Determining carb sensitivity

[Jonathan_R]

How do you determine sensitivity to carbs? Do you do it with out meds (lantus and humalog)? Do you do it with just lantus? Do you do it with meds as normal?

My calculations so far are about 7.9. In other words, for every carb I consume it raises my blood sugar 7.9 points. Or for every 7.9 points I need 1 unit. I haven't bolused to that cause I am working on raising my basal.

On top of this, there is the glycemic load. The glycemic index tells you how fast it will raise blood sugar. The glycemic load tells you how much. Not all carbs are equal. Some are fiber, and do not get digested. So there is like a percentage of the carbs that will raise your blood sugar. Or at least a scale.

I have noticed that I can do calculations, measure the portions, and yet I still end up with high blood sugars. Some times only a little high, some times it's way off.

This makes calculating difficult for me. my former primary care doctor could not figure my sugars out. My former endo was having such a hard time that he wanted me on a pump.

In order for me to nail this down, I need to figure out my sensitivity to carbs. I also need to better understand the glycemic load.

I dug up this formula and applied my numbers to it. TDD=grams of carb covered by one unit of Humalog (500/63=7.9). TDD is total daily dose. Since then, I'm sure it has changed. I did this toward the beginning of the month. I have changed my basal, as well as my bolus ratios.

[Kirsty-Marisa]

Hey Jonathan!
A simple way to do it is to start off with one unit of your rapid acting insulin for every 10g of carbs consumed.
So, for example, a bowl of cereal may read 28g of carbs per 40g serving. If you eat 40g of cereal (about half a bowl) you need to inject 3 units of rapid acting insulin.
Check your blood sugar level before eating. Inject for what you've had, and then check again two hours later. If your level is within 1-2 points of your level before eating it's generally enough.
If you start off with a reading of 7 and after two hours your reading is 11, next time have 1.5 units for every 10g of carbs. Easy way to work it out is as 1 per 10g, and add half of the dose again, so for that same bowl of cereal you'd inject 4.5.
Alternatively if you hit hypo (below 4.0) after injecting, reduce the dose to 0.5 units per 10g. So half of the original dose - 1.5.
By using these clear cut numbers and testing two hours after injecting/eating after about a week you'll have a more sound idea of what your body needs. Over in England this is how we're all started out.
Good luck hun!
Kirsty-Marisa

[Kirsty-Marisa]

Aaaaaaaaaaalso...
I assume you take your lantus in the evening. This should really only be affecting your morning reading. So if you're high in the morning the dose may need to be increased. If it's low decrease your dose.
Experiment changing it 2 units at a time in whichever way needed, but changing the unit amount no more than every week. Your body needs time to adjust to the change.
Ratios are all well and good but they're only a guideline. You just need to find what's right for you :)
Kirsty-Marisa

What My Pancreas Did Next (http://www.whatmypancreasdidnext.blogspot.com)

[genie86333]

I notice you said you're trying to raise your basal while figuring out carbs too...I'd advise adjusting one first, then the other... do some basal testing to get it right first then figure out the carbs. If you're changing both at once you'll never know which change is working.

[Rekarb]

I get what you're doing but ... I'm finding that all carbs, at least in individual reactions to them, are not created equal. I've a friend who loves his morning oatmeal, even though he's diabetic. It has no effect on bg, he might as well be eating cheese. Me? I look at a box of oatmeal and I've got a problem.
You might try cataloging classes of foods and their bg index for you, then you might be able to line out the data and get some results. I think this is what actually happens with most people. Over time, experience allows them to know the effects of the things they eat and they adjust accordingly. The truth is, how wide is the general diet? There is a general guideline that most people develope who are conscientious.

Mike

[butterflykisses]

Are you referring to the 500 rule? If so, it's 500/TDD=grams per unit, not how many 500/carb. You do need to be taking both your Lantus and Humalog in order to get things right. If you take your blood sugar, eat, bolus and wait 3-4 hours test again and are close to where you were before bolusing, then you're in the ballpark. It would be much easier if you could get your basal adjusted first. Trying to adjust your I:C ratio with that off is going to be challenging. If your fasting glucose is consistently high that's a clue that it needs adjusting. You should pick up the book Using Insulin. I think it might help, and I hope you're talking to your doctor through this!

[Jonathan_R]

6.849. But then that's based on yesterdays numbers.

Yesterday I had an awesome day. My BG levsl looked like this:

8:54 AM 247BG 1 serving of cereal GI=74, GL=15 30 carbs 31u Lantus 16u Humolog

12:10 PM 98BG 2 hamburgers from McDonalds 62 carbs 4u Humolog

1:21 PM 169BG

5:15 PM 159BG stew 60 carbs 8u Humolog

8:23 PM 114BG 15u Lantus

Those are the best numbers I have ever had.

