Hi all about to go onto multi injections and start carb counting. Was wondering what one does if you need 1.5 units and your pen only goes up in units, no halfs? Do you air on caution and give 1? Or if you slightly higher before meal than you want to be give 2 and then if slightly low before meal give 1?
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Carb Count Question
- Thread starter astbury1
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Yes! Sounds like you are approaching this perfectly. In loose terms you might decide to 'round up' if you were generally jigher than normal that week, or 'round down' if you were a bit on the low side.
The only other fine-tuning you might consider would be based on more formally adding or subtracting a 'correction' dose based on your pre-meal BG and your expectation of BG change with 1u of rapid insulin.
As an example (all your numbers will more than likely be different to this:
Expected reduction in BG for 1u: 3mmol/L
'Perfect' BG sweetspot: 6mmol/L
Insulin:carb ratio: 1u:10g
Premeal BG: 7.5mmol/L
Carbs in meal: 45g
So:
Basic dose 4.5u
1.5mmol/L above 'perfect' = +0.5u
Final dose = 5u
Whereas:
Premeal BG: 9mmol/L
Carbs in meal: 45g
Would mean:
Basic dose 4.5u
3mmol/L above 'perfect' = +1u
Final dose = 5.5u and probably 'round up'
Of course this becomes a little more of a brain ache when your ratios and corrections are not quite so mathematically easy (1u:11g and 1u for 3.4mmol/L for example) - in which case it may well be worth asking your DSN for one of the 'smart' meters (Accuchek Expert or Insulinx) which will do the donkeywork for you and suggest a dose for you to accept or overrule.
The only other fine-tuning you might consider would be based on more formally adding or subtracting a 'correction' dose based on your pre-meal BG and your expectation of BG change with 1u of rapid insulin.
As an example (all your numbers will more than likely be different to this:
Expected reduction in BG for 1u: 3mmol/L
'Perfect' BG sweetspot: 6mmol/L
Insulin:carb ratio: 1u:10g
Premeal BG: 7.5mmol/L
Carbs in meal: 45g
So:
Basic dose 4.5u
1.5mmol/L above 'perfect' = +0.5u
Final dose = 5u
Whereas:
Premeal BG: 9mmol/L
Carbs in meal: 45g
Would mean:
Basic dose 4.5u
3mmol/L above 'perfect' = +1u
Final dose = 5.5u and probably 'round up'
Of course this becomes a little more of a brain ache when your ratios and corrections are not quite so mathematically easy (1u:11g and 1u for 3.4mmol/L for example) - in which case it may well be worth asking your DSN for one of the 'smart' meters (Accuchek Expert or Insulinx) which will do the donkeywork for you and suggest a dose for you to accept or overrule.
DeusXM
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Another thing to remember is that carb counting and ratios aren't an exact science. The carb content of your food is an estimate and could be off. Your BG readings can be off by as much as 10% either way. And finally, your insulin ratio is a best guess. So don't get too hung up on half units. Your body's an analogue system, not a digital one.
With a fear of hypos I rekon I will be rounding down for a while until I get the hang of it!
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Oddly enough I just saw a link to this 'Carb counting' starter book by Diabetes in Scotland which contains a pretty thorough overview of the basic ideas, hints, tips, some examples to try and useful reference tables for common ratios too.
Not so keen on the 'eatwell plate' high-carb fixation, but that's more of a personal thing really as moderate-ish carb (120-170g a day) works more reliably for me, and was what I was advised at Dx.
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Not so keen on the 'eatwell plate' high-carb fixation, but that's more of a personal thing really as moderate-ish carb (120-170g a day) works more reliably for me, and was what I was advised at Dx.
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Another thing you can do is ask your GP for a NovoPen Echo... they do half units, and also have a memory function that shows you how much and how long ago you last injected - very handy if like me you tend to multitask and then afterwards wonder if you really injected or not! And I love the flexibility of half units, I have one for NovoRapid and levemir (different colour pens!), couldn't cope without half units now!
Phil65
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ummmmm! yes!
....I still check my BG 2 hours post prandial. Also when carb counting think about the GI of the food and if it is higher in fat.....so complicated!
robofski
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I was certainly like that when I started on MDI and I think I still keep myself a little on the high side to avoid them, 5 months into things I've only had the shakes once at 4.2 and last week recorded a 3.9 but didn't have any symptoms (maybe meter error margin meant I was really over 4)
Phil65
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...Good link Mike, but ....why don't they include GI? ....goes hand in hand with carb counting.
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...Good link Mike, but ....why don't they include GI? ....goes hand in hand with carb counting.
I guess because it's just intended as an introduction - there is a vague mention of simple and more complex carbs (though we all know it's a lot more complex than that!) and I guess they figure that's enough to start with.
heasandford
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You can get various calculating apps for your smartphone too, I started with InsulinCalculator, which will also talk/send information to DiabetesDiary for your records. I have an Accuchek Expert, but still use the app sometimes when it won't quite do what I want!
Keep at it, you're definitely on the right track!
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I think that depends on what you mean by 'hypo'. If you mean full-on symptoms, sweating, confusion, vision probs etc then I've not had one of those for nearly 3 years. If you mean what someone I know on twitter descrtibes as feeling a bit 'waffy' - a bit hungry and spaced out in the high 3's then yes, I can get a few of those a week (couple of fruit pastilles and all's well). Not that I am belittling those moments and not that I don't try to run good averages without them - but I think it's important to draw a distinction.
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Ahhh I see! I had quite a wobble when I read that people had such frequent hypos! Am glad you have pointed this out! Was starting to think 'I will just have insultard' and that is that! lol
The challenge of course (and why you can't afford to take your eye off them) is that the more 'waffy' moments the have, the likelier is that you won't spot them so early. All levels above 4 is ideal, but you have to decide for yourself (and with your D) about the relative merits of a lower average and A1c versus the increased likelihood of dipping below 4 every now and then.
And it's worth pointing out that anything below 5 means that driving has to wait (now a legal requirement not a suggestion). Anything below 4 means that you need to get above 5 and then wait another 45 minutes after that.
Such a darned nuisance that the body is so brilliantly good at running perfectly 'just on the edge' of a hypo for non-D peeps! 🙄
heasandford
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And of course you don't want to be running high all the time because that's what causes the complications long term - hence 'Balance'! People on here try hard to get it right most of the time!
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