Daily Diabetical Carbcount conundrum

[everydayupsanddowns]

My rule of thumb tends to involve the total dose as much as the meal type.

I'm lucky not to have too much of a problem with pasta or even half a regular supermarket pizza, but once my dose goes over a certain limit I know I'll have to split it (fish and chips, takeaways etc).

The time of day also has a significant effect on how 'early' I need to inject. 30-60 minutes at breakfast, 15-30 minutes at lunch, just before at dinner.

Well that's the case if I'm in range anyway. Additional time-to-get-going is usually required if I'm a little high before a meal. Which might mean waiting 2 hours 😱 after injecting before I can eat any breakfast! I've tested this on more than one occasion testing BG every 20-30 minutes so I know that it's not a case of me dropping low and then bouncing back up. After an hour it's likely I'll have only dropped 1mmom/l from a high fasting BG. Once it gets going it seems to behave more by the book.

 

[novorapidboi26]

My rule of thumb tends to involve the total dose as much as the meal type.

I'm lucky not to have too much of a problem with pasta or even half a regular supermarket pizza, but once my dose goes over a certain limit I know I'll have to split it (fish and chips, takeaways etc).

The time of day also has a significant effect on how 'early' I need to inject. 30-60 minutes at breakfast, 15-30 minutes at lunch, just before at dinner.

Well that's the case if I'm in range anyway. Additional time-to-get-going is usually required if I'm a little high before a meal. Which might mean waiting 2 hours 😱 after injecting before I can eat any breakfast! I've tested this on more than one occasion testing BG every 20-30 minutes so I know that it's not a case of me dropping low and then bouncing back up. After an hour it's likely I'll have only dropped 1mmom/l from a high fasting BG. Once it gets going it seems to behave more by the book.

I have never considered experimenting with injecting times to this extreme, I will need to try this........

 

[everydayupsanddowns]

Actually looking back over recent weeks 30 minutes seems more like it for breakfast.

From 27th October though:
07.54 10.2 (FBG) 7u Humalog and 15u Lantus
08.57 9.7 (No carbs yet, just coffee)
09.47 8.9 20g Carbs (about half normal)

Looking back at this I suspect a little Liver tomfoolery. Additionally, of course, I'm taking my Lantus in the morning so I am up and about (and wanting to eat) during its onset period. This probably goes a long way to explaining the increased requirement for giving Humalog a bit of a head start.

30th October though:
08.38 7.5 (FBG) 8u Humalog and 15u Lantus
09.40 7.9 Again, just coffee, but a minimal rise!) 50g carbs
11.42 10.4 (a little on the high side)
13.30 4.7 (Lunch time)

Today:
07.06 4.6 (FBG) 6u Humalog 14u Lantus (slightly reduced basal)
07.47 ?.? 35g carbs
08.48 5.9
10.45 3.7 (oops!)
13.01 4.9

It's taken a bit of trial-and-error guesswork to get the delays roughly right and it's not 100% there by any means but it seems to be more or less working. Well until everything changes again that is!

M

 

[Phil65]

Actually looking back over recent weeks 30 minutes seems more like it for breakfast.

From 27th October though:
07.54 10.2 (FBG) 7u Humalog and 15u Lantus
08.57 9.7 (No carbs yet, just coffee)
09.47 8.9 20g Carbs (about half normal)

Looking back at this I suspect a little Liver tomfoolery. Additionally, of course, I'm taking my Lantus in the morning so I am up and about (and wanting to eat) during its onset period. This probably goes a long way to explaining the increased requirement for giving Humalog a bit of a head start.

30th October though:
08.38 7.5 (FBG) 8u Humalog and 15u Lantus
09.40 7.9 Again, just coffee, but a minimal rise!) 50g carbs
11.42 10.4 (a little on the high side)
13.30 4.7 (Lunch time)

Today:
07.06 4.6 (FBG) 6u Humalog 14u Lantus (slightly reduced basal)
07.47 ?.? 35g carbs
08.48 5.9
10.45 3.7 (oops!)
13.01 4.9

It's taken a bit of trial-and-error guesswork to get the delays roughly right and it's not 100% there by any means but it seems to be more or less working. Well until everything changes again that is!

M

Hi Mike,

Do you take lantus before bed time, as well as morning? I am thinking of taking some lantus in the morning instead of 38 units before bed. As I often go a little low/very minor hypo late afternoon.

 

[everydayupsanddowns]

Hi Phil

I experimented with splitting my lantus dose morning and evening, but that didn't work out for me (though I know it does for many). Possibly because my dose is quite small, so splitting it meant two small doses which don't seem to last as long.

The problem I was working around was waking up low in the mornings (several times a week at one point). By shifting Lantus dose to breakfast time it seems that when I need less overnight now coincides with my Lantus dose petering out. It did play havoc with post-breakfast levels for a while, but a little experimentation seems (at the moment at least) to have provided a half-decent workaround.

