Carbohydrate to insulin ratio changed

[JohnBont]

Hello
Hope you are all well.
Has anyone experienced a change in their CIR?
I’ve been a type 1 for 46 years and lately my CIRs have changed. A year ago I was using a ratio of 1 unit to 3.5 gms of carbs. I now find that’s too much and am using a ratio of 1 unit to about 6 or 7 gms of carbs. I use novorapid and toujeo.
I was getting hypos about 1 or 2 hours after meals.
I was instructed by my nurse to change my injection site for my toujeo from my leg (which I’ve used for 40 odd years!).
Also changed my novorapid site.
Any comments would be appreciated.
Thank you
John

 

[helli]

My CIR often change.
For me it varies according to when I eat, time of year, how much I exercise and my starting blood sugar.
I have read that some people find their insulin sensitivity can go down when they lose weight.

Have you recently done a basal test to check your basal requirements have not changed too?
The usual advice is to change basal first and then adjust bolus.

In my experience, neither stays stable all the time.

 

[Inka]

Yes, my ratios change frequently. It can be the time of year, my weight, what I’m eating, just about anything. My basal changes too.

All I do is monitor the problem meal for a few days to make sure the problem wasn’t a one-off, then if I’m still getting the same issues I change my ratio.

Perhaps your change of Novorapid site has had some effect on absorption?

 

[Pumper_Sue]

My basal rate changes a fair amount but carb ratio stays fairly static. 1 -16 at lunch time 1- 14 tea time and 1 - 20 if I eat breakfast, which is as rare as hens teeth.

 

[Jenny101]

I'm like Pumper sue, my basal rate changes a fair bit, carb ratios is 1:10 all the time but at breakfast and lunchtime I eat 20 mins after releasing insulin and at tea-time I eat 5 -10 minutes after insulin (any more than that and I'm hypo). Having said that, if I eat something sweet I'll wait 10 minutes further before eating as sugar kicks in pretty damn quickly.

 

[Ljc]

My carb ratio stays fairly static but my Basal changes frequently.
Do you have a half unit pen for your Novorapid, if not it would be a good idea as sometimes a whole unit change is too much .

 

[Kaylz]

My basal changes fairly often but then in turn that changes my bolus ratios for a few days until I've sorted the basal issue out (Tresiba so 3 days to take effect) currently in Tresiba adjustments and have been using 1U:21g carbs for breakfast for instance xx

 

[trophywench]

Mines 'usually'1u:10g. But if I fancy a bit of cake with my afternoon cuppa (and I do today cos we not only have scones - we have clotted cream too!) it's nearer 1u:12 or 13g. If I have more at that time of day, hypo before dinner.

 

[JohnBont]

My CIR often change.
For me it varies according to when I eat, time of year, how much I exercise and my starting blood sugar.
I have read that some people find their insulin sensitivity can go down when they lose weight.

Have you recently done a basal test to check your basal requirements have not changed too?
The usual advice is to change basal first and then adjust bolus.

In my experience, neither stays stable all the time.

Thanks helli, I haven’t done a basal test recently I’ll read up to see how to do that. It’s reassuring to hear that your CIR changes as well. Thank you again, best wishes John

 

[JohnBont]

Yes, my ratios change frequently. It can be the time of year, my weight, what I’m eating, just about anything. My basal changes too.

All I do is monitor the problem meal for a few days to make sure the problem wasn’t a one-off, then if I’m still getting the same issues I change my ratio.

Perhaps your change of Novorapid site has had some effect on absorption?

Thanks for your reply Inka. I agree that the novorapid site change would affect the absorption but the CIR change is still happening some time after the site change. Thanks again, best wishes, John

 

[JohnBont]

My basal rate changes a fair amount but carb ratio stays fairly static. 1 -16 at lunch time 1- 14 tea time and 1 - 20 if I eat breakfast, which is as rare as hens teeth.

Thanks for your reply Pumper Sue much appreciated

 

[JohnBont]

I'm like Pumper sue, my basal rate changes a fair bit, carb ratios is 1:10 all the time but at breakfast and lunchtime I eat 20 mins after releasing insulin and at tea-time I eat 5 -10 minutes after insulin (any more than that and I'm hypo). Having said that, if I eat something sweet I'll wait 10 minutes further before eating as sugar kicks in pretty damn quickly.

