carb counting help please

[losinen]

I have a long and tedious story of my D to date but here is a brief as possible run down. DX nearly 3 years ago, metformin for first year, met and glic for second year with a dash of HumilinI thrown in this last 6 months. BG's still very erratic so prescribed Humalog, un prescribed gliclazide and that's where I am today. I was initially told ( 2 weeks ago) to take 5u of humalog with each meal. I quickly realised that this wasn't enough for most meals as my BG back in high teens low 20s. Tried roughly estimating how many carbs per meal and trying 1u per 4g of carbs. Things a bit better but fasting BG back up 7-8 (I had got it down to 4-5) and 1-2 hours after meals, sometimes in the teens again. Trying to eat low carb but if I have a carb free meal, should I be using any Humalog? I had a horrible night hypo last night, the first at night since I started Humalog, went to bed at 7.6 @ 10.30, woke up 2 hours later BG 3. Only the second hypo since starting Humalog, the other one at 2 in the afternoon whilst out for a walk last week.
When should I correct and at what BG reading. I have little useful contact with my DSN and as lovely as my GP is, diabetes is not his expertise (his words not mine). I have learned all about DB from other peoples posts as my DSN really uninformative and rarely accessable. Seeing consultant next month but generally can't understand a word he says as his accent is so heavy. Really struggling to stay positive at the moment.

 

[trophywench]

Well this all sounds a bit potty. People who are uninformative and you can't understand are no use whatever to you.

Do you perchance have another nearish hospital you could ask your GP to be referred to?

Are you still on the Humulin I as well as the Humalog? - trouble with H I is, it has a peak and if that clashes with a peak of the fast acting (or gives you a peak at any time you don't need one) then yes you will be in trouble.

If you are T2 rather than T1, that probably means you will still be producing some of your own insulin so that can affect the balance a fair bit.


There is a way of testing your basal insulin (in your case Humulin I) to see if it's the right dosage and at the right time but if you aren't still on it ..... tell us some more (are you, and if so what time do you take it) and we'll take it from there !

 

[everydayupsanddowns]

Hi Losinen

I'm not really sure how carb counting works with T2 I'm afraid. As a T1 if a meal had no carbs I would not need any rapid acting (providing my basal was right).

Corrections would be tricky to calculate I suppose because of the peak and fade of Humulin I, difficult enough to know what to do whan basal and bolus are kept separate and you are only having to watch how much of your 'rapid' is working. The danger of leaping to a correction with lots of active insulin on board is that the dose for the meal might have been OK, but the timing of absorption/activity between insulin and food might have been off.

If high immediately before a meal bolus (assuming meals approx 4 hours apart) you might add a small amount to the dose with the aim of correcting yourself back to 6.0 or something?

The difficulty is that these are questions usually best discussed with your team who know and understand your precise circumstances - but it seems you are not being very well supported at the mo.

The books/courses that deal with tweaking MDI are usually written from a T1 perspective (courses like DAFNE/BERTIE and books like Using Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner). There might be some general food for thought in the books, but the detailed of differences in approach between T1 and T2 would need to be carefully considered.

 

[losinen]

Thanks both. I take the HumilinI literally just before I go to bed. I have been trying to match each 4g of carbs with 1u of Humalog, adjusting a little up or down depending on my BG just before eating. I have had OK'ish results but some spectacular fails too. At the point of just giving up.

 

[everydayupsanddowns]

D can be like that!

Basal bolus/MDI seems to work best for me when my basal has been adjusted for whatever the current requirements are. As the seasons/months/years roll by my needs seem to rise and fall, sometimes predictably, sometimes not. A week of chaos in BG after a steady ish patch is more often than not down to needing to adjust basal so that it *only* takes care of the background glucose output from my liver. Not easy on MDI, and often involving a 'least worst' approach over the 24 hours. I'm not sure whether there would be differences in basal testing for a T2, but it might be worth considering.

http://www.diabetes-support.org.uk/info/?page_id=120