Insulin ratio to Carbohydrate portions

[rebrascora]

I would swap the cartridge in the NR pen for a new one and see what happens.... I too am now wondering if it is just the NR not working for some reason. That would explain such a big rise despite giving yourself a 3:1 ratio. Has it been left in the car or out in the sun the last few days when it has been hot and got compromised, Do you change the needle every time (I am a bit naughty for not doing that 😉) Just wondering if you may have a blocked needle that isn't dispensing any insulin..... or could you have forgotten your morning Levemir?

 

[Pumper_Sue]

Hi Claire another way of seeing if your basal is correct is to inject your NR 30 mins before you eat with a blood test and just before you eat test again. If no movement in BS then you know your basal is not correct so need more Levemir.
As you are low carbing, like many others you will probably need a lot more background insulin to mop up the fat and protein you are eating.
I know if I have a high protein meal I need a shed load of background insulin to absorb the high numbers.
Also depending on what you eat perhaps consider splitting your bolus insulin at meal times.

This all after you have checked your basal though 🙂

 

[rebrascora]

Hi Claire another way of seeing if your basal is correct is to inject your NR 30 mins before you eat with a blood test and just before you eat test again. If no movement in BS then you know your basal is not correct so need more Levemir.

Only providing the NovoRapid is working correctly of course and you would normally respond to it within that 30 mins,

 

[ClaireM43]

Hi Sue,
I've definitely been through the menopause so I don't think it could be that still?
I can't think of anything different that's happened recently to make my BG levels so erratic although I am having to take 6 Co-Codamol tablets a day to try and treat a frozen shoulder. Would that affect it?
I've never had good diabetes control but even now that I know what I'm meant to be doing correction wise, carb counting etc, my levels still make absolutely no sense at all.

 

[trophywench]

Aaaargghh = frozen shoulder = pain and inflammation - ergo the perfect recipe for higher BG, Usually only lasts for 3-6 years for diabetics though …..

Finished up my shoulder wasn't damaged whatever, I'd torn a tendon utterly and literally with an ace serve against the mega hard hitting male partner we were playing mixed doubles with and only discovered by a private (ex NHS) physio I consulted, it had healed in nodules attached to the edge of my shoulder blade and both of us could only stand the pain for 5 minutes, using her thumbs to individually break down what was more or less like bone by then it was so long since I had free movement. Was referred to see a surgeon but he was truthful and said TBH all they could really do when they got in there - was yank it free again so did I want that? Well no thanks, I didn't. He told me to access physio but of course the NHS sort it clashed with work, hence why I decided to go privately and got recommendations from wherever I could.

Batty as this may sound - if you happen to have any Sports Physio clinics you could do a lot worse.

 

[ClaireM43]

Oh wow Jenny - this must be the reason then. It's bl**dy agony and I've had it for about 18 months now and it's not getting any better. So far I've had NHS physio, NHS acupuncture, a blood test for Rheumatoid Arthritis and an X-ray!! I think that when GP's are actually seeing patients again I should go back in and tell them it's playing havoc with my BG levels. What would you do in the meantime? Shall I carry on with my plan of experimenting with the higher Levemir doses or will it not make any difference? I can't believe that this is because of my shoulder but now you've mentioned it - it makes sense. Do you know what causes the erratic BG readings - is it the generally debilitating pain or the Co-Codamol tablets (or the ensuing constipation with these tablets). I'm so happy that you posted your reply - I was beginning to lose my mind with not being able to work out what was happening.

 

[leonS]

I would urge you NOT to change the base dose by more than the smallest possible amount! Leave things at the increased dose for a few days and then retest - if you need to you can increase the dose again.

A very small increase will have a dramatic effect on BG and you will need some time to adjust your bollus ratio

Unless you get the base dose right NOTHING will work as it should.

 

[Lizzzie]

Hello! Just wanted to add to that (didn't read all the replies) are you doing less exercise lately? I mean, just less walking around eg if you work in a school and tend to pace, but are off cos of covid. For me I'd put the basal up the smallest amount first then change after another few days. Hope you find a way that works

 

[rebrascora]

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

If your basal dose is not correct, nothing will make sense, that is why it I so important to know how to test and adjust it. Have you had or been offered a DAFNE (Dose Adjustment for Normal Eating) course or whatever your local equivalent is? It is a 5 day course and will help you make sense of your diabetes and give you the knowledge to understand what is going on and how to deal with it.

I find that I sometimes have to adjust my basal insulin (usually my evening dose) by one unit on a day by day basis to take into account things like if I have been more physically active that day or whether I had a glass or two of wine with my dinner or if I ate a low carb but protein and fat rich meal for dinner. With Levemir I find the changes have the desired effect over the dose period for me rather than having to wait 2 or 3 days to see the change, like some other basal insulins. This works well for me as I don't have much routine in my life, so having that flexibility is useful. The point is that getting your basal insulin dose right means that your bolus insulin will work as you expect it to.

It is possible that your shoulder pain is causing a rise in your basal needs but I would still ditch that NovoRapid pen and try another one and go back to just a 2:1 ratio because if it was compromised and the new one is working properly you could have a nasty hypo with all that extra insulin and as @Inka said test a lot more frequently for a day or two after you make changes to make sure you are safe.

And yes, if it is the shoulder pain/inflammation causing the problem, then increasing your basal insulin is the correct thing to do to account for that but I would be surprised if it would have that much effect and I would have thought that your night time levels would be affected as well, so do keep an open mind about the possible cause and not just latch on to one possible solution.

