New type1 - carb counting ratios confusion

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Wonky

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Type 1
Hi All, am in month 4 of my type1 diagnosis. I've muddled through starting carb counting but am assuming as I seem to be in the honeymoon period it's not at all uniform so finding it a bit awkward. I need 1unit of fiasp for app.26g carbs and 2 for 36g so am always adding up to these counts as multiples don't seem to work. I haven't got further and a little nervous in knowing what level to go for next. Am trying to put on a bit if weight also as I lost a lot on the run up to diagnosis. Any advice as dsn says too early to carb count but how else do I asses insulin needs? THANKS PS DAFNE course not available in my area!
 
I think a lot of us find that our insulin ratios haven’t read the textbook. There’s an oft quoted saying 'You need what you need' and it’s probably not the same as what I need, or what others need. Most people start with a basic carb/insulin ratio, experiment, keep notes, and adjust as they find out what actually works for them.
 
Hi and welcome.

If you want my honest opinion, I would say that you are trying to be far to precise with your ratios and unless your basal insulin is holding you incredibly steady all the time, then ratios of 1:26 or 2:36 are just "pie in the sky". Even with a half unit pen (hopefully you have one of those... a NovoPen Echo Plus... but if not ask about it, as you are obviously very sensitive to insulin at this stage and need to be able to adjust at half unit levels.) you are going to struggle to be sufficiently precise to dose to that sort of ratio. I would maybe aim for 1:20 and see how you go with that. You may find that you need more for bigger meals and then we sometimes just add an extra unit or two if the carb count is above a set number of carbs. So for instance, if it is about 50g carbs my normal ration may not work and I might need an extra unit.

Most of us find we need more bolus insulin at breakfast time so you may need a higher ratio of insulin to carbs in the morning.... say 1:15 or maybe 1:10 even and some people need 1:5 or even 1:2. It is very individual.

Personally I find that I can stick with the standard 1:10 ration throughout the day BUT at breakfast time I add 1.5-2units extra to deal with Dawn Phenomenon (DP) or Foot on the Floor Syndrome (FOTF), rather than use a higher ratio., This is because, if I don't eat any breakfast, I will still need to inject that small dose of Fiasp before I get out of bed to deal with the rise caused by our liver releasing glucose to give us energy for the day ie DP/FOTF. In reality our basal insulin should cover this rise but practically speaking it isn't possible to dose MDI (multiple daily Injections) basal insulin to this level of precision, so you need to compensate a bit with your bolus insulin.

I am very conscious that a lot of this may well be going over your head with you being so newly diagnosed but there is a lot to learn and understand and in the honeymoon period it can very difficult to settle into a set carb ratio that consistently works, so using a very approximate and easy to calculate ratio like 1:20 which is somewhere between the 1:26 and 2:36 you mention would be close enough.

Do ask about a half unit pen if you don't have one and probably 2 if you don't need much basal insulin either.

Out of curiosity, which basal insulin are you using and how many units? Have you done any basal testing before you started working on your ratios because if your basal dose isn't as close to keeping you level as possible, then your ratios are pretty meaningless. If you don't know how to do a basal test, there is a sticky post in the Pumping and Technology section of the forum, but if you can't find it, do ask.

Just want to say that the first year is not easy because there is so much to learn and even if you get to grips with all the theory of it, your body will be quite different in practice. Add in the unpredictability of the honeymoon period and it is really more a question of just doing the best you can to get through it without worrying too much about being overly precise or "perfect". Good enough is good enough with diabetes. Life is hard enough without trying to work with a 26 times table. 🙄 Working in 20s or 15s or 10s is much more doable and then round up or down as you think appropriate.

If you were on a pump and needing to be more precise and your basal profile was holding you lovely and steady every hour of every day, then your are able to be more pecise with dosing and it can pay off, but on MDI, injecting basal and bolus in whole units or even half units, the adjustment possible is just too basic to make enough difference to worry about 5g, 6g or even 10 g of carbs here and there, which is why you may be told that you don't need to bolus for a snack of up to 10g carbs.

If there is anything you don't understand about what I have posted above, please do ask as I am well aware I have posted a lot of info and you may not be aware of some of it.
 
Wonky said:
Hi All, am in month 4 of my type1 diagnosis. I've muddled through starting carb counting but am assuming as I seem to be in the honeymoon period it's not at all uniform so finding it a bit awkward. I need 1unit of fiasp for app.26g carbs and 2 for 36g so am always adding up to these counts as multiples don't seem to work. I haven't got further and a little nervous in knowing what level to go for next. Am trying to put on a bit if weight also as I lost a lot on the run up to diagnosis. Any advice as dsn says too early to carb count but how else do I asses insulin needs? THANKS PS DAFNE course not available in my area!
Click to expand...

Simplify things - carb counting has been made out to be terribly, dreadfully, awfully complicