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Early days.. insulin ratio..

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
christophe

christophe

Well-Known Member
Relationship to Diabetes
Type 1
Maybe it is too early to try to make an actual rule but I have been making notes of carbs and insulin, initially all was going well based around a guess at one unit of novo rapid for every 10-12.5g carb. I had very settled numbers in the morning with 15 units of Tujeo injected around 10pm and very stable background numbers during the day ( if that is the right phrase.. basically whatever mess I made of guessing and calculating for meals, when it had all settled down I would be in the 5s, I could also eat a tiny bit and come back 5 something without novo rapid).
The last couple of weeks the waking and background number is in the 6s... if I dare eat without novo rapid it goes up and is really slow to come back to low 7 then maybe 6.5, by that time I am ravenous and have to eat "properly". At this time I have been using an extra unit to pull the numbers back to my previous normal but this doesn't seem to work, 6-7 is becoming normal..
Am I expecting too much, asking for this level of control? I know we are all different, I guess I shouldn't be surprised my body is letting me down.. is this an expected development as I get used to having insulin in my system??

I knew it was going too well...!
 
christophe said:
Am I expecting too much, asking for this level of control? I know we are all different, I guess I shouldn't be surprised my body is letting me down.. is this an expected development as I get used to having insulin in my system??
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Hi @christophe,what may be happening is that your ratios are changing - this happens to most people and for a variety of reasons. For some, it can be the change in seasons, temperature, length of day, activity levels - I'm afraid it does make things trickier :( Hopefully, as you gain more experience of how your body responds you will see the patterns. My daily insulin needs can change over the course of a year from 12 to 35 units of novorapid, but what tends to happen is they start to change (I notice I need more, or less) then they settle sat a new level for a while, so it's not a case of having to constantly adjust, just when the Diabetes Fairy pokes me with her wand to make sure I'm paying attention 😱

Keep monitoring and learning, it will become clearer in time, but there may always be occasions when you get thrown a curved ball 😱 🙂
 
12-35!! Oh my... I have a lot to look forward to. I am more used to the unpredictable bounce of the oval ball, but at least that has the decency to bounce in relation to its trajectory once or twice before throwing a wild one.
More learning to do.. my poor fingers.. Thank you for the advice Northerner
 
A question for the Pig of the North (!) or anyone else..
would you expect to tweak the long acting dosage as well from time to time?
 
christophe said:
A question for the Pig of the North (!) or anyone else..
would you expect to tweak the long acting dosage as well from time to time?
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Yes, more than likely 🙂 It's advisable to do a periodic 'basal' (long-acting) test so you can check the dose is correct. The basal is supposed to take care of the slow trickle of glucose released by your liver throughout the day and night, so it should keep your levels steady when you are not eating (this glucose is needed to keep your heart, lungs, brain and digestive system supplied with energy when you are not eating e.g. when you are asleep).

Have a read of this link to understand how to do it 🙂

http://www.diabetes-support.org.uk/info/?page_id=120
 
Got it, thank you.. definitely time to test in a controlled manner.
 
When were you diagnosed Christophe? I do recommend basal testing - but just wondering, if you've only relatively recently been diagnosed - are you in fact just coming out of the so-called honeymoon period?
 
Since January, Jenny.. I had that thought but I didn't really know what it meant..
I suppose even if it is a transitional time, having some record is better than nothing. Does the end of the honeymoon period mean I won't ever get back to where I was while I was in it?
 
christophe said:
Since January, Jenny.. I had that thought but I didn't really know what it meant..
I suppose even if it is a transitional time, having some record is better than nothing. Does the end of the honeymoon period mean I won't ever get back to where I was while I was in it?
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The honeymoon period lasts a different amount of time for each individual, the tighter the control from diagnosis the longer the honeymoon period lasts apparently (or that's what my consultant told me at the start of the month lol), unfortunately nobody can really answer your questions as insulin requirements have a mind of their own 🙄 your very recently diagnosed so I wouldn't be too concerned with things, just keep regular records and in touch with your team 🙂 my insulin has changed dramatically since I was diagnosed in 2016, back then I was on 8 units of Tresiba before bed, now I'm down to only 2! 😱 xx
 