But most importantly, do ask about an education course like DAFNE if you haven't done it. It is not just helpful in terms of what you learn but also having the opportunity to spend time with other Type1 diabetics and learn from their experiences...both good and bad.... and develop a network of support and even make new friends..... like us on this forum, they are the people who understand the frustrations of diabetes and are therefore best placed to offer sympathetic support.

 

[DaveB]

Hi. A strange comment from your consultant! It sounds like you are having too many carbs in your diet and insulin resistance is creeping in. Keep the carbs down and see if you can gradually get the weight into a good region. Yes, check the Basal. It should keep your BS stable when fasing e.g. overnight and a another guide is to have a morning fasting BS between 5 and 7 mmol

 

[Ian T]

Hi - one thought from me - are you using Freestyle Libre monitor? It has really helped me to understand what is going on, timings and trends etc. I used to do finger prick tests about ten times per day but even that didn't really give me the level of info I needed. I am currently at hba1c of 50 and I couldn't get below mid 60s before I used it. They can be available on prescription if you meet a couple of criteria or you can buy them direct but not cheap at about £100 per month. They have a starter pack which is a bit cheaper if you wanted to try. Worth talking to your doctor or Diabetes Nurse.

 

[ClaireM43]

Hi there,
I upped my Levemir to 21 this morning and my BG reading just now was 7.4 so I'm delighted 🙂 🙂 .
I'll keep trying 21 for the next few mornings and hopefully it will make a difference.
(I've left my NR dose at 2:1 until I can speak to the DSN - I think they must be really really busy at the moment).
Yes I've been on a DAFNE course and I found it invaluable. If anyone hasn't been on one and is offered the opportunity to do so then it really is worth 5 days out of your life. It's given me much more confidence with counting carbs and correction doses but even so I've been totally flummoxed by my recent readings. Also Ian, I've tried to get on the list for a Freestyle Libre as everyone else on my course had one but according to my NHS trust I don't qualify. My consultant did say that she'd review my situation at my next appointment in December so we'll see. It just seems it would make life much easier without all the finger pricking but I guess I'll just have to wait.
Many thanks again for all your great advice and comments.

 

[trophywench]

I'm glad the extra unit has helped - but I still think you ought to do a basal test, frankly - there is no substitute and OOoh yes it's a bit easier with a Libre, but you still can't do it any quicker really, it's just the BG testing that's easier - you still have to alter the timings of some meals to get the required lengths of time with ONLY basal insulin circulating. Link below to how to go about it.

Constipation, I'm a sod cos I know I don't drink enough - hence I'd always say make sure you drink enough plain tap water, and go for a 10 minute walk if you can - this weather should you walk a lot further you would be likely to need more water just to cover the walk, so it isn't going to help much. If the house is cool though, vigorous vacuuming, cleaning tiled floors etc, that doesn't require more fluid to drink, could help?

Basal insulins « Diabetes Support Information Exchange

www.diabetes-support.org.uk

Can ignore top half of the page - you already know what basal insulin's for.

 

[ClaireM43]

Aaarghh - woken up and it's 15.7 this morning.

 

[Pumper_Sue]

Aaarghh - woken up and it's 15.7 this morning.

So what did you eat for your evening meal? Also what was your blood sugar at bedtime?

 

[ClaireM43]

Hi Sue,
I did have a high carb dinner (a tin of curry and a packet of rice) which totalled 106 CP.
My BG before eating this was 11.7 so I corrected by 3 (1 NR unit reduces by 2) and using the ratio 2:1 used 22 NR so 25 NR in total. Good, I thought, got the CP covered.
Reading before bedtime (5 hours after previous dose) was 7.4. Great, I thought!!
So that dispels my theory of using 3:1 as my bedtime reading of 7.4 would have made me hypo.
So have you any ideas what I'm doing wrong? What would you do?
There is something that I'm just not doing right as the variance in my readings is huge.
I could post a spreadsheet of all my May readings if you want to have a look but I don't want to bore people 🙄🙂

 

[Pumper_Sue]

Hi Sue,
I did have a high carb dinner (a tin of curry and a packet of rice) which totalled 106 CP.
My BG before eating this was 11.7 so I corrected by 3 (1 NR unit reduces by 2) and using the ratio 2:1 used 22 NR so 25 NR in total. Good, I thought, got the CP covered.
Reading before bedtime (5 hours after previous dose) was 7.4. Great, I thought!!
So that dispels my theory of using 3:1 as my bedtime reading of 7.4 would have made me hypo.
So have you any ideas what I'm doing wrong? What would you do?
There is something that I'm just not doing right as the variance in my readings is huge.
I could post a spreadsheet of all my May readings if you want to have a look but I don't want to bore people 🙄🙂

Well there's your problem as rice is a very slow release carb, it came back and bit your bum hard

Perhaps when you have a slow release carb, like pasta, rice or a high fat meal try splitting your bolus dose so you don't get hammered bs wise again. Trial and error is the name of the game.

I use a pump so can split my bolus and run it over a number of hours others also increase their basal when having a meal like that.

 

[ClaireM43]

Brilliant - thank you so much Sue. That's another question answered.

 

[Pumper_Sue]

Brilliant - thank you so much Sue. That's another question answered.

You are more than welcome 🙂

 

[DaveB]

A couple of points. Do you mind me asking what your current BMI is? I wonder whether insulin resistance is playing apart? BTW with regard to Frozen Shoulder, if it it's really adhesive capsulitis, then amitriptyline can be a great help. My wife's consultant prescribed a very low dose of this anti-depressant and it worked wonders. She regrets taking Ibuprofen for many months as she now has Stage 5 CKD and this Ibuprofen is one suspect so avoid it if possible as it's known to cause kidney damage.