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Insulin ratio to Carbohydrate portions

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ClaireM43

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Relationship to Diabetes
Type 1
I'm hoping someone can advise me.
I've had Type 1 diabetes for about 20 years and I've been using the ratio of 2 units of Novorapid per 10g of carbohydrate for about the past 8 months. (Raised from 1:1 ratio) and I'm still getting high BG readings after eating. For example at lunchtime I'll have 30 portions of carbohydrate so I will inject 6 units of Novorapid. Then when I take my BG reading before my evening meal it will be far too high. I'll then use a corrective dose plus the right amount of insulin to correspond to what I'm having for the evening meal. Then before I go to bed the BG reading will still be too high.
It makes sense to me to up the insulin ratio but is using 3 units of Novorapid too high or do people use an even higher ratio?
I've left a message with my diabetic nurse but I'm waiting to hear back.
Thank you for reading!!
 
Have you basal tested to make sure its not a problem with your basal dose rather than your bolus ratio?
xx
 
I agree with @Kaylz Check your basal dose as it could well be that that needs adjusting.

Also, how far in advance of eating do you bolus? Once you’ve got your basal sorted, you could try bolusing a little more in advance. For breakfast, I need to bolus 30 mins in advance, for example (less early for other meals).
 
I would agree that it sounds like your basal needs may have changed rather than your bolus ratios would change by that much. Definitely would be good to do basal testing. Basal needs can change for any number of reasons including changes in routine/activity and even the seasons.
Many people are finding that their basal needs have changed during the lockdown, either because they are more active getting out for daily exercise just to get out of the house or staying in and not going to the gym etc and being less active.
 
I would also agree with @Inka that timing of bolus can be really important if your basal tests show the dose is right and experimenting with the timing of your bolus by bringing it forward in 5 min intervals can be really helpful. I often need 45 mins on a morning for Fiasp to get going before I eat or as much as an hour for NovoRapid but just 20 mins the rest of the day.
 
Good idea - I'll test the Basal ratios. I'm currently on 20 units of Levemir in the morning and 16 units at night.
I'll have a carb free day tomorrow and test my BG at 3am and go from there.
Thanks all!!
 
It might be easier to do the day/night in segments. I always don’t eat at all when I basal test because I find even non-carb meals eg protein affect blood sugar.

Splitting the day and doing the test over a few days is easier and more accurate IMO.
 
It's looking more and more like it is the Basal dose in the morning.
Today my BG at 1.30pm was 6.6 and I ate 40g of carbs so I used 12 units of Novorapid (using my new 3:1 ratio). I've just tested my blood now and it's shot up to 14.6. I'll do a corrective dose of Novorapid as I don't think I'll have any dinner.
So how much would you increase your morning dose - from 20 to 22 and then see how it goes over the next few days?
(My diabetic consultant actually reduced it from 20 to 18 back in August but I've since put it back up to 20).
I'll try and get hold of my diabetic nurse again tomorrow.
 
I’d be tempted to put the morning dose up by 2 units, but I’d make very sure to test lots during the day. For an evening dose, I’d be more cautious and raise it 1 unit at a time. Remember to give your change a few days to settle in before looking to adjust it again.

If in doubt, be cautious. Better to go slowly and carefully 🙂
 
Do you feel unwell at all? That is quite a dramatic rise considering you used a 3:1 ratio for your NR at lunchtime. Just wondering if you may be coming down with something which is pushing your levels up that much. Obviously that will not apply to the last 8 months of needing more insulin, but I would assume your readings have not been going that high for all of that time?
Excellent advice from @Inka re adjusting it more cautiously at night.
 
Hi Inka
Yes I'll try upping it to 22 tomorrow morning and keep an eye on how I feel during the day.
My blood sugar in the morning is relatively OK so I'll keep the night time dose at 16 then.
Thanks a lot for your help - I edited my last post just before you replied - sorry!!
I feel a bit fed up about it really as I'd managed to get my HbA1c down from 90 to 66 in 6 months so I desperately don't want it to go up again before my next appointment. Mind you the appt's not until December now so I've got time
 
The only other things I’ve thought of are dodgy insulin - ie insulin that’s become ineffective - or poor absorption from your injection sites.
 
