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oblivious

What is your experience starting on insulin?

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oblivious

It has been almost a month now since I first started using insulin.

I was low carbing at the beginning and found that the basal 14 units was enough to have a pretty descent BG value during the day.

 

Introducing more carbs to my diet felt very good, so I had a week with medium carb intake and upped my basal to 16 units plus 3 bolus at meals.

Still the BG values were pretty good, and using a standard of 1u bolus per 15gr carbs worked very well.

 

Now the last 10 days, I have given in to temptation and splurged a bit in holiday treats. Not major, but I have had some cake and candy.

I have tried to use the same rule, 1u bolus for 15gr carbs, but I still end up getting high FBG and even though BG goes down to normal levels after 2 hours+, at 4 hours my BG is on the rise again.

So I see that the type of carb to insulin ratio varys a great deal, but also that ingesting high GI carbs increases BG after the bolus starts to loose it`s effectiveness.

 

It is pretty clear (and has been in the past aswell) that high GI foods makes controling BG a lot more dificult, and low to medium GI foods are a lot more predictable.

But how have you experienced this? Can you take the same ammount of bolus for 50gr carbs from sugar/wheat as you can from fruit/oats/barley?

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Uff Da

My BG will normally peak to over 200 if I eat more than about 25 carbs for breakfast or 45 carbs for lunch or dinner unless I over-bolus for the amount I eat initially, then save part of the "meal" for a snack two to three hours later.  High GI carbs are worse this way, but it is a problem with low GI foods, too.  

 

My insulin needs are very different than yours, though, making reaction to foods more extreme.  I need only eight units daily of basal, but my I:C ratio for breakfast is 1:4 and for lunch and dinner it is 1:8.  So before breakfast I often bolus for 32 carbs, but only eat about 24 at the meal and save the rest for later.  For lunch and dinner I most frequently bolus for  56 to 64 grams carb, but eat only about 45 and save the rest for a snack.  That's the only way I can eat up to about 160 grams of carb a day and maintain my A1c between 5.5 and 5.9.

 

With my method I don't peak nearly as high as if I ate the entire amount at once.  However, there is the risk of going hypo between meals if I get distracted and forget to eat my snack on time.  The timing changes depending upon what bolus insulin I'm using, too, as the duration of action is an hour or two different between Apidra, Humalog, and Novolog for me.

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oblivious

I noticed that aswell that I need to bolus more for breakfast than other meals.
And I have made a bolus calculator that gives me a correction number for bolus if my numbers are high before the meal.

The bolus correction has to be higher later in the day though, than the correction for high FBG.

Probably because there is not much food left in the gut to raise/keep high BG, contrary to later in the day when you probably still have quite a bit of food beeing digestet in the gut.

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aggie168

Yes, for MDI, any food that does not match your insulin active profile will require some form of split dosage if we want the best outcome. In most cases, user just do a best guess effort.

 

This is where a pump do make life easier. I have the option of an immediate bonus, bolus over a time period and split bolus that I can get a percentage immediately and the balance over time. But then, a pump is something attached to your body at all time and not everyone likes it.... :)

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SweetAndBendy

I'm type 1 so was started on insulin the very same day that I got diagnosed which is little over 10 years ago now. 

There was a lot of trial and error in the beginning, a lot of testing too to see what works and what doesn't and when, still test quite a lot and also wear a CGM. The key for me was to find the insulin to carb ratio and learn when to take my bolus and how. Some types of food works best for me if I pre-bolus a little while before eating, that mostly goes for sugary things like candy or other things that hits your bloodstream fast... While a regular meal is generally fine for me to bolus as I sit down to eat or just after finishing the meal. Bolusing just after finishing eating works well for me if having something that's carby and high fat content like pizza, but really, I can bolus after eating with most things because my Novorapid/Novolog hits pretty fast. With things like pizza I also use split bolus or extended bolus function on the pump so that the pump doesn't give the entire bolus in one shot, it can be done manually too with several injections over time but it's definitely easier and more precision with a pump. 

 

With new foods it's still a bit tricky, but with time and patience I got to where I am today with a pretty good A1c and not too many food related highs and lows. Of course I can go high at times from taking the wrong dose (I go by experience and guesstimate more than actually weighing food) or having something behave unexpected but the really bad highs comes from delivery issues with my pump normally. Food related highs are normally just high but not OMG high so to say  :P

 

But yeah, trial and error and a lot of testing. 