M

 

[everydayupsanddowns]

I am thinking of taking some lantus in the morning instead of 38 units before bed. As I often go a little low/very minor hypo late afternoon.

That seems slightly counter-intuitive to me (though may work despite that!).

It would seem to me that by late afternoon the activity of your evening dose would be beginning to fade away (suggested activity is 22 hours +/- 4 hours)

Have you basal tested* at that point to see what happens if you have no rapid-acting on board?

M

* Choose a not-especially active day. Eat no lunch, drink only water and test every hour or so over the course of the afternoon. With no rapid-acting on board Lantus *should* hold BGs steady +/- 1.7 mmol/L

 

[Phil65]

That seems slightly counter-intuitive to me (though may work despite that!).

It would seem to me that by late afternoon the activity of your evening dose would be beginning to fade away (suggested activity is 22 hours +/- 4 hours)

Have you basal tested* at that point to see what happens if you have no rapid-acting on board?

M

* Choose a not-especially active day. Eat no lunch, drink only water and test every hour or so over the course of the afternoon. With no rapid-acting on board Lantus *should* hold BGs steady +/- 1.7 mmol/L

Tried this yesterday:

ate my evening meal at 5.26pm (probably 3 hours earlier than normal) BG 4.7 65g Carb took 14 units humalog, then fasted uniti 08.30 this morning. I was really impressed with the results, I am going to fast at other times of the day to give me more of an indication that my basal dose is right.

9.50pm BG 3.0 (ate a cookie 14g carb.....I know, I know!! This is not fasting!)
10.14pm BG 4.7
11.19pm BG 6.0 (took 38 units Lantus)
00.02am BG 7.2
03.04am BG 4.4
04.04am BG 4.6
06.31am BG 4.4
07.36am BG 6.3
08.39am BG 8.5

ate Breakfast at 08.45.

Very surprised with these findings (had a few glasses of red as well!!)although a little scared at readings of 4.4 during the night!! Very rarely tested at night, unless hypo.

 

[everydayupsanddowns]

9.50pm BG 3.0 (ate a cookie 14g carb.....I know, I know!! This is not fasting!)
10.14pm BG 4.7
11.19pm BG 6.0 (took 38 units Lantus)
00.02am BG 7.2
03.04am BG 4.4
04.04am BG 4.6
06.31am BG 4.4
07.36am BG 6.3
08.39am BG 8.5

Looks great! You are your own CGM

Hardcore basal-testing veterans will say that results don't really count (or at least need to be viewed with some caution) if you have had a hypo before you start. Nevertheless as you say, it's a pretty good set of figures.

Really you'd need a few more samples to check for consistency in changes and/or to spot any emerging patterns but here's what that list looks like to me:

• I would expect the cookie to have been pretty much done and dusted in an hour, so the rise to 6.0 is more than likely that alone. Possibly with a little bit of Lantus-fade added in.
• Over the next hour the 1mmol/L rise is a great result, especially since you are likely to be between the activity of the old Lantus and during the onset of the new dose.
• Lantus has a mini-peak (typically around the 4-5 hour mark) which might explain the drop to 4's at that point
• From 6.30 onwards there's a fairly significant rise which might be indicative of some Dawn Phenomenon going on, though you'd need a few more tests to be sure...
• So if we kinda ignore the post hypo wobble it was 6.0 - 8.5 which is not too shabby at all. 10 gold stars to you 🙂

M

 

[bigpurpleduck]

Hardcore basal-testing veterans will say that results don't really count (or at least need to be viewed with some caution) if you have had a hypo before you start. Nevertheless as you say, it's a pretty good set of figures.

And if nothing else proves your 14g cookie is the perfect hypo treatment for you!

• Lantus has a mini-peak (typically around the 4-5 hour mark) which might explain the drop to 4's at that point

I didn't know about this peak. I often wonder if I could have managed better control on MDI had I actually known anything about how it worked! Do you get any of your info from DSN/consultant, or is it all your own research?

 

[everydayupsanddowns]

I didn't know about this peak. I often wonder if I could have managed better control on MDI had I actually known anything about how it worked! Do you get any of your info from DSN/consultant, or is it all your own research?

All stuff I've found out this year. After realising that Lantus was causing a few problems I've done some looking around and a fair bit of trial-and-lots-of-error testing. When I asked my DSN about changing the timing of my Lantus (which was suggested in a comment on our blog and has been spectacularly successful) she just said that in her experience it simply 'moved the problem'.

Here's a graph from http://www.sanofi-aventis.co.uk/products/Lantus_OptiClik_SPC.pdf

That shows a minor peak followed by a bit of levelling off and though it doesn't show much of a fade at the end, I'm pretty sure that's what happens for me. This graph, being one of those 'averaged' ones won't necessarily be 100% accurate for anyone. I suspect every individual is likely to have something a bit different. Tch! typical!

