Insulin Requirement

[newbs]

Carb Counting has been going well with my general ratio 2:10 and BS a lot more in range than before. Went to see DSN for review and she said that my numbers all looked great, however, she felt 2:10 was too high for someone of my size (I'm quite petite) so told me to inject 1.5:10 instead. Been doing that for 2 days and BS's all high so have gone back to my original 2:10. Does it matter that I need more than "expected" for someone my size? Surely it is the BS being in range that matters. I was totally confused by "you're doing great but lets reduce your insulin"!

 

[Robster65]

Hi newbs.

Assuming you're in range before meals, implying that your basal is good, then as you say, you inject what you need.🙂

I work it out as a ratio based on 1u and vary the amount of carbs it covers.

It works out as 1:9 for breakfast (1u to 9g carb), 1:10 for lunch and 1:12 for tea. It allows a bit mroe flexibility with variations. You can adjust in 1g increements rather than having adjust the ratio in whole or half units. You can then make a judgement on how many units based on what the result is. eg. If it works out at 7.38 units for the meal, I cna decide on 7 or 8u depending on how busy I'll be.

But do what you know works unless the DSN is going to alter your basal to cater for the high BGs, and only then if they're out of range before meals or overnight.🙂

Rob

 

[Northerner]

Personally it sounds to me like one of those 'textbook guidelines' that a person of X weight should need Y amount of insulin per kilogram. When I was diagnosed I weighed 3.5 stones less than I do now (my bodyweight has increased by 33%) , but I needed twice as much insulin. I think the overriding thing is always to do what works for you. Rob makes a very good point about the basal being correct though - you need to ensure that you are not covering basal requirements with extra bolus insulin, and vice versa.

 

[newbs]

My basal overnight has been an issue with my morning readings being 10+ but over the past 2 weeks most the readings have been in-range so DSN decided not to change this as yet.

Will look at changing the ratio for different meals as I definitely need more at breakfast than at lunch, not sure on the evening meal yet ... I definitely feel improvements since carb counting though, just wish I had been taught this years ago!

 

[Northerner]

I need about three times as much insulin in the mornings as I do in the evening, so it's certainly an area where experience and ratio adjustments can make a big difference 🙂 Do you split your levemir? It might help if you need more overnight and in the early part of the day.

 

[newbs]

I need about three times as much insulin in the mornings as I do in the evening, so it's certainly an area where experience and ratio adjustments can make a big difference 🙂 Do you split your levemir? It might help if you need more overnight and in the early part of the day.

That's really interesting, breakfast is something I have struggled with for a long time, if I get the 2 hour post breakfast reading within range I almost certainly go hypo an hour before lunch. (Don't like snacking much and don't feel I should have to, silly as that probably is). I don't split my levemir, DSN doesn't think I need too although it is something I've suggested a few times.

 

[Robster65]

Sounds like your DSN needs to be a bit more flexible in her approach !

There's a possibility that your bolus is making your daytime premeals look ok but your wakign reading is basal alone.
And/or could be the split is needed.
And/or could be the DSN is going to try one thing at a time and eliminate a few ideas as she goes. But I would have thought she would move your basal from morning to night (or vice versa) to see if the morning high becomes an evening high.
If so, its likely a basal split.
If nothing changes, it may mean your basal is too low and needs to go up, while lowering your bolus.

It's possible that she dropped your bolus and, obviously BGs go up, but after a few days, she could have raised your basal slightly to cover it.
Seems odd just to do one without the other.

Rob

 

[trophywench]

Can I ask as I'm a bit confused here, why are you asking the DSN to tell you what to do with this or that?

Test your basal yourself! Takes a little while as you can't really do more than one time block at a time, but works wonders in your getting to know your own diabetes. Plus it would do you NBG at all to miss too many meals in a short period of time.

Start with your overnight one, cos that's the worst seeing as you have to set the alarm for the middle of the night! Didn't you know that's what weekends are for ? LOL

And of course if you can get your FBG on track it gives you a jolly good base to proceed from.

 

[Abi]

I find my ratios are higher i.e. I need more bolus insulin than the text book advice for someone of my size/ total insulin doses etc. And I agree with what others say regarding breakfast. As I am on a pump I have a higher basal rate from 7 to 10am but when injecting I need to add in a unit or two of Novorapid to the breakfast dose

The best way to tell if you need a split dose of basal is to see whether your blood glucose rises in the evening even with skipping food and therefore novorapid- or if generally your night and day time needs are different e.g. hypoing a lot at night but struggling to keep readings down during the day

I don't know why your DSN is being so non comittal about the basal- if you've got to grips with carb counting then it should be quite easy for her to see whether this is needed or not