Been carb counting for over a year now, started off 1 unit of novarapid for every 10g of carbs, been more or less ok with it but for some reason now it seems as if my readings are dropping a lot quicker than they used to before, should I be changing the ratio, 1unit for 20g carbs or try and contact my DN. Thanks again.
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Carb counting
- Thread starter Charl
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@Charl
Our insulin dose does not stay stable for ever. For example, many if us find we are more sensitive to insulin in the hot weather. (Others find they need more 8nsulin in hot weather.)
Typically, it is the basal dose which is reduced first. You say your levels are dropping faster, what about at night when you eat no food and take no NovoRapid? If your levels drop them, it is more likely that it is your basal that needs to be reduced.
As @Lucyr suggests, it depends how confident you are to change your dose. Or you should contact your DSN.
Our insulin dose does not stay stable for ever. For example, many if us find we are more sensitive to insulin in the hot weather. (Others find they need more 8nsulin in hot weather.)
Typically, it is the basal dose which is reduced first. You say your levels are dropping faster, what about at night when you eat no food and take no NovoRapid? If your levels drop them, it is more likely that it is your basal that needs to be reduced.
As @Lucyr suggests, it depends how confident you are to change your dose. Or you should contact your DSN.
Inka
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It could well be the heat. I’ve had to reduce my basal and also reduce my mealtime ratios. As said above, look at your basal first, then look at your mealtime ratios. I usually say to start with your breakfast ratio but if there’s a meal you’re particularly dropping fast after, look at that ratio first. You might find it easier to have the same, easily countable meals while you’re sorting your ratios.
Remember that ratios can be anything 1:10, 1:8, 1:16, 1:25. Remember too that they can change and that it’s normal to have to tweak them and to have different ratios for different meals.
SB2015
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Hi @Charl
Quite a few people have been on here saying that they find they need less insulin in the hot weather (and some need more!! Diabetes is so different in each of us) As @Inka says you don’t need to use just multiples of 10. As you change your bolus ratio it is worth doing this in small increments. I was told no more than 10% at a time, so if I was using 1:10 I would go to 1unit for 11g of carbs. That small change can still have a big impact.
If you are using pens it is worth using a half unit pen as that allows more accurate dosing. This is especially helpful if you are needing small doses.
Things keep changing for us and diabetes keeps us on our toes.
Quite a few people have been on here saying that they find they need less insulin in the hot weather (and some need more!! Diabetes is so different in each of us) As @Inka says you don’t need to use just multiples of 10. As you change your bolus ratio it is worth doing this in small increments. I was told no more than 10% at a time, so if I was using 1:10 I would go to 1unit for 11g of carbs. That small change can still have a big impact.
If you are using pens it is worth using a half unit pen as that allows more accurate dosing. This is especially helpful if you are needing small doses.
Things keep changing for us and diabetes keeps us on our toes.
Back again....This morning's reading
13.6..took basal as normal,
7 units of rapid acting insulin,
5 for the upcoming breakfast
and 2 as a correction dose,
Had breakfast 30mins later it had dropped to 11.5 breakfast was 45g carbs
Took reading 2hrs later..13.4
Was expecting a lower reading after injecting an extra 2 units as a correction, what am I doing wrong sure my carb count was correct. Thanks
It is now 11.00am and my reading is now 6.1 don't think it will last till I have my lunch at 12 so I will have to snack to try and get the number up because in 30 to 40 mins time I will have to inject ready for dinner...
13.6..took basal as normal,
7 units of rapid acting insulin,
5 for the upcoming breakfast
and 2 as a correction dose,
Had breakfast 30mins later it had dropped to 11.5 breakfast was 45g carbs
Took reading 2hrs later..13.4
Was expecting a lower reading after injecting an extra 2 units as a correction, what am I doing wrong sure my carb count was correct. Thanks
It is now 11.00am and my reading is now 6.1 don't think it will last till I have my lunch at 12 so I will have to snack to try and get the number up because in 30 to 40 mins time I will have to inject ready for dinner...
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@Charl if you are starting your day at 13.6, it suggests your basal dose is not high enough or running out.
You need to get this right before tweaking your bolus. Otherwise, it is like building a house on unstable foundations.
And a high blood sugar can cause insulin resistance so you need more to correct.
There are threads about basal testing which should help you.
You need to get this right before tweaking your bolus. Otherwise, it is like building a house on unstable foundations.
And a high blood sugar can cause insulin resistance so you need more to correct.
There are threads about basal testing which should help you.
