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#1
forty_caliber

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My first instructions for NovoLog dosing were on a sliding scale based on BGL

Like this:
<180 0 Units
181 - 250 6 Units
251 - 300 8 Units
301 - 350 10 Units
351 - 400 12 Units
>400 12 Units and call Dr

Now the doc has said to use this formula instead
(BGL-100) / 20

Using the formula,
BGL reading below 120 results in an outcome of less than 1 unit.
BGL reading of 140 results in an outcome of 2 units
BGL reading of 160 results in an outcome of 3 units and so on.

I'm new to this and am wondering how others are told to use this medication their specific for situation. Would you stick yourself for 1 or 2 units?

.40

#2
mom24grlz

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i'm totally confused by your new method of figuring out insulin! I've never heard it done like this before. It's kind of like an insulin to carb ratio (which my daughter is on). But instead of using Carbs/ratio. You're doing BS/ratio. if my daughter had a result of .4 I'd do 1 unit of insulin.

Chris mom to 13 year old daughter with type 1 diabetes. Pumping animas ping

#3
Joisey

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What it looks like to me is, he's helping you to determine the correction factor of your bolus. That's fine and should help with better control, but the other part of the bolus is to cover the carbs you're about to eat. I don't see where that is factored into the equation. I usually don't bother to bolus unless it comes out to 4 or 5 units. YMMV.

#4
Tribbles

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It looks like he is just having you correct after the fact. I think that he has you on an I:C carb ratio of 5 if you were carb counting.

#5
forty_caliber

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What it looks like to me is, he's helping you to determine the correction factor of your bolus. That's fine and should help with better control, but the other part of the bolus is to cover the carbs you're about to eat. I don't see where that is factored into the equation. I usually don't bother to bolus unless it comes out to 4 or 5 units. YMMV.


It looks like he is just having you correct after the fact. I think that he has you on an I:C carb ratio of 5 if you were carb counting.


I knew I came to the right place to learn from others experience. I totally have no clue what a bolus is and I'm not sure how to figure a carb ratio.

According to the paperwork I'm allowed to have 60-75 grams of carbs per meal x3 daily plus 1 30 carb snack.

In addition to the Novolog when needed, I take 25 units of Levemir in the evening no matter what and 500mg of Metformin 3x daily with meals if BGL is above 80 before eating.

After changes in diet, my rising BGL is around 150 tapering off to the 100-120 range during the day. Only very occasional doses of Novolog are needed at this point but lots of other meds besides Novolog are taken throughout the day.

I think I'm going in the right direction but after reading some of the comments on the board it couldn't hurt to have some other opinions.

I'm also testing after meals to determine what causes my spikes. So far Pasta is the worst.

.40

#6
Subby

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The method you have described is an established one, it is pre the methods other people have mentioned here. It is indeed called a sliding scale. It may have some more valid application in hospital situations, but is certainly a real shame to use on a daily occurance.

It is reactive rather than proactive. It is outdated and leaves a lot to be desired in terms of meeting bolus challenges successfully and with a maximum chance of good blood sugar control.

I recommend you get the book Using Insulin by John Walsh, or Think Like a Pancreas by Gary Scheiner, and learn the ins and outs of modern insulin bolus use: carb counting and using an insulin to carb ratio and using Correction Factors (otherwise known as Insulin Sensitivity Factors). It will also show you how to troubleshoot and basal test your long acting or basal insulin, if you use any.
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#7
Pixi Stix

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I am a nurse. We do it that way in the hospital as its the easiest thing to do. But its by far, NOT the best way. If all your meals consist of exactly the same amount of carb every time, it could work if its been calculated to your meals, but this will not help you with a larger than average meal or smaller than average carb load. The best thing to do is to know the carb count of everything you put in your mouth and find a ratio that works well for you. I'm a very insulin resistant person on a 1:3 ratio and a high correction factor. Correction factor is additional insulin needed when your glucose is high because the higher you are, the more insulin per carb you need. (your resistance goes up) But if you want to keep your glucose down, this is the best way to do it.
If you have a smart phone, there are a few great apps to help you determine your dosage. I use glucose companion for the iphone.
Lisa Type2 20 years. Levemir 40am/50pm 1:3 carb ratio correction factor: 5

#8
jenb

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I second Subby's suggestion of the two best references for insulin users: Think Like a Pancreas by Scheiner and Using Insulin by Walsh. Either one will take you methodically through the process of establishing an optimal basal rate for yourself, then will give you the tools you need to develop your insulin:carb ratio for meals and a correction factor for times when your blood sugar exceeds your target range. While I find that insulin dosing is as much art as science, these fantastic books give you excellent starting places and really make the whole thing easier!

Jen

#9
Hammer

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I don't use a sliding scale like your doctor recommended for you. Most people don't like using a sliding scale because it's outdated and less effective that counting carbs, but it is easier to follow. A sliding scale has you inject insulin after you see what your BG (blood glucose) levels are. That means that if you see that you are at 300, then you inject a certain amount of insulin. By waiting to inject after you see what your numbers are, your BG levels are in a dangerous area for a period of time. That's not good. By using the carb counting method, you inject before you eat and that prevents you from spiking too high. That's a lot better for your body and seems to be a better way to control your diabetes. I'd rather count the carbs in the food I'm about to eat, take the appropriate amount of insulin for those carbs before I eat, and keep my BG levels under 120 as opposed to spiking to say 300, then taking the insulin.

Like Jen said, using insulin is an art. I find that I adjust my dose for each meal based on my before meal BG levels and what I am about to eat. By adjusting constantly, I can keep my BG levels in a narrow range without spiking too high and doing damage to my body. Carb counting is a bit more work but it's the most effective way for a type 2 to control their BG levels when using insulin.

Presently taking: Hyzaar for blood pressure:
Novolog and Lantus for diabetes.
Welchol for cholesterol and diabetes
Mega-Red Omega-3 Krill Oil (300 mg)
Mega-Red D3 (5000 IU)
I was diagnosed in 2003...

(The human body is so resilient that no matter how badly you abuse it, it will still last you a lifetime.)


#10
forty_caliber

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Began reading "Think like a Pancreas" this morning. Thanks for all of the great responses.

.40

#11
forty_caliber

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Finished reading " think like a pancreas". In the introduction, Gary mentions that diabetic get seated in restaurants faster but doesn't say why.

Anyone know more about why he chose to include this statement?

.40
I felt a great disturbance in the Force... as if my BGL was out of control.

Type 2 - Diagnosed 3/27/2012 BGL 545
Metformin 500mg 3x daily with meals
Novolog as needed (BGL-100)/20 before meals
Levemir 25 units with evening meal

#12
Bountyman

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Finished reading " think like a pancreas". In the introduction, Gary mentions that diabetic get seated in restaurants faster but doesn't say why.

Anyone know more about why he chose to include this statement?

.40


Unless someone has DIABETIC written across their forehead...I don't see how any particular restaurant would know one is diabetic.




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