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Bolus advice

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
MeganN

MeganN

Well-Known Member
Relationship to Diabetes
Type 1
Hi all.

I believed through pre meal testing and 2hr after testing that my bolus ratio was 3.5u for every 10CHO that I ate.

However due to recent hypos I wondered if this was actually too high and I was maybe going too low 1hr after meals resulting in a liver dump giving skewed results at the 2 hr test.

So this morning I lowered my ratio to 3:1
So for 25cho I would dose 7.5u

I was 9.2 pre breakfast
1hr later 11.0
2hrs later 8.3

Does this look about right or could I still be taking a bit too much??

Any advice would be fab
 
Probably too much as a carb ratio as Novarapid usually lasts around 4 hours.

However being as you needed a correction when you started as 9 is too high before a meal, it will probably be OK this morning, but if your BG was say 5 before eating, then you'd be hypo at 3 hrs if not sooner.

When does Insulatard peak? - I don't know. Lets just hope whenever it happens it doesn't meet your Novarapid hypo.

Now then - why were you 9? What was your pre-bed?
 
My pre bed was 9.2 so my bolus is holding steady overnight.

I think insulated peaks 1-1 1/2 hrs after injecting and is suppost to last about 16hrs

I only went to bed on a 9 coz I hypo'd earlier in the eve. Normally go to bed at around 7ish
 
DUK Meds & Kit suggests Insulatard main activity is 1-12 hours with a fade up to about 18 hours. No detail as to the profile within that - do the manufacturer suggest anything?

Looks a bit high to me too Megan. In a perfect world, if you were 9.2 before a meal and took only a meal dose you should be 9.2 again approx 4-5 hours after eating (ie the Novo should completely deal with the meal carbs and nothing else).

8mmol/L at 2 hours looks like Novo overreached a little, but without a 4-5 hour test it's hard to know whether that was meter accuracy and you might end up at 9ish at lunchtime
 
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Ill let u know the 4 hr one a bit later then
 
Agree with all the above but also depends on what I eat.

For example if I eat a bit of cereal with mixed nuts for breakfast (Adding extra fat) I can be expecting my result to be the same after 2 hours as 4 hours. It seems to delay the digestion of the carbs, and the 20% - 30% insulin left between 2 and 5 hours and delayed digestion seem to match nicely and keep me level till lunch.

If I dont eat the fat though, Ill expect to be higher after 2 hours, and for my insulin to make me fall more depending on the dose I take. I usually take a test after 2 hours and calculate that I have 25% insulin still on board which will burn over the next 2 hours...

This works for me, (Its seems) It may be completly differnt for you though.
 
4hr test is 7.1
 
Had you started at 5 then the same reduction would have left you with a hypo so I would think even your 3:1 ratio might be a bit much, but to Ben's point, what you eat will have a big effect on matching peak to peak!

Do you vary your ratio throughout the day? I find 2:1 for breakfast and 1.5:1 lunch and dinner is about right for me (usually!!) and will leave me where I started after 4-5 hours.
 
For breakfast I had 2slices of small loaf granary bread with ham and a small amount of BBQ sauce so 20g for the bread and 5g for the sauce

I'm gonna try 2.5 ratio for lunch and see what occurs. All this I tricky stuff lol
 
MeganN said:
All this I tricky stuff lol
Click to expand...

If it was easy it wouldn't be any fun...oh wait it's not fun!

Keep trying and keep testing it's all you can do 🙂
 
Nearly 6hrs later and my pre lunch reading is 5.2

Out for a meal now. Having steak and new potatoes. Will figure out carb ratio when it gets to the table ad then work it out using carbs and cals book. Will try 2.5u per 10g of carb and see how I go. ...
 
From breakfast:
9.2mmol/L +25cho Dose 7.5u

6 hours later (dose fully gone)
5.2mmol/L

So effectively 7.5u = 25CHO + 4 mmol/L 'correction'

DAFNE often starts people at 1u:10g and 3mmol/L = 1u

If you were 2u:10g and 1.5mmol/L =1u (ie double DAFNE 'starter' doses), then your 7.5 would have been

Food = 5u
Corr = 2.5u (well 2.6 but I rounded down!)