There just isn't a right way to do this is there! At first I wanted to reduce the amount of injections which meant fairly radical changes to what I ate.. now it seems like even tiny amounts of carbs sends the bg up out of range. It is hard not to get a bit stressed about looking at a number on a meter, I find myself trying to guess the result while the egg-timer is spinning.. then it's either disappointingly high (higher than I would want to be fair.. I am keeping out of double figures) or very surprisingly low, maybe that indicates I am putting too much novorapid in.. don't know.. it is still early and I am reacting rather than getting control of it.
Not unhappy, just a little frustrated at times. Thanks Northerner, Jenny and Kaylz, I know you know what it is like.
Chris
 
We all get frustrated when it takes time to work out what's going on when something goes pear shaped, but with time you learn to work it out quicker, I'm sure your team will help in every and any way they can! Please be careful on the journey of insulin and food, I have gotten myself into a bad way this and developing a 'fear' of carbs due to comments from others in our situation, I am now skin and bone so please don't get too hung up on that side of things :( xx
 
I know what you mean.. I am walking away from food at the moment if I think I can't work out what I need to do, I am not unhealthy though.. a bit unconfident I guess. Work makes things hard to get enough time to think it through properly, the nature of work I mean, no routine to build anything around.
Sorry to hear about your problem and thanks for the warning.. it is too easy to fall into a place where something is "bad",
 
I think what Kaylz has said is very pertinent - it's really easy to get hung up on the carbs. It's also difficult to know whether to bolus for a snack, or wait until the novorapid has left your system before injecting more - I know I was worried about 'stacking' the insulin.

In time I would absolutely recommend getting on a DAFNE course if you can. In my area you have to have been diagnosed for at least 6 months. It stands for Dose Adjustment for Normal Eating and is a comprehensive course into how insulin works in our bodies, carb counting, sick days, and how to make informed decisions about dose adjustments to both your fast acting and background insulins. It is a week long - but I felt it was well worth the week's holiday I took from work to go on it. Your employer should let you attend anyway I think, but I just chose to take it as holiday for other reasons.

All that being said, I think what comes in time and with experience is something that can't really be taught - and that is two things. Most importantly is an ability to have some perspective about the numbers. Just as in all areas of life, we have good and bad days - these days maybe because we didn't perform to our best ability (as no one can every day) and / or outside factors beyond our control affected things. This is so true for managing Type 1 diabetes.

There was a thread recently on the forum where we discussed what winds us up and I have to say that I get frustrated when people say - oh you have had diabetes for 4 years now, you must have good control. This ability to be frustrated comes from the knowledge that every day is a new one, and whilst I may have a bank of knowledge and continue to learn things about my diabetes, there are many variables beyond my control and that is just the way it is. That is not to say I don't try to stay within healthy parameters - but the weather, my hormones, the amount of walking I do, hoovering, stress, the diabetes fairy, it being the third Thursday of the ninth month etc etc might put an oar in too.

The second thing is confidence - which can only grow with experience. Confidence in yourself to recognise when you might be going low and that the situation can be easily sorted, confidence that you don't have to exactly carb count everything as you get used to eyeing a plate of food and getting a pretty good estimate (I have developed a skill of cutting a 50g in weight slice of cake - sadly it's a lot smaller than you think), confidence in having a snack etc

We all have to find a place with our management where we are content to be. Some of us like to keep as tight a control as possible because this gives us confidence and reassurance, some like to put the diabetes on the back burner as much as possible, some of us do a mixture of the two. I guess with experience we learn to walk our own tightrope with our own balancing aid and know everyone on here is there to catch us if and when we fall.
 
Thanks Steph, in short.. no short-cuts! I think I am tending toward tight control then hopefully I can back it off a bit when I need to let go once in a while. I got Kaylz's message.. I can see it happening, back away from the thing that is causing the problem.. it even sounds good on paper, less so when the thing that is capable of killing you is what you need to live!
I know this is my.. what is the right word? Journey, with changing ratios and rules with an unruly fairy for company, on a tightrope.. but knowing you have all been there, in fact are there, is a massive help..

Can I ask a question? Maybe it is covered on a course or maybe it is answered as you go.. does insulin get used up or wear off?? Is that making sense, what I don't know is we inject for a given amount of carb..but the insulin stays on board until it's time is up, or we inject for the carb and it is finished when the carbs are gone ( always assuming the weights and measures are good..!)

