Bolus Calculation?

J

Jhp86

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Relationship to Diabetes
Type 1.5 LADA
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Hi All!

So after my initial appointment with the dr, he saw me again following my blood test.

In short, he’s now confirmed it’s LADA. Antibodies were positive and c-peptide test was low, HBA1C was 102 which I expected given the past few months.

He’s told me to continue on the basal bolus regimen which does seem to be helping. Bloods are now on average between 8 at lower end and 12 highest.

What I’m not sure about is bolus calculation.
Because I’m still producing some insulin, is it needed?

On average I’m currently doing 36u of lantus in the evening, then 10u at breakfast,
10 lunch and 10 dinner of Humalog.

However, the other day I did this and had a hypo. I think it was down to not eating very much at lunch and maybe injecting too many units?

With this in mind would I be better off using bolus calculation? I use my sugar so I can use the calculator on there, but not sure if it would be beneficial?
 
Yes, you should use a ratio to calculate your bolus dose @Jhp86 BUT you need to know your insulin to carb ratio first. That can differ between people quite significantly and can also vary for each individual meal (ie breakfast, lunch, etc) Fixed doses of bolus insulin only really work well if you eat the correct and same amount of carbs at each meal (which might be different for breakfast, lunch, etc).

If you don’t know your ratio, you can get a good idea of it by counting the carbs in each meal you eat and recording your blood sugars.
 
Inka said:
Yes, you should use a ratio to calculate your bolus dose @Jhp86 BUT you need to know your insulin to carb ratio first. That can differ between people quite significantly and can also vary for each individual meal (ie breakfast, lunch, etc) Fixed doses of bolus insulin only really work well if you eat the correct and same amount of carbs at each meal (which might be different for breakfast, lunch, etc).

If you don’t know your ratio, you can get a good idea of it by counting the carbs in each meal you eat and recording your blood sugars.
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Thank you,
So for working out the ratio how does it work? Is it the case of working out how many carbs and seeing how much my sugars rise/fall after 2 hours?

Generally for breakfast and lunch Monday to Friday I eat the same thing, dinners are varied but follow a steady pattern of carb content, and then weekends, breakfast is usually the same, and lunch varies.
 
So - as a first stab at this, 1u bolus for each 10g carbs is suggested - and no way do I ever eat 100 g of carb for one meal so if I injected 10u I'd be flat on the floor hypo - but of course I've no idea whether you eat that much or don't. :D
 
trophywench said:
So - as a first stab at this, 1u bolus for each 10g carbs is suggested - and no way do I ever eat 100 g of carb for one meal so if I injected 10u I'd be flat on the floor hypo - but of course I've no idea whether you eat that much or don't. :D
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Thank you!
Yeah I took a Quick Look on google and it said around the 1:10 to begin with.

On average breakfast is about 30 grams, lunch about 15-20 and dinner around 30-50 depending on what we have.

What’s mad to me is going from 10u to like 3-4!
 
As you’re taking 10 units for approx 30g, I personally wouldn’t start on 1:10g if it were me @Jhp86 That’s just a rough guess and if you have an idea of your needs, you’d be better off starting on a more focussed ratio.

I’d start with Breakfast, count your carbs carefully (ie weigh cereal, check bread, etc), take your normal 10 units to start with as you’ve been doing, and note your figures over a period of days - by figures, I mean before meal blood sugar, 2hrs after, 3hrs after if possible and before the next meal. Jot down any unusual things, eg if you had unexpected exercise, and then you should be in a position to judge whether the 10 units works for your 30g breakfast carbs.

However, the foundation of control is your basal insulin - it’s the base we build our ‘house’ on. If that’s wrong, it makes everything harder to get right. So I’d turn my attention to that first so you can be as sure as it’s possible to be that that’s pretty much right.
 
Inka said:
As you’re taking 10 units for approx 30g, I personally wouldn’t start on 1:10g if it were me @Jhp86 That’s just a rough guess and if you have an idea of your needs, you’d be better off starting on a more focussed ratio.

I’d start with Breakfast, count your carbs carefully (ie weigh cereal, check bread, etc), take your normal 10 units to start with as you’ve been doing, and note your figures over a period of days - by figures, I mean before meal blood sugar, 2hrs after, 3hrs after if possible and before the next meal. Jot down any unusual things, eg if you had unexpected exercise, and then you should be in a position to judge whether the 10 units works for your 30g breakfast carbs.

However, the foundation of control is your basal insulin - it’s the base we build our ‘house’ on. If that’s wrong, it makes everything harder to get right. So I’d turn my attention to that first so you can be as sure as it’s possible to be that that’s pretty much right.
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Thank you.

I do tend to test before/after meals and record in any case.

Lately I’ve been around 9ish on waking, and about 11-12 after breakfast, 7-8 before lunch and 8-10 after and much about the same dinner.

For the basal, I’m on 36u currently so thinking to increase to 38/40? Just to see if it helps bring my waking sugars into range?

Also, for basal, can this be split into morning and evening?
 
Depending on the insulin, yes, basal can be split (lantus in your case will have an effect if split), though I would be tempted to follow your health care professional's advice as I'm assuming (perhaps wrongly though) that you're fairly new to this. Not that you can't DIY, but best to keep them onside while you still need support. The more important factor is that you're already doing your basal injection in the evening, so it should be peaking (it does have a small peak) during the night, so splitting it probably won't help with bringing down morning BG values.