Thanks for your reply Jenny101 much appreciated. Can I ask, how do you know your basal rate changes, what are the symptoms please? Regards John

 

[JohnBont]

My carb ratio stays fairly static but my Basal changes frequently.
Do you have a half unit pen for your Novorapid, if not it would be a good idea as sometimes a whole unit change is too much .

Thanks for your reply Ljc. Can I ask how do you know your basal rate changes, what symptoms do you experience please? Regards John

 

[JohnBont]

My basal changes fairly often but then in turn that changes my bolus ratios for a few days until I've sorted the basal issue out (Tresiba so 3 days to take effect) currently in Tresiba adjustments and have been using 1U:21g carbs for breakfast for instance xx

Thanks for your reply Kaytz much appreciated. Can I ask, similar to what I’ve asked the others who commented on their basal rate changing, how do you know the basal rate has changed, what symptoms do you get please? Regards John

 

[Kaylz]

Thanks for your reply Kaytz much appreciated. Can I ask, similar to what I’ve asked the others who commented on their basal rate changing, how do you know the basal rate has changed, what symptoms do you get please? Regards John

For me I know when I'm spending most of the day on the low side and needing to keep topped up with carbs so not just after a bolus dose, I don't really conduct a full basal test as it's easier to see with the Libre and I can't do without grub but it hasn't failed me yet using this method xx

 

[everydayupsanddowns]

Thanks for your reply Ljc. Can I ask how do you know your basal rate changes, what symptoms do you experience please? Regards John

I’m another who relies on basal tweaks based on experience of the last 10 years or so.

My carb ratio and correction factors do change through the seasons (I generally need less insulin in the warmer months), but in between times my basal ebbs and flows and I find I need to tweak it one or more times a month.

Essentially, when my basal drifts my I:C stops working as expecting, and I need to either stave off hypos or dose repeated corrections. A small tweak to my basal, and things start working again.

If multiple tweaks have happened in the same direction eventually I will need to amend my I:C and ISF.

Something I discovered with repeated fasting basal checks. But these days I generally just adjust based on CGM readings.

 

[rebrascora]

I have to tweak my basal as frequently as 2-3 times a week sometimes and other times it can be stable for months. Having a basal insulin which is easily adjustable is enormously important to me as I don't have a set routine and some days I will be much more active than others, Split dose Levemir allows me that flexibility and if I need several corrections in a day to keep me in range or to treat or head off repeated hypos then it is usually a basal issue, especially as I follow a low carb diet so bolus ratios are much less relevant.

Toujeo is a much less flexible basal insulin and takes about 3 days to stabilise before the result of any corrections can be assessed. It can be a bit unpredictable for some people too. I am inclined to think it is probably a better basal insulin for Type 2 diabetics who are less sensitive to insulin.

If you don't have Freestyle Libre and don't test very frequently, then it is more difficult to spot these trends. Being able to scan 20 or 30 times a day enables you to see much more clearly what is going on than just 5 or 6 finger pricks a day.

 

[Pumper_Sue]

Thanks for your reply Jenny101 much appreciated. Can I ask, how do you know your basal rate changes, what are the symptoms please? Regards John

I'm not Jenny 🙂 but rule of thumb is if running low or high more than two hours after a meal it's normally a basal problem. If to high or low within two hours of a bolus then it's a bolus problem.

If you pop into the pump forum there's a sticky in there on how to do a basal test. Have a go and see how you get on.

 

[Ljc]

Thanks for your reply Ljc. Can I ask how do you know your basal rate changes, what symptoms do you experience please? Regards John

I use the freestyle Libre now , so it’s easier to spot on the continuous graph when things are going awry when I have no active Novorapid.
Prior to the Libre , if I had too many hypers or hypo’s I did a Basal test. I only learned about Basal testing from folks on here my nurse didn’t know about Basal testing , she wasn’t a DSN though.

 

[nonethewiser]

Can't remember last time changed insulin carb ratio, had to change basal rates last week, nowt new for this time of year, usually see decrease now increase later on.