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oblivious

I noticed that I often get within a good range 2 hours after i bolus, then it goes up again 3-4 hours after that.

Maybe I should try to split the bolus in two like you say.

One pre meal and one an hour post meal?

 

I also see quite often that I go to bed with good numbers and wake up high, but I don't think it's DP. I might need to up my basal from 18.

 

Tracking everything in a spreadsheet helps a lot with understanding the trends, I would be lost if I didn't do that.

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aggie168

Maybe I should try to split the bolus in two like you say. One pre meal and one an hour post meal?

 

I also see quite often that I go to bed with good numbers and wake up high, but I don't think it's DP. I might need to up my basal

Yes, try split the dose. That should help...

 

Not to be an advertiser, that is one of the reason why some of us use a pump.. For me, I have four I:C, three sensitivity ratio and five basal rate in a 24 hour cycle.

 

Another compound factor to the above, I use 20-30% more insulin in the winter month. Yes, keep one busy all the time :)

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Uff Da

I noticed that I often get within a good range 2 hours after i bolus, then it goes up again 3-4 hours after that.

Maybe I should try to split the bolus in two like you say.

One pre meal and one an hour post meal?

 

I also see quite often that I go to bed with good numbers and wake up high, but I don't think it's DP. I might need to up my basal from 18.

 

Tracking everything in a spreadsheet helps a lot with understanding the trends, I would be lost if I didn't do that.

 

From your comments the problem could be inaccurate bolus amounts.  Use of an insulin to carb ratio with the dose changing based upon the carbs in your meal is more accurate than trying to use a set dose.  

 

But it could also be that your total amount of basal insulin is inadequate.  

 

If you have never done a proper basal test, you should do so.  I strongly encourage you to buy (or find at your local library) one of the two books Using Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner.  Both will give you complete instructions on basal and bolus testing, as well as a lot of other hints to make your insulin work for you.  Here is a brief set of directions to a basic basal test in the meantime.  It will get you started, but certainly isn't a substitute for all the hints you'll find in those books.

 

http://integrateddiabetes.com/basal-testing/

 

One really needs to get the basal dose right before one can expect to get the bolus dose correct.

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oblivious

From your comments the problem could be inaccurate bolus amounts.  Use of an insulin to carb ratio with the dose changing based upon the carbs in your meal is more accurate than trying to use a set dose.  

 

But it could also be that your total amount of basal insulin is inadequate.  

 

If you have never done a proper basal test, you should do so.  I strongly encourage you to buy (or find at your local library) one of the two books Using Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner.  Both will give you complete instructions on basal and bolus testing, as well as a lot of other hints to make your insulin work for you.  Here is a brief set of directions to a basic basal test in the meantime.  It will get you started, but certainly isn't a substitute for all the hints you'll find in those books.

 

http://integrateddiabetes.com/basal-testing/

 

One really needs to get the basal dose right before one can expect to get the bolus dose correct.

 

Great tip, thanks for that.

I will try to get a hold of one of those books and educate my self.

Looks like good information on the site you provided as well.

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SweetAndBendy

A set dose rarely or never works, unless you always eat the same things. But most people like to vary their diet so learning to count carbs (or at least get real good at guesstimate them) and knowing your insulin to carb ratio is the key really, along with having the right amount of basal insulin at the right time. Some need to take their basal in the evening, some do it in the morning, some need to split the dose and take both in morning and evening and not everyone split it 50/50 even but maybe 60/40 or so. Reading, testing and trial and error. It takes time and patience and a lot of test strips to get there... 

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rzrbks

When first Dxed, they thought I was T2. But still put me on insulin and pills immediately.

 

Dropped the pills after about 6 weeks as the CDE I trained with assured my GP that I was 1.5.

 

Basal has changed over time and what time of year it is  --- Winter, more sitting so I need more, Spring, Summer, early Fall, much activity so Basal goes down.   ( I do 18 hour checks every 6 weeks or so, 18 hours without any carbs and test every 2 hours)

 

Bolus, it just depends on 1) level of activity 2) type of meal, 3) type of carbs.

 

And I admit that a former member on here taught me how to determine my Bolus Correction ratio so that I have an avg A1c of 6.1 which is exactly where my current GP (of 12 years) wants it.

 

I do not use an Endo, as all of them in my area are Personal Friends of God and their egos/Bwaims are stuck WAAAAAAY too far up a certain part of their anatomy.

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