Yesterday evening
17.30....reading 9.6..rapid taken ready for evening meal
18.00...start evening meal..reading 8.3
19.00...reading dropped to 6.0
19.20....went up to 8.1
21.00..dropped to 7.7
In the next 90 mins it was in the 6s,
when dut to go to bed at 22.30 it had dropped to 6.3 so ate a slice of bread because no doubt my libre would have been alarming through the night again, once again I'm sure my carb count was correct, sorry for the drama but it feels like I'm going in circles.
17.30....reading 9.6..rapid taken ready for evening meal
18.00...start evening meal..reading 8.3
19.00...reading dropped to 6.0
19.20....went up to 8.1
21.00..dropped to 7.7
In the next 90 mins it was in the 6s,
when dut to go to bed at 22.30 it had dropped to 6.3 so ate a slice of bread because no doubt my libre would have been alarming through the night again, once again I'm sure my carb count was correct, sorry for the drama but it feels like I'm going in circles.
rebrascora
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At 11am I think your bolus insulin will now be spent so there should be no concern that your levels will drop lower now .... unless your basal insulin is not holding you steady. I wonder if you are confusing your self with the 2 hour post meal readings.
It looks to me like you calculated this and managed it fine but that you are now panicking that it will drop lower when it is unlikely to do so and if you have a Libre you can keep an eye on it anyway. Eating extra carbs now will likely make you high at lunchtime or will be releasing when you calculate your lunch bolus and then throw things out of kilter for the afternoon. 6 is a good level to be on at this time of day.
If it was me I would be absolutely delighted with that result. If I dropped to mid 4s I might have a jelly baby to top me up a bit before lunch and keep an eye on my Libre but a BG of 6 4-5 hours after your bolus injection is perfect.
It looks to me like you calculated this and managed it fine but that you are now panicking that it will drop lower when it is unlikely to do so and if you have a Libre you can keep an eye on it anyway. Eating extra carbs now will likely make you high at lunchtime or will be releasing when you calculate your lunch bolus and then throw things out of kilter for the afternoon. 6 is a good level to be on at this time of day.
If it was me I would be absolutely delighted with that result. If I dropped to mid 4s I might have a jelly baby to top me up a bit before lunch and keep an eye on my Libre but a BG of 6 4-5 hours after your bolus injection is perfect.
rebrascora
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In that situation I personally would have one jelly baby and keep an eye on things.... bearing in mind that Libre will probably show you continuing to drop for another half hour whereas your levels will likely have come up again if you do a finger prick check. The fact that they have continued to drop significantly after your bolus insulin has finished suggests to me that your basal dose may be too high. Doing some basal testing might be a wise move to see what your levels are doing in the absence of food and bolus insulin. This is generally done over several days where you skip a meal each day and see what your levels do for that period of the day, when there is only basal insulin working. Obviously if levels drop too low, then you eat some fast acting carbs but make a note of that as that will generally tell you that basal is too high for that part of the day. So.... one day you skip breakfast and the next day you have breakfast but skip lunch and then another day you have breakfast and lunch but skip your evening meal and see what happens during those fasting periods. If the general trend is downwards then your basal is too much. If it goes up, obviously it isn't enough. You may find that one period of the day, like in the morning it rises initially and then drops and keeps dropping for the rest of the day and there are strategies to tackle this which might involve changing the time you take your basal, or injecting some extra bolus insulin to counteract that rise. So for me, my levels start to rise sharply as soon as I get out of bed and can rise by as much as 6mmols on a bad day, so I inject 2 units of bolus insulin as soon as I wake up and before I get out of bed to deal with that, even if I am not going to have any breakfast. I also make sure that I inject my morning long acting insulin as soon as I wake up and before I get out of bed..... I did even try setting my alarm for an hour before I needed to get up to see if that helped, and it did, but the novelty soon wore off 🙄 and I can get a good result by injecting the bolus insulin to cover it so why bother.
I should point out that I am not suggesting you do what I do, but just that there are different strategies to tackle different issues but knowing where the problem lies by doing some basal testing is the foundation for fixing things and making it all more stable.
littlevoice359
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I would echo what @rebrascora has said about blood sugar rising in the morning before getting up. Here, there are two separate phenomena at play - Dawn Phenomenon and Foot on the Floor (FOTF) . The former can cause blood sugar to start to rise anytime after 4am, typically, while the latter will typically cause blood sugar to rise once I get up and start moving about. Personally, I use CGM alerts to help me manage the former and, for the latter, I inject breakfast bolus insulin as soon as I wake up. Also, depending on how I feel and what my blood sugar is on waking, I may choose to take longer to eat my breakfast and/or not eat all my cereal (muesli and greek-style yoghurt). This strategy may not work for everyone, but I have found that it gives me the best chance of starting each day on an even keel.
Best of luck finding a strategy that works for you.
Best of luck finding a strategy that works for you.
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