Whatever you do don't increase basal that much in one go, that's a massive amount. One unit at a time (a single unit can make quite a large difference as people have noted in other threads.) You may also find that it's not in fact a lack of basal that's making you higher in the morning, but actually a larger/more slowly absorbed supper which causes a spike in the early morning (which would point to adjusting your evening bolus dose, perhaps splitting it). Do you have a CGM, this would be the easiest way to determine this?
 
SimonP said:
Depending on the insulin, yes, basal can be split (lantus in your case will have an effect if split), though I would be tempted to follow your health care professional's advice as I'm assuming (perhaps wrongly though) that you're fairly new to this. Not that you can't DIY, but best to keep them onside while you still need support. The more important factor is that you're already doing your basal injection in the evening, so it should be peaking (it does have a small peak) during the night, so splitting it probably won't help with bringing down morning BG values.

Whatever you do don't increase basal that much in one go, that's a massive amount. One unit at a time (a single unit can make quite a large difference as people have noted in other threads.) You may also find that it's not in fact a lack of basal that's making you higher in the morning, but actually a larger/more slowly absorbed supper which causes a spike in the early morning (which would point to adjusting your evening bolus dose, perhaps splitting it). Do you have a CGM, this would be the easiest way to determine
Click to expand...
 
SimonP said:
Depending on the insulin, yes, basal can be split (lantus in your case will have an effect if split), though I would be tempted to follow your health care professional's advice as I'm assuming (perhaps wrongly though) that you're fairly new to this. Not that you can't DIY, but best to keep them onside while you still need support. The more important factor is that you're already doing your basal injection in the evening, so it should be peaking (it does have a small peak) during the night, so splitting it probably won't help with bringing down morning BG values.

Whatever you do don't increase basal that much in one go, that's a massive amount. One unit at a time (a single unit can make quite a large difference as people have noted in other threads.) You may also find that it's not in fact a lack of basal that's making you higher in the morning, but actually a larger/more slowly absorbed supper which causes a spike in the early morning (which would point to adjusting your evening bolus dose, perhaps splitting it). Do you have a CGM, this would be the easiest way to determine this?
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Yeah so they’ve told me to do it in the evening so I do it around 9pm an hour before bed.

I’ve been on insulin 2 years, but only recently been put on Basal/bolus, was on mixed before. And thanks to my team basically giving it to me and sending me on my way, it’s a case of me learning myself!

Could be that I’m less active after dinner? Like I try to do a bit of house work so I’m semi active, but not as active as after breakfast or lunch. Been using a libre for a few weeks, so I can see the patterns.
 
Activity plays a part but people also have different insulin sensitivities at different times of the day so hard to tell. What does your overnight BG look like? Could you share a screenshot and details of what you had for supper (carb quantity, what the meal was to be able to judge absorption time, etc.)

I used to do my basal in the evening (abasaglar - similar to lantus) but split the dose (kept total quantity the same though) as I was running low overnight.
 
SimonP said:
Whatever you do don't increase basal that much in one go, that's a massive amount. One unit at a time (a single unit can make quite a large difference as people have noted in other threads.)
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Not really a massive amount - 36 to 38 is only just over 5%. One unit may make a large difference if you are only taking small amounts, but to me (on 42U am and 26U pm) it would probably not be noticeable at all.
 
That is a large amount of insulin - it does seem that splitting your basal into two doses may be beneficial - I'm not sure Lantus is the best one to do this with - maybe suggest Levemir?
 
SimonP said:
Activity plays a part but people also have different insulin sensitivities at different times of the day so hard to tell. What does your overnight BG look like? Could you share a screenshot and details of what you had for supper (carb quantity, what the meal was to be able to judge absorption time, etc.)

I used to do my basal in the evening (abasaglar - similar to lantus) but split the dose (kept total quantity the same though) as I was running low overnight.
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So currently overnight it seems to go somewhere between 10-11 highest and on waking is between 8-10.

Food wise it’s usually about 30-40g of carbs and mostly some form of chicken or fish with veg and either a small amount of carbohydrates such as brown rice/wholewheat pasta or a low carb wrap.
It’ll depend on what I have in the day tho as I try to stick to having carbs in one meal per day, usually dinner.
 
You only have carbs in one meal a day @Jhp86 ? If you’re restricting your carbs like that you may well have physiological insulin resistance, which is caused by eating too few carbs. @Tdm has experience of this. The recommended diet for Type 1s, of which LADA is a form, is the same normal healthy diet recommended for everyone. Is there a reason why you’re eating so few carbs?
 
Inka said:
You only have carbs in one meal a day @Jhp86 ? If you’re restricting your carbs like that you may well have physiological insulin resistance, which is caused by eating too few carbs. @Tdm has experience of this. The recommended diet for Type 1s, of which LADA is a form, is the same normal healthy diet recommended for everyone. Is there a reason why you’re eating so few carbs?
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I’ve always done that since being diagnosed type 2,

I think based on what you’re saying, as well as doing some research I need to reassess.
I’ve asked the diabetic team if there’s any education courses I can attend, I did DESMOND a few years back, but think it may help to do some education around Type 1/LADA diet as it does seem different
 
Type1/LADA is very different @Jhp86 🙂 You could check out this online course:


There are also a couple of great books about Type 1. Let me find the links for you.
 
Inka said:
Type1/LADA is very different @Jhp86 🙂 You could check out this online course:


There are also a couple of great books about Type 1. Let me find the links for you.
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Thank you! Will definitely take a look at this and the books!

I’d love to say my team are as helpful but because it’s LADA They said they won’t send me to type one education and it’s not enough support on the type 2 education!
 
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