Morning insulin ratios

[pinkjessi21]

Hi, I have had type 1 for 4 years (diagnosed aged 30). I am on levemir and novorapid. I usually do an insulin ratio1:10 but I find this never works with my first meal of the day. If I take more insulin I hypo. I can never get it right. Just wondered what everyone else does for breakfast? Or do people eat a low carb breakfast? Thanks.

 

[Robin]

Hi, I have had type 1 for 4 years (diagnosed aged 30). I am on levemir and novorapid. I usually do an insulin ratio1:10 but I find this never works with my first meal of the day. If I take more insulin I hypo. I can never get it right. Just wondered what everyone else does for breakfast? Or do people eat a low carb breakfast? Thanks.

I find that it helps if I don’t think of ratios at breakfast. Whatever I have for breakfast, I need 2 extra units of insulin to cope with my dawn rise. (That’s just me, you will have to experiment until you find what you personally need). The point is, it’s no good me working on a different ratio for breakfast. I normally need 1:10. Say I decided to try 1:5. For a 20 carb breakfast, I'd take 4 units. This would work for me, because I'd be getting 2units to cover the carbs, and 2 units to cover the dawn rise. If I decided on a 40 carb breakfast, though, on that ratio, I’d take 8units of insulin, which would be 4 for what I need to cover the carbs, 2 for the dawn rise, and er, 2 that I didn’t need which would send me hypo mid morning.

 

[pinkjessi21]

I find that it helps if I don’t think of ratios at breakfast. Whatever I have for breakfast, I need 2 extra units of insulin to cope with my dawn rise. (That’s just me, you will have to experiment until you find what you personally need). The point is, it’s no good me working on a different ratio for breakfast. I normally need 1:10. Say I decided to try 1:5. For a 20 carb breakfast, I'd take 4 units. This would work for me, because I'd be getting 2units to cover the carbs, and 2 units to cover the dawn rise. If I decided on a 40 carb breakfast, though, on that ratio, I’d take 8units of insulin, which would be 4 for what I need to cover the carbs, 2 for the dawn rise, and er, 2 that I didn’t need which would send me hypo mid morning.

Thanks for your reply.
So would you that make you likely to mid-morning hypo? Do you just make sure you have a snack ready to prevent the hypo?

 

[Robin]

Thanks for your reply.
So would you that make you likely to mid-morning hypo? Do you just make sure you have a snack ready to prevent the hypo?

Firstly and most importantly, I always have a snack with me in case of hypos, because you never know when one will crop up.
But no, I don’t hypo mid morning normally, my morning strategy is one of the most stable, because I tend to do the same sort of routine every morning, so I’ve found what works for me to keep my levels where I want them to be.

 

[TheClockworkDodo]

I have a different ratio for each meal of the day, and also I find I need to inject a different length of time before each meal. You don't say what happens if you don't have more insulin with breakfast - do you spike with your usual ratio but hypo with extra insulin? If so, you may find that instead of having the extra insulin you need to inject ten or fifteen minutes (or more) earlier for that meal than you do for others, to prevent either highs or hypos.

 

[nonethewiser]

Bolus further ahead for breakfast compared to other meals, being on pump deals with dawn rise easier than when I was injections, basal rate is raised to deal with dawn rise, or foot on floor whatever people want to call it.

Breakfast today is porridge yogurt made with full fat milk, 4 units to deal with 50g carbs, same ratio for brekkie most days.

 

[everydayupsanddowns]

Welcome to the forum @pinkjessi21

When you take your usual 1:10 ratio and it doesn’t work - can you describe what the ‘doesn’t work’ is? What happens to your BGs after 2 hours and then by lunchtime? And do you have to correct mid-morning and if so, by how much?

 

[Hannah.amelia]

Hi! just wondering what happens if you do a 1:10 ratio? I usually find that having a low carb breakfast and I give myself 1 unit for every 20g of protein (but this is just what I have found works for me) or else my blood sugar rises rapidly even after taking insulin. Maybe experimenting with the ratio in small increments would help find out what works for you?

 

[SB2015]

Hi, I have had type 1 for 4 years (diagnosed aged 30). I am on levemir and novorapid. I usually do an insulin ratio1:10 but I find this never works with my first meal of the day. If I take more insulin I hypo. I can never get it right. Just wondered what everyone else does for breakfast? Or do people eat a low carb breakfast? Thanks.

Welcome to the forum.

When you say your ratio doesn’t work at Breakfast, are you finding that you spike, or is it that you hypo?

I find I need different ratios through the day. This is easier for me as I use a pump so can fine tune them more. Prior to the pump, when I was in Injections I found it helped to switch to a half unit pen, which enabled me to make finer adjustments.

As others have said it can be useful to adjust the timing of your Bolus at meals. I find that I need a bigger delay to my meal after the Bolus in the morning than at any other time in the day. I have found the delay that I need by trial and improvement. It will be different for each of us.