 

[Phil65]

All stuff I've found out this year. After realising that Lantus was causing a few problems I've done some looking around and a fair bit of trial-and-lots-of-error testing. When I asked my DSN about changing the timing of my Lantus (which was suggested in a comment on our blog and has been spectacularly successful) she just said that in her experience it simply 'moved the problem'.

Here's a graph from http://www.sanofi-aventis.co.uk/products/Lantus_OptiClik_SPC.pdf

That shows a minor peak followed by a bit of levelling off and though it doesn't show much of a fade at the end, I'm pretty sure that's what happens for me. This graph, being one of those 'averaged' ones won't necessarily be 100% accurate for anyone. I suspect every individual is likely to have something a bit different. Tch! typical!

I tend to agree, I am sure my lantus has a mini-peak but also I reckon starts to wear off after 20 hours or so, so significantly better than Humilin I, but I am doing more fasting sessions at different times in a 24 hour period......watch this space, if you are interested. I am pretty happy with my humalog and carb ratio with the odd hiccup obviously!!

 

[Phil65]

And if nothing else proves your 14g cookie is the perfect hypo treatment for you!



I didn't know about this peak. I often wonder if I could have managed better control on MDI had I actually known anything about how it worked! Do you get any of your info from DSN/consultant, or is it all your own research?

For me identifying a 15g Carb treatment for a hypo has been perfect, chocolate not a good idea as slow release (took me a long time to realise that!) glass of orange juice also 15g and a good treatment, I always test 15 mins later to confirm, I used to stuff anything down my neck, inevitably it was always too much and my BG then went too high!!

 

[Catwoman76]

Hello people,

I thought it might be an idea to have a thread where you can quickly note what insulin (or other meds) you have taken for a meal or snack and how you worked it out.

We could go on and discuss the other factors and see what your levels are like an hour or two or later to see how well we are carb counting!

Together we can share some insight to how we all work the carbs out and how other factors affect us in working out the carb count! Maybe one day I'll stop guessing!

Hopefully it will help share our knowledge and maybe if we're on mdi or a pump we can tighten up our understanding even work out our ratios and dual waves! (Sorry not really sure about pumps, but notice the phrase dual wave mentioned a fair bit)

I'll start with first post below...

Cheers

Rossi 🙂
-----------

Morning,

Last night I was a good 5.8 before tea (not that great I had corrected after lunch as was in teens!), had a bowl of pasta I would guess 70gramms of pasta when dry and alsoa small portion of cabbage and corgette with it, and a little pot of yoghurt, I inject 6 units of novorapid, I think I had guessed it would be a 80 grams of carb meal? I was shaking like a leave whilst shifting a washing machine around about an hour or so later! I really am struggling with evening meals the most at the moment!

Does that carb count seem right to any of you?

Cheers

Rossi

Hi Rossi I went on a carb counting course in September at my local hospital and I had the most problems with my evening meal. My ratio is I unit for 10 carbs but in the evening my blood sugars were crashing so I was put on 1/2 unit for every 10 carbs but that went high and then high readings in the morning, After a while I changed it to 3/4, so if the total was 12 units of insulin I will take 8 or 9 and that is working much better for me. So I take more for my lunch than I do for my dinner! I don't know if this might help you, you could give it a try and see how it affects you, I didn't think carb counting would work for me, but after a lot of tweeking I got there in the end. Sheena

 

[rossi_mac]

Evening D's

So had a good few days even though last night I sinned and had sausage fish & chips, hey I was hungry!

Anyway a thought I had, when I once mentioned I had veg with pasta and some said don't count for that veg, well tonight I had mince with kidney beans not too many and some veg, I had it all with pitta bread in an easy tea meh-hi-co stylie, so I only counted for the pita as the veg wan't much and the beans weren't huge in quantity, but thinking back would you have counted for the chilli beans too?

I guess I'll find out soon enough!

Sheena, thanks I think I am getting there with the help of y'all! 🙂

eduad - wow cracking info there cheers! 🙂

Cheers

Rossi

 

[Northerner]

I was told not to count pulses like kidney beans 🙂

 

[rossi_mac]

I was told not to count pulses like kidney beans 🙂

Cheers big guy, I'm finding a lot of useful stuff oot!

I'm celebrating this new knowledge with a pint of thatchers gold, I think I'll need to correct after that!

 

[Northerner]

Cheers big guy, I'm finding a lot of useful stuff oot!

I'm celebrating this new knowledge with a pint of thatchers gold, I think I'll need to correct after that!

OoH! Enjoy!

 

[rossi_mac]

Hi folk

All going allreet at the mo give or take.

Twas thinking, my breakfast ratio is pretty solid, mainly varies when I vary my work activites in the morning. Lunch I'm not so hot on but not bad really, generally go high in the afternoon when I end up munching! Dinner is my worst success at carb counting and working out my carb to insulin ratio. So I thought would it be worth having a few nights of say microwave meals which accurately (are they?) quote the carb contents? Then I could see what I do need (work out a ratio), then fine tune my carb counting skills!??

Hope you allreet too

Rossi 🙂