Hi Barbara,
A lot of the time my readings do not make any sense to me at all.
I can go to bed with a reading of 16.7, wake up in the morning and it will have decreased to about 14.3. On another day I could go to bed with the same reading and wake up with a reading of 5.5.
I'm using a corrective dose of 1 unit of NR reduces by 4 at bed time (advised by my diabetic nurse as I was having a lot of hypos in the early morning) and 1 unit of NR to reduce by 2 for the rest of the time.
I don't feel unwell - I just think I defy science :(
 
I'm wondering if I need to get the brand of insulin changed or could I have become insulin intolerant?
 
ClaireM43 said:
I'm wondering if I need to get the brand of insulin changed or could I have become insulin intolerant?
Click to expand...

Some people I know have found Novorapid less effective than others. You could try swapping to Humalog maybe? It’s a similar profile of action but I prefer it to Novorapid.

Apologies for the rude question, but have you put on any weight recently? I found that when I put on a few pounds, my basal needs went up more than I’d have imagined they would. Some of my ratios changed too. And has anything else changed eg amount of exercise, work, routines, other medication?
 
Loath to ask a personal question but are you carrying any excess weight. It may be that there is some insulin resistance developing if you can be sure that insulin you are using is not compromised.
 
Yes I have put on about a stone since last August. My consultant said this was because I'd got my diabetes more under control and therefore as I wasn't weeing so much I was putting on weight. This was the same appointment that she reduced the Levemir from 20 to 18. I've currently lost 6lb's (started trying about 3 1/2 weeks ago) by not eating any snacks, no alcohol and generally eating 1 meal a day.
 
rebrascora said:
if you can be sure that insulin you are using is not compromised
Click to expand...

that was what I was wondering too - are all these non-functioning doses coming out of the same Novo pen?

Plus... don’t forget your ratio doesn’t have to be in whole units. If you’ve a calculator on your phone there’s no need to keep the maths easy. You can adjust by decimal points which add/subtract say 10-20% rather than doubling your doses as you did from 1:10 to 2:10, and then adding another 30% for 3:10.

If you can’t get hold of your own DSN there is an NHS helpline you can call for dose adjustment advice:

forum.diabetes.org.uk

NHS Diabetes Advice Helpline

Thought this might be useful for any insulin users struggling to contact their GP or diabetes clinic for advice and support: NHS Diabetes Advice Helpline What it is and who is it for? NHS Diabetes Advice is provided by NHS England and NHS Improvement in response to disruption to normal...
forum.diabetes.org.uk forum.diabetes.org.uk
 
ClaireM43 said:
Yes I have put on about a stone since last August. My consultant said this was because I'd got my diabetes more under control and therefore as I wasn't weeing so much I was putting on weight. This was the same appointment that she reduced the Levemir from 20 to 18. I've currently lost 6lb's (started trying about 3 1/2 weeks ago) by not eating any snacks, no alcohol and generally eating 1 meal a day.
Click to expand...

I wasn’t in any way suggesting you were overweight. Sometimes putting on a little weight is a good thing especially if it’s due to improving your control 🙂

You said you’re only eating one meal a day? Did I understand that right? If so, another possibility is that your body is pushing out glucose in the absence of food. My body does this sometimes if I miss a meal, especially in the morning. If that’s a possibility for you too, you could try eating 3 meals a day but still watching carbs and calories eg having a salad and fruit and/or oatcakes for lunch, etc.

Just an idea - you’ll know your own body 🙂
 
Thanks for all your really helpful suggestions - it's so nice to know that I'm not alone!!
No offence taken at all about the weight gain :D:D:D!!
Yes all the NR doses are from the same pen. I have disposable Levemir pens so it can't be them.
I think it's back to trial and error again. I've got very good at keeping my diary and just when I think I can see a pattern emerging then it all goes awry.
I'll try all your suggestions and if I can't get hold of the nurse then I'll book a phone call with my GP.
Thank you all once again and keep safe.
 
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