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Carb counting and insulin dose

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Bat5

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Type 1
I’m finding that carb counting often gives to higher dose rate meaning 1;10 and sometimes 1;15 is too much lispro insulin so I end up reducing by two or four units.
I find it hard to trust the carb counting as if I did I’d end up in hypo permanently after eating, I can appreciate the summer heat makes a difference.
Any suggestions or ideas.
Thanks everyone.
 
This suggests your insulin to carb ratio is incorrect.
However, it could also be that your basal dose is too high.
I would recommend doing a basal test to check that first.
Then, once you are confident the basal is correct, reduce your insulin to carb ratio
Bear in mind you may need different ratios at different times of the day.
 
I think you’re on Semglee for your basal? That’s not a very flexible basal. For example, you might need less basal at night, and more during the day - a once daily basal like Semglee doesn’t allow you to do that.

So do a basal check as suggested above, and also consider whether you’d be better off on a twice daily basal. If your basal is ok, then look at your ratio for each meal. Reduce the ratio for the meals after which you’re going hypo, but do it one meal at a time. You say you’re reducing your bolus/meal insulin by 2-4 units at each meal? So you must be taking quite a few units of Lispro. Can you give a little more information about that eg Breakfast 50g carbs, 7 units of Lispro or whatever your figures are.
 
Mmmmm - how did you decide on your bolus insulin to carb, ratio?
 
Inka said:
I think you’re on Semglee for your basal? That’s not a very flexible basal. For example, you might need less basal at night, and more during the day - a once daily basal like Semglee doesn’t allow you to do that.

So do a basal check as suggested above, and also consider whether you’d be better off on a twice daily basal. If your basal is ok, then look at your ratio for each meal. Reduce the ratio for the meals after which you’re going hypo, but do it one meal at a time. You say you’re reducing your bolus/meal insulin by 2-4 units at each meal? So you must be taking quite a few units of Lispro. Can you give a little more information about that eg Breakfast 50g carbs, 7 units of Lispro or whatever your figures are.
Click to expand...
Breakfast would be 40g porridge taking 2 units equally 50g on three or four units would be too much.
 
Yes, same here, BUT we were all advised to check - ie eat a strictly calculated amount of fast-ish acting carbs at approx 10g (or 20g) when our BG was stable, eg ONE digestive biscuit (NOT choc coated) or whatever; jab 1 unit - and test test test every half hour thereafter to see whether 1u is enough or not.

You might land up actually needing 1u for 8g or 1u for 12g or 17g or anything.

As we rarely eat exactly divisible amounts of carb, you calculate the dose required for 43g or whatever is on the plate, and jab the nearest to the amount required. Half unit pens are freely available now, so the dose of insulin for the food won't be ever so far 'out'.
 
Bat5 said:
Breakfast would be 40g porridge taking 2 units equally 50g on three or four units would be too much.
Click to expand...

Sorry to be pedantic but I don’t want to misunderstand you - do you mean 40g porridge oats or 40g carbs?

If you mean 40g carbs, and you take 2 units for that, then your ratio is 1:20 ie 1 unit of insulin covers 20g carbs. If you’re taking your 2 units, eating your 40g carbs and still going low, you need to check your basal amount in case it’s too much basal that’s pushing you low rather than your Lispro.

If you’re sure your basal amount is right and you’re still going low, then you could try reducing your Lispro by half a unit or keeping the 2 units the same and slightly increasing your carb amount.

Insulin needs can change - because of the weather, hormones, weight, and many other things. Adjust as needed and always err on the side of caution to make sure you avoid hypos.
 
Sorry I was meaning 40g of porridge oats equals three units which I round down to two. The three units would be too much .
 
trophywench said:
Yes, same here, BUT we were all advised to check - ie eat a strictly calculated amount of fast-ish acting carbs at approx 10g (or 20g) when our BG was stable, eg ONE digestive biscuit (NOT choc coated) or whatever; jab 1 unit - and test test test every half hour thereafter to see whether 1u is enough or not.

You might land up actually needing 1u for 8g or 1u for 12g or 17g or anything.

As we rarely eat exactly divisible amounts of carb, you calculate the dose required for 43g or whatever is on the plate, and jab the nearest to the amount required. Half unit pens are freely available now, so the dose of insulin for the food won't be ever so far 'out'.
Click to expand...
I never got told to do that test but I might give that a go. I think I'm 1 to 20g so could I try? X
 
Bat5 said:
28.7g of carbs
Click to expand...

OK - that’s what’s important 🙂 So you were working on a 1:10g ratio and rounding the 28.7g carbs up to 30g, which meant you should take 3 units. But you found that sent you too low so instead you take 2 units.🙂

If that 2 units works for you, then just carry on with it. That would give you a ratio of just over 1:14g.

If the 2 units is still sending you low, try 1 and a half units. As you’re only on small doses you really need a half unit pen (have I mentioned this to you before a while ago - it seems familiar )

Hot weather can affect doses so you might find your ratio needs changing again when it gets cooler. I do encourage you to do a basal test though. If your basal is wrong, it makes it a lot harder to get your ratios right.

You can trust carb-counting. You just need to ensure you’re using the ratio that works for you.
 
It can take a while to establish workable insulin:carb ratios in the beginning. Especially if basal insulin is still being adjusted/optimised, and particularly during the ‘honeymoon period’ where your remaining beta cells may occasionally help out by splurging some unexpected home-grown insulin into the mix.

I’d agree with others that fine-tuning up or down by small amounts is very important, especially as you are quite sensitive to insulin. Changing from 1:10 to 1:15 is huge! Much better to try 1:11 1:12 etc and rely on your phone calculator or a bolus adviser app.

And yes… annoyingly ratios can be different at different times pf day too. Keeps us on our toes eh!

Hope you get hold of a 0.5u pen without any hassle. Sounds like you need one!
 
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