30g fat and don't have extra Levemir, my blood sugar rises 7 mmol every hour for the next 23 hours. I don't think this happens to everyone though. Testing might help you figure out if fat is rising your blood sugar levels and meet your own individual insulin needs. I require 1 unit novorapid per 20g fat, and 1 1/2 units Levemirfor 30- 40 g fat and then 2 Levemir for 40-90g fat. I can eat 20g fat meals as long as they are 3 hours apart, otherwise it combines and goes into the 30g fat category. confusing!