A final question Steph and you don't need to answer! If you misjudge the 50g of cake.. what happens to the extra??
 
Ha! I like the final question! I guess it depends on what sort of day I'm having... 🙂 Just to let you know - there is a more serious answer to that one for me also. I was wrongly diagnosed type 2 as I was over 40 when I got diabetes. This meant that I got more and more ill and my blood sugars would not go down. I managed this as best I could be severely restricting my carb intake. The up shot of this was, that it took me well over a year after being re-diagnosed to learn to be a bit more flexible with carbs. In my mind they had become the enemy. The DAFNE course helped hugely with this and I am happy to say I now eat cake with pleasure! Even the naughty extra bit🙂🙂

Your novorapid works independently to your carb intake. Once injected it takes around 20 minutes to get going (this varies from person to person) and reaches its peak around 1-2 hours, falling off from then. It lasts between 4-5 hours. Thus, in an ideal world you should finish up where you started, blood sugar wise 5 hours after injecting (not allowing for any corrections you may have needed).
I should add, this is supposing your background insulin is also set right to keep you steady!
 
Good for you!
I haven't quite worked up to a good wedge of cake yet but I will... I don't fear carbs as such, just don't trust myself to handle them properly until I work out this whole insulin thing.
I seem to get the novorapid activating very slowly, I get a steep rise in bg so I wait for as long as I can to eat after injecting.. up to a hour if I can.. then if I have done my numbers properly the peak in bg isn't too bad. More experiments and learning.. Thank you to all, information and warnings noted and I have a mental image of you people that I keep in mind when I am scratching my head about what to do about this 44.5g intake.. not sure that helps but it means I have company when I am struggling..
 
@christophe I developed a massive eating phobia, for a while I wouldn't touch more than 20g per meal! I am having to work through this problem on my own as I cant manage the fortnightly 6 hour trip to see a psychologist unfortunately, I didn't think I would eat cake or things again, at Christmas I had a slice of strawberry gateau and then New Year I had a massive chunk of chocolate yule log, I guess all I'm trying to say is it can be done, it may take you time to get there, but you will, the guys here will agree, I mean if I can do it, you certainly will! 🙂
May I ask are you using pre-filled pens? xx
 
If a label tells you the cake is Xg carb per 100g weight - use a calculator to calculate how many g 44.5 g of it is, and again use it to calculate the dose of insulin. Round odd amounts of insulin DOWN. Better to be a bit higher for a little while than in the back of an ambulance!

Do NOT aim to stay at 5.0. That's far too close to hypo to give you a safety margin for errors - or having to run for the bus, etc. Aim for more like 6.5 at the moment.

The aim of this treatment is to let us lead as normal as possible lives - so start cutting yourself a bit of slack mate - cos hopefully you'll have a LONG one!
 
Kaylz, I never doubted for a moment that you would be getting yourself back.. I am no expert but someone who is fighting their own problem and can still come here to help other people is no kind of pushover.. good and bad days right? Learn what you can from the bad ones but remember the good ones.
I have to give it time as you say.. look, going through what you do, on your own.. it is inspiring,ok. I wish nothing but good things for you and I will get myself sorted.

That all came out in a rush but I am not sorry about it..
To answer, yes I am using the disposable pens from day 1 to now. Kept in the fridge except for the one in use and a spare just in case.
 
christophe said:
Kaylz, I never doubted for a moment that you would be getting yourself back.. I am no expert but someone who is fighting their own problem and can still come here to help other people is no kind of pushover.. good and bad days right? Learn what you can from the bad ones but remember the good ones.
I have to give it time as you say.. look, going through what you do, on your own.. it is inspiring,ok. I wish nothing but good things for you and I will get myself sorted.

That all came out in a rush but I am not sorry about it..
To answer, yes I am using the disposable pens from day 1 to now. Kept in the fridge except for the one in use and a spare just in case.
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Awww jeez thanks, you just made me smile for the first time in a while!! 🙂
What I found out quite early on is that the pre-filled pens
1 - work out more expensive over time and
2 - they can be pretty useless if your not a standard 1 unit to 10g OR your extremely sensitive and need a small correction
It may be worth asking your team if you could have a half unit pen, these are much sturdier and it only takes a minute to change the cartridge when it needs done, its just a thought like but it made my life so much better when I was prescribed the half unit pen xx
 
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