Mis Counted Carbs

[mum2westiesGill]

I've done something really stupid at lunchtime - my lunch was
Ham sandwich - 2 rounds of bread 36g carbs
Roysers crisps 12g carbs
48g carbs altogether

but instead I injected for

Ham sandwich 1 round of bread 18g carbs
Roysters crisps 12g carbs
30g carbs altogether

so I've not injected for the extra
18g of carbs which I ate

what would anyone do in this situation?

 

[SB2015]

We have all done things like this. If I notice straight after a meal I would just do another bolus for the remaining carbs. if it was a while ago that you ate ,your levels are likely to have gone up and if you are using a bolus wizard it might try to do a correction as well, which will effectively be for those carbs as well.
whatever you choose to do keep a watch on your levels which might wobble around a bit because of the delay in action of insulin.

 

[mum2westiesGill]

Thanks @SB2015 - I did decide to inject a further 2u for the 18g of remaining carbs & will keep an eye on levels.
Re correction - at lunchtime my level was 13.4 so mysugr advised 4u correction which was done at lunchtime - so all I've done now is 2u for the remaining carbs

 

[EllsBells]

Forgive me for sounding out of turn @mum2westiesGill but I get the impression you are quite anxious about carb counting at the moment and not a lot of confidence in yourself to manage your BG and insulin. Am I right in thinking you've been T1 and on insulin for a while? I'm just wondering if you've talked to your team about this.

 

[mum2westiesGill]

@EllsBells you're right about the anxiety - my dsn can only speak over the phone at the moment and yesterday said it would be a while until they can do face to face appointments. She said yesterday she thinks I'm doing too many corrections so she said to stop correcting for levels over 8mmol and to just correct for levels over 12mmol

Re lunchtime at least I've given it a go myself to inject a further 2u for the forgotten carbs

 

[Inka]

If I miscalculated my carbs, I’d just inject the missing insulin unless it was hours later that I realised. In that case, I’d correct if high and just carry on as normal.

 

[mum2westiesGill]

Hi @Inka that's what I decided to do

2pm - injected for lunch
15:06pm - injected for missing carbs

 

[Inka]

Hi @Inka that's what I decided to do

Good call @mum2westiesGill 🙂

 

[mum2westiesGill]

Thanks @Inka

 

[Lucy Honeychurch]

I would have done the same, injected for the missing carbs when I realised. Hope you see someone soon, in the meantime perhaps write the carbs down and double check until you're more confident x

 

[mum2westiesGill]

I would have done the same, injected for the missing carbs when I realised. Hope you see someone soon, in the meantime perhaps write the carbs down and double check until you're more confident x

I use the accu-chek mobile meter & use mysugr app for my bolus advisor - this is where I write the carbs down

 

[mum2westiesGill]

Since my lunch
2pm - 13.4 - injected and also did advised correction dose
15:06pm - injected 2u for the forgotten carbs

On freestyle libre
15:41pm - 12.4
16:51pm - 9.1
17:27pm - 8.8

 

[pm133]

Since my lunch
2pm - 13.4 - injected and also did advised correction dose
15:06pm - injected 2u for the forgotten carbs

On freestyle libre
15:41pm - 12.4
16:51pm - 9.1
17:27pm - 8.8

I'm a bit lost. How many units did you inject in total? It sounds like you injected for 30g PLUS a 4 unit correction and then another 2 unit correction an hour later.

Also, what is your insulin to carb ratio?

ETA. Ah hang on. You injected 4 units to counter the pre-meal 13.4 and THEN injected as normal for lunch (the 30g and then the further 2 units an hour later) right?

 

[mum2westiesGill]

Also, what is your insulin to carb ratio?

ETA. Ah hang on. You injected 4 units to counter the pre-meal 13.4 and THEN injected as normal for lunch (the 30g and then the further 2 units an hour later) right?

@pm133 re my carb ratio it's 1:10 / 1u for every 10g of carbs.

That's exactly right
Before lunch I injected 3u for the 30g plus the advised 4u correction dose then 2u an hour later for the 18g of carbs which I forgot to inject for before lunch

 

[pm133]

@pm133 re my carb ratio it's 1:10 / 1u for every 10g of carbs.

That's exactly right
Before lunch I injected 3u for the 30g plus the advised 4u correction dose then 2u an hour later for the 18g of carbs which I forgot to inject for before lunch

Right I understand now.

Mine is also 1:10 so that's makes it easier.

So here are my thoughts. The counting for the 48g is pretty much spot on at 5 units. That's what I would take.

The 4 unit correction at 13 is more of a concern. I would definitely not have taken 4 units for that. I'd have taken 2 units and kept an eye on it over the next couple of hours.

More importantly, I would definitely not have eaten at all with a glucose reading that high because your blood already had more than enough glucose. It just lacked the insulin to get it where it was needed. 48g of carbs is a lot of carbs to add to that and will likely have taken you into dangerous blood glucose territory of at least 17 to 18 before your insulin kicks in. I would additionally have jumped on my exercise bike after about 20 minutes (to let the insulin kick in before exercising) and wouldn't have eaten until my levels had settled to under 8 and generally I prefer my readings to be under 7 before putting more food in.

These are just my personal thoughts though. Others may have better advice.