 

[rebrascora]

I need to pre bolus at least an hour, ideally an hour and a half for breakfast and like @Robin, I need 2 units "for the road" and then whatever carbs I eat, but I do tend to find it best if I eat low carb for breakfast, so even an omelette with salad which has no appreciable carbs will need a 2 unit NR jab and if I have a 10g Nature Valley protein bar, I need 3 units.... 2 "for the road" and 1 unit at 10:1 for the protein bar. This only applies at breakfast time. I follow a 10:1 ratio for the rest of the day. I used to have real problems with breakfast until I increased my pre-bolus time.

 

[pinkjessi21]

Hi all. Thanks for your replies. I have always given my insulin after eating, not before.
After breakfast if I use my 1:10 ratio, my BG will be raised 2 hours afterwards. When I have tried changing my ratio so I have more insulin, I end up hypo. I have now started just adding one extra unit on to what I would normally give (as the first person who commented said they give themselves an extra 2u) and it seems to be improving. I think I will also try injecting pre-meal in the morning too. How long before eating do you inject? Thanks again for your replies, it really helps to not feel alone in this!

 

[nonethewiser]

How long before eating do you inject? Thanks again for your replies, it really helps to not feel alone in this!

As a rule 25mins providing bg is in range, for example today woke to 5.6 so 25mins will give insulin ample time to get to work.

Another example, was above 10 yesterday morning so waited 50mins before eating, libre is useful in these situations. How far you inject ahead is individual so experiment my friend.

 

[SB2015]

As you mention that increasing the insulin makes you Hypo, it definitely sounds like a timing issue. I was taught at the start to Bolus after my meals. It was only when I started to do them before the meal that I started to bring my post meal levels down. I was always fine before the next meal, but the Libre certainly demonstrated what was happening with bike spikes without a pre Bolus.

The ‘science’ behind it is that the insulin needs to get into your blood, along those tiny capillaries, to get to where the glucose is, and then takes a bit of time to get started. So blousing after a meal will give that time lag a chance to elevate the BG and then once high it is harder to bring levels down. Let your experiments begin and move the timing to suit you. Be cautious and test regularly.

One argument for blousing after that I was given was you then know what you have eaten. At breakfast I know what I am eating so that is not a problem. If I am out it is more of a problem, so I deliver insulin once the good is on the table, or earlier if I know absolutely when it is coming. The hard bit is if I go for a scone. I know the carbs and have it in front of me. It is hard to wait, when our local cafe does the best ones ever. I could Bolus before I get there but these are so good they often run out!

 

[rebrascora]

@SB2015 ... are those cheese scones by any chance?? That used to be my absolute favourite mid morning snack with a cup of hot chocolate. I have not had a scone since diagnosis. My lovely neighbour used to kindly bake me a batch every now and then and I had to ask her to stop when I started low carb for my diabetes. I dread to think how much insulin you need for a good cheese scone and hot chocolate!

@pinkjessi21 I am really surprised that you were instructed to bolus after eating. My initial instruction was to bolus when I was dishing up or sitting down to the meal but before eating. After breakfast time problems with spiking and hypoing, I started to experiment and found that at least an hour before food was necessary and if my fasting reading was high (8-10) which I have been of late, then up to 2 hours was best. I also give myself at least 10mins but normally 20mins before food at other times of the day. If you are going to experiment then do make sure you do test every 10-15 mins to see when the insulin starts to kick in. My metabolism is very fast with carbs and it amazes me how quickly what goes in my mouth gets into my blood stream to meet that insulin, so I don't really worry about going too low doing this. I definitely think the timing of your bolus may be crucial to the problem you are having and it does seem to be very common for people to be much more insulin resistant in the morning. Don't forget that your blood glucose meter is a tool for you to manage your diabetes, so don't feel restricted to only using it a set number of times a day. It is there to help you figure out the best system for you and that can only be determined by experimenting.

 

[SB2015]

@SB2015 ... are those cheese scones by any chance?? That used to be my absolute favourite mid morning snack with a cup of hot chocolate. I have not had a scone since diagnosis. My lovely neighbour used to kindly bake me a batch every now and then and I had to ask her to stop when I started low carb for my diabetes. I dread to think how much insulin you need for a good cheese scone and hot chocolate!

Black coffee and half a cheese scone (the other half goes home to my husband). 25g carbs after an exercise class. Sorted. Libre shows happy lines.

 

[rebrascora]

Black coffee and half a cheese scone (the other half goes home to my husband). 25g carbs after an exercise class. Sorted. Libre shows happy lines.

Wow! You have serious self restraint! I absolutely could not stop at just half a cheese scone and my partner hates them so I wouldn't even have the incentive of treating him to the other half, to keep me from eating the whole thing and I would probably not want it without the hot chocolate.... the two are hopelessly married as far as my taste buds are concerned. I guess I'm an all or nothing girl!

 

[TheClockworkDodo]

How long before eating do you inject?

I inject half an hour before breakfast - unless my waking reading is below 5, in which case I inject about 10-15 minutes before breakfast. But I only inject about five minutes before lunch, and in the evening I inject when the meal's being served up as I find otherwise I tend to hypo in the middle of it!

Timing is a very individual thing, so I think it takes a bit of experimenting to work out what's best for you.

 

[SB2015]

Wow! You have serious self restraint! I absolutely could not stop at just half a cheese scone

You haven’t seen the size of them!!