Carb counting to include current reading?

[Cam3r0n]

Hi
Like many people on this forum I was diagnosed at the very beginning of the pandemic and so over the past year education has not been very forthcoming from the usual sources. Nobody's fault......just my body's unfortunate timing!
I want to be better at controlling my diabetes and specifically my insulin doses.
(I use both Levemir and NovoRapid pens)
I currently calculate my units with the basic 1 unit per 10g of carbohydrate which is just about working for me.
However, assuming this dose is correct when my meter says I'm 5 -7, I don't know how to adjust that dose if my meter reads 16 for example. I presume I need to administer more insulin but how much more?
Any advice would be greatly appreciated.

 

[Robin]

Hi
Like many people on this forum I was diagnosed at the very beginning of the pandemic and so over the past year education has not been very forthcoming from the usual sources. Nobody's fault......just my body's unfortunate timing!
I want to be better at controlling my diabetes and specifically my insulin doses.
(I use both Levemir and NovoRapid pens)
I currently calculate my units with the basic 1 unit per 10g of carbohydrate which is just about working for me.
However, assuming this dose is correct when my meter says I'm 5 -7, I don't know how to adjust that dose if my meter reads 16 for example. I presume I need to administer more insulin but how much more?
Any advice would be greatly appreciated.

Yes, you’re right, if you’re above target when you come to inject for a meal, you need to add a correction dose. We really can’t advise what yours would be, and if possible you should try and speak to your 'team' (though I can hear the hollow laugh, what team?). I think on some of the online courses, such as the BERTIE online carb counting course (worth doing if you haven’t, I did it after being diagnosed for 14 years, and I learnt stuff!) they suggest that if your insulin/carb ratio is 1/10 then a good starting point for correction is to assume that 1 unit of insulin will bring you down by 3mmol. If you were to experiment, I'd start cautiously, keep notes, and see where you get to,

 

[Cam3r0n]

Thank you, Robin, for your very prompt and informative reply!
A general rule of thumb for dosing a higher reading was exactly what I was hoping for and you kindly provided.
As you say, we're all different. However, you have given me a safe starting point.
Thank you, once again!

 

[helli]

@Cam3r0n the suggestions from @Robin are a good starting point.
Bear in mind it is common to become insulin resistant as our numbers rise. My correction ratio from 8.5 to 5.5 would be different to that from 16.5 to 13.5, for example. So if you decide to experiment take a note of your starting level.

The other thing to be aware of if you are including corrections in your bolus dose is "insulin on board". Most fast acting insulins will continue to have a significant affect for about 4 hours. So if you have bolused less that 4 hours ago, take care with any corrections you make.

 

[Inka]

I find I need a larger correction dose if I’m above approx 12 @Cam3r0n so if you’re at 16 as in your example and you find a correction dose that works on that occasion, don’t assume it will work if you’re correcting, say, a 10. You’ll have less insulin resistance then so will probably need a smaller correction.

 

[Cam3r0n]

Thank you all for your responses.
You have given me a lot to think about!

 

[pm133]

Hi
Like many people on this forum I was diagnosed at the very beginning of the pandemic and so over the past year education has not been very forthcoming from the usual sources. Nobody's fault......just my body's unfortunate timing!
I want to be better at controlling my diabetes and specifically my insulin doses.
(I use both Levemir and NovoRapid pens)
I currently calculate my units with the basic 1 unit per 10g of carbohydrate which is just about working for me.
However, assuming this dose is correct when my meter says I'm 5 -7, I don't know how to adjust that dose if my meter reads 16 for example. I presume I need to administer more insulin but how much more?
Any advice would be greatly appreciated.

I'm also on a 1:10 ratio.
Of course, how I would correct for that would be different to you but purely to give you a feel for this, I would not eat at all at that level because the body has more than enough glucose swimming in the blood. It just needs insulin to get it into the cells.

Please don't take any of the following as advice. It's just what I would personally do if it was me in that situation.
I would do one of two things.
Either take 3 units and then see how it goes over the next 2-4 hours.
Or take 2 units and go for a walk or jump on the exercise bike for 20 minutes.

The key is monitoring what you've done over the next few hours to ensure it comes down without causing a hypo and then only eating once my levels had dropped under 8 (and preferably under 7).

 

[Peely66]

I would suggest as others have here that in the absence of any face to face education to do the Bertie course online. I'm working my way through it as a refresher as I did a DAFNE course many years ago and I think it's pretty good stuff.

 

[Spozkins]

Yes - I'd also add that if you are above target pre-meal but don't want to forgo eating then you can figure out how much extra insulin you want to take (I'd second Robins advice here). I was always taught 1 unit to bring me down 2 mmol and that has always worked for me, but 3mmol is probably a safer bet until you know better. There are things to consider though for example if you already have insulin in your system then you really shouldn't correct. And I think some people advice you shouldn't really correct more than 5 units at a time.

I'd also recommend waiting a little longer for your insulin to work before eating. Usually I wait 20 mins after taking insulin but if its a bit higher I'd maybe wait 30 mins and if its really high (like 16) I'd probably give a good 45 mins to an hour if I could (normal meal insulin + correction dose).

Are you keeping a written diary? That would probably be really helpful in learning what works for you and what sort of correction ratios to use.

 

[Inka]

Another thing to mention is that corrections will work slower if your blood sugar is high. It can sometimes take approaching three hours to see a shift so it’s really important to bear that in mind and wait not assume you need more insulin.

Finally, I’m always extremely cautious about correcting in the evening. I’d rather be a bit high than risk a nocturnal hypo.