[Lizzie G]

6.849. But then that's based on yesterdays numbers.

Yesterday I had an awesome day. My BG levsl looked like this:

8:54 AM 247BG 1 serving of cereal GI=74, GL=15 30 carbs 31u Lantus 16u Humolog

12:10 PM 98BG 2 hamburgers from McDonalds 62 carbs 4u Humolog

1:21 PM 169BG

5:15 PM 159BG stew 60 carbs 8u Humolog

8:23 PM 114BG 15u Lantus

Those are the best numbers I have ever had.

your fasting BG is very high. you need to figure out whether this is due to your basal being too low, or not bolusing adequately for your evening meal. best way to do this is to test about 4 hours after your last morcel of food (yes this does sometimes involve setting the alarm for 1am but its the only way to figure it out) and then re-test when you wake up, and any movement is down to the basal being too high or low (make sure that evening meal isnt really fatty or this doesnt work, very basic unprocessed carbs work best for figuring this stuff out, very simple meat and potatoes or some pasta with a tomatoey sauce).

[genie86333]

Hi, Johnathan.

I'm glad your numbers are better than usual, but I'm really thinking it still needs some tweaking. 5 hours after your lunch your blood sugar was still 159, which means either the 4 unit bolus wasn't enough for the 62g of carbs or your basal isn't enough...possibly both.

I do think it was partially your basal, since your fasting was so high as Lizzie mentioned. I'd work on that with the basal testing she recommended before adjusting your boluses, because otherwise you'll have to recalculate the boluses all over again after your basals are right.

[Jonathan_R]

To consider the fasting basal, you really need the stats from the previous day. The following day, my stats continued in this same trend.

I think what made the difference is Saturday, I had some rather good exercise. I helped my brother move.

I have also noticed, since I have returned to my regular activity, which is almost nothing, that my blood sugars are going back up.

There is no way I will continue that intensity of exercise. I can walk 4+ miles with out thinking about it, but that day, I sweat almost all day long. It also exacerbated my carpal tunnel.

This tells me 2 things. Exercise had quite the impact on the effectiveness of insulin. Also that I am on the right track. I agree, the basal still needs work. The ratio for the bolus might need some fine tuning, but I'd rather not mess with both at the same time.

[Lizzie G]

To consider the fasting basal, you really need the stats from the previous day. The following day, my stats continued in this same trend.

I think what made the difference is Saturday, I had some rather good exercise. I helped my brother move.

I have also noticed, since I have returned to my regular activity, which is almost nothing, that my blood sugars are going back up.

There is no way I will continue that intensity of exercise. I can walk 4+ miles with out thinking about it, but that day, I sweat almost all day long. It also exacerbated my carpal tunnel.

This tells me 2 things. Exercise had quite the impact on the effectiveness of insulin. Also that I am on the right track. I agree, the basal still needs work. The ratio for the bolus might need some fine tuning, but I'd rather not mess with both at the same time.


i was just suggesting that you work on the basal first; the reason being is that if you have all your carb ratios sorted, then find that your basal is completely wrong, you will end up re-adjusting your ratios as the ratios you figured out that worked would have been to cover the food and basal errors, believe me it is FAR simpler to do this first.

as regards exercise, i find a 2 day effect either way. generally i exercise quite a bit, but if i havent exercised for 2 days i put my pump onto a different setting, delivering about 10% more insulin. likewise i need to adjust back down 2 days after getting back into exercise. on lantus its slightly more difficult because it takes longer to change the levels in your system, but try switching up or down a couple of units a day depending on your anticipated exercise. i also find that after exercise my carb ratios move quite considerably, for example in the evening my 1:15 ratio is more like about 1:20.....these are things you just have to keep tweaking!

[Jonathan_R]

Tell me about it. Last night I had 2 hypo attacks. One right after the other. This told me my ratios were wrong cause I was still feeling the effects of the exercise. Now my blood sugar is likely to be high before breakfast (haven't tested yet).

[DannyK]

Jonathan...

This link may be of some help to you.

http://www.diatribe.us/issues/13/learning-curve.php

Hope it helps you in figuring out your basal. ;) Good Luck!

[It Ain't Over]

Jonathon: Carpal Tunnel? My md told me to apply aspercream to the wrists. Have found it gives almost instant relief. Don't have a severe condition though.

[Jonathan_R]

I re-injured the carpal tunnel and now it hurts worse than ever.

Just an update on my diabetes. About a month ago, my 30 day average was over 300. I just checked today, and my 30 day average is 200. I brought it down 100 points. I'm still trending down. I am now starting to see more normal blood sugar ranges.

It was all due to this forum. The feedback I got was absolutely invaluable. Ofcourse my log helped to, but really, with out you guys looking at it with me, interpreting it with me, and helping me make corrections, I wouldn't be where I am now. That is a simple fact.

[dbaratta]

[QUOTE=Jonathan_R;480867]I re-injured the carpal tunnel and now it hurts worse than ever.

Just an update on my diabetes. About a month ago, my 30 day average was over 300. I just checked today, and my 30 day average is 200. I brought it down 100 points. I'm still trending down. I am now starting to see more normal blood sugar ranges.
QUOTE]


Way to go Jonathan!!! ;)