Total dose = 7.5u

Which makes those doses seem to make some kind of sense.
 
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everydayupsanddowns said:
From breakfast:
9.2mmol/L +25cho Dose 7.5u

6 hours later (dose fully gone)
5.2mmol/L

7.5u = 25CHO + 4 mmol/L 'correction'

DAFNE often starts people at 1u:10g and 3mmol/L = 1u

If you were 2u:10g and 1.5mmol/L =1u (ie double DAFNE 'starter' doses), then your 7.5 would have been

Food = 5u
Corr = 2.5u (well 2.6 but I rounded down!)

Total dose = 7.5u

Which makes those doses seem to make some kind of sense.
Click to expand...

Megan's original post didn't indicate how much of the 7.5 was added as a correction it was caclulated at 3:1 for the CHO so the same caclulation starting at 5 wouldn't have been a good idea.

Your explaination does seem pretty bang on so maybe trying your suggested ratio's would be a great starting point.
 
Just 2.5u per 10g carbs for lunch.
Carbs were boiled potatoes and a bit of ketchup with steak

Total 45grams so injected 11.5 (rounded up from 11.25)
Pre lunch level 5.2
1hr test 8.6

Will have to see what 2hr will say
 
everydayupsanddowns said:
From breakfast:
9.2mmol/L +25cho Dose 7.5u

6 hours later (dose fully gone)
5.2mmol/L

7.5u = 25CHO + 4 mmol/L 'correction'

DAFNE often starts people at 1u:10g and 3mmol/L = 1u

If you were 2u:10g and 1.5mmol/L =1u (ie double DAFNE 'starter' doses), then your 7.5 would have been

Food = 5u
Corr = 2.5u (well 2.6 but I rounded down!)

Total dose = 7.5u

Which makes those doses seem to make some kind of sense.
Click to expand...

I wasn't factoring in a correction this morning. Just wanted to see what my ratio of 3:1 would do on its own.

If I take a 1u correction without food etc it takes me down about 3.3mmol
 
MeganN said:
I wasn't factoring in a correction this morning. Just wanted to see what my ratio of 3:1 would do on its own.
Click to expand...

Exactly Megan - I was merely using conjecture based on the dose - which while you didn't *mean* for any of it to be correction, certainly resulted in your BG 'correcting' pretty much perfectly from 9.2 to 5.2 That just got me thinking as to what might have been going on behind the scenes - and which bit of the dose might have been doing what 🙂

Since the usual starter splits handed out are often 1u:10g CHO for meals and 3mmol/L for corrections it would seem a little unusual to me for you to have 3u:10g CHO as a meal ratio (ie more insulin resistant) but be using 1u:3.3mmol/L (ie more insulin sensitive) - though of course you'll know your diabetes best. Do your corrections usually work as expected?
 
That was only based on one correction dose I have done admittedly that 1u took me down 3.3mmol so I couldn't say if it would work again yet.

So lunch dose of 11.5u for 45g carbs (2.5:1 ratio) worked as follows;

Pre lunch 5.2
1hr after 8.6
2hr after 6.1

Soo should I try a ratio of 2:1 for dinner and try again??

You guys are being invaluable in all of your help so think you very much
 
MeganN said:
That was only based on one correction dose I have done admittedly that 1u took me down 3.3mmol so I couldn't say if it would work again yet.

So lunch dose of 11.5u for 45g carbs (2.5:1 ratio) worked as follows;

Pre lunch 5.2
1hr after 8.6
2hr after 6.1

Soo should I try a ratio of 2:1 for dinner and try again??

You guys are being invaluable in all of your help so think you very much
Click to expand...

Well it's always a bit of a movable feast isn't it?! Your readings post-lunch look pretty darned good so far to me. If you end at 5 or 6 at eve meal time I'd count that as a win!

If you drop to low 4's it might be worth trying 2u:10g for a day or so and seeing what happens.

Sometimes it's worth leaving any change you make for a while though (as long as it's not giving disastrous numbers!) so that you have a few more days numbers to consider. Otherwise you can end up chasing your tail, when some of those results were just 'freak' ones that have nothing to do with what you are experimenting with 🙄
 
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