Mdi

[Doddy]

I have been on MDI for 2 weeks now. I am very pleased with the improvement I have seen so far. However, I still have so much more room for improvement.

I have been toying with the idea of carb counting and injecting accordingly. However, when I have carb counted a meal, taken my rapid and then seen the result 2 hrs later...things don't add up.

For example. Last night, I worked out for the snack/tea I had, with a ratio of 1:8, I would have needed just 3 units of rapid. however, I took my usual 20, and I rose by 2mmols 2 hrs later. Now, if I had injected just 3u, I dread to think how much I would have gone up by. (before meal 9.1, 2 hrs after 11.4)

I am thinking of all this wrong, or am I going to need a much smaller ratio...maybe 1:5? I know I am still working towards doses that are going to bring me to normal figures, and sometimes I do get there...just not enough of the time!!

 

[trophywench]

Remind us (or tell us, can't recall if you have or not!) by what means you determined you needed 1u to 8g?

Oh yeah - what did you actually eat?

 

[DeusXM]

I'm guessing that means you ate around 24g of carbs if you think on 1:8 you'd have needed 3u.

If that's the case, it sounds like your insulin ratio is much nearer 1:1 rather than than 1:8. This is extremely insulin resistant, so I'm wondering if you miscalculated the amount of carbs you had or if you had something else beforehand that you hadn't considered.

The other possibility is that your basal dose is off by some margin.

 

[Northerner]

24g of carbs is quite a small amount, what did you eat and how did you work it out?

 

[Doddy]

I'm guessing that means you ate around 24g of carbs if you think on 1:8 you'd have needed 3u.

If that's the case, it sounds like your insulin ratio is much nearer 1:1 rather than than 1:8. This is extremely insulin resistant, so I'm wondering if you miscalculated the amount of carbs you had or if you had something else beforehand that you hadn't considered.

The other possibility is that your basal dose is off by some margin.

Yes, you are correct.

I ate 2 breaded camembert which are 13g carbs each (amount taken from packet). I had already had dinner, and just wanted a small tea.
I am beginning to think I am gonna need a ratio of 1:1 which seems very extreme, but so far, my journey has proved I am extrememly insulin resistant. Even my GP was shocked!

How did I get the ratio of 1:8...well, I read on here that most people start at 1:10, and seeing as I know I respond to insulin, I knew my requirements would be higher. But I don't want to go in like a bull in a china shop and end up hypo!

Are there people who have ratios' of 1:1...I will have to go no carb if that's the case!

 

[robofski]

I use 1:5 for my breakfast and 1:7 for lunch and dinner. My 2 hour after readings are not great but 4 hours I'm back to pre-meal level. One of the more experienced here will no doubt correct me but I thought a couple of mmols rise after 2 hours was OK? NR in me at least seems to keep working for 4-5 hours so if I was back at pre meal levels after two hours I'd be hypo after 4!

 

[Doddy]

I use 1:5 for my breakfast and 1:7 for lunch and dinner. My 2 hour after readings are not great but 4 hours I'm back to pre-meal level. One of the more experienced here will no doubt correct me but I thought a couple of mmols rise after 2 hours was OK? NR in me at least seems to keep working for 4-5 hours so if I was back at pre meal levels after two hours I'd be hypo after 4!

I thought within 2mmols was ok...but then I thought it still had to be below 9?

 

[Hanmillmum]

I thought within 2mmols was ok...but then I thought it still had to be below 9?

I think 2 mmols is ok post meal too, but you may need to factor a correction into your bolus to get back down to your target range if pre-meal is on high side ? Also wait "x" minutes prior to eating if on high side. 🙂

 

[Doddy]

I think 2 mmols is ok post meal too, but you may need to factor a correction into your bolus to get back down to your target range if pre-meal is on high side ? Also wait "x" minutes prior to eating if on high side. 🙂

How do you do this...does x amount of units lower it by y number of mmols?

 

[Hanmillmum]

How do you do this...does x amount of units lower it by y number of mmols?

Yes, you need to find your own individual correction, for instance my daughters is 1u-to-10mmols, 1 unit will bring her BG's down by 10 mmols, first thing on a morning she needs more as more insulin resistant so we have 1u to 8mmols - (hence our need for a pump with those tiny amounts.) This will contrast greatly to adults I'm sure.

 

[Northerner]

Yes, you need to find your own individual correction, for instance my daughters is 1u-to-10mmols, 1 unit will bring her BG's down by 10 mmols, first thing on a morning she needs more as more insulin resistant so we have 1u to 8mmols - (hence our need for a pump with those tiny amounts.) This will contrast greatly to adults I'm sure.

Yes, for me one unit lowers my levels by about 3 mmol/l. I think it's another of those things where you need to be cautious and learn gradually by experience.

 

[robofski]

I was told 1u would bring me down by 2-3 mmols, I need a bit more than that, but haven't tested formally to confirm my exact amount.

 

[DeusXM]

I ate 2 breaded camembert which are 13g carbs each (amount taken from packet). I had already had dinner, and just wanted a small tea.

There's a couple of things here. Firstly, depending on how much you ate for dinner, what you ate and when you ate it, there might still be a lot of residual glucose conversion. For instance, if I eat pizza, this will continue to raise my BG for a good 6-8 hours after eating because of the starch and fat combo. This would then impact on your insulin requirements as it's not just your tea that is contributing.

Secondly, Camembert is high in fat (which delays carb digestion) and protein (which slowly converts to glucose). That can also interfere with insulin ratios. I'm also assuming you didn't have these with the traditional cranberry sauce.

I'm sure there are people out there with 1:1 ratios. That doesn't mean you need to go no-carb if you don't want to though, although as a T2, reducing your carb intake should probably inform your treatment method more than anything else.

 

[trophywench]

Well - being told something doesn't make it so! LOL

What you do is a test meal with an exactly measured amount of reasonably fast acting carbs. A sandwich is ideal as long as not great wodges of fat or eg jam in it LOL. You have to have not weaten or bolused in the last at least 4 hrs, longer if poss.

So ham and tomato, or salad, or tuna both without mayo or whatever - not cheese. You work the carbs of the brad out (and weigh the bread, andcalculate it from the carbs per 100g - my bread says it's 17.8g carb per slice. It ain't, it's usually 15g LOL) and take the appropriate amount of insulin for that. ie working on 1u to 10g, my sandwich = 3.0units.

Test before you eat, then at 2 hours, 3 hours, 4 hours and 5 hours or whenever you have your next meal if it's before 5 hours. But don't have anything else with carbs or fat in it, in between.

What happens to your BG, and does it finish up where it started from give or take? If not adjust doseage as necessary until it's right more often than it isn't.

Ditto corrections - again you can't have eaten or bolused in the last 4 hours and your BG has to be sufficiently high to warrant a reduction of a couple of mmol/L.

Take 1u of insulin and test test test - 1 hr, 2 hrs, 3 hrs, 4 hrs .....

But be warned, you could have different carb ratios at different mealtimes, people usually need more either at brekkie or at night, rather than midday, but YMMV.

If you do have a ratio of 1 to 1 or it's getting to look as if you do, I would suggest making starting with a very small test meal though - because there's less margin for error when injecting smaller amounts of insulin and if eating higher amounts which require higher doses, you may need to actually increase the doses by another X percent, to get the right result. But don't worry about that one now!

For info, one McVitie's Digestive is near enough 10g ! So your belly will be rumbling my mid afternoon, get over it LOL Not everything we have to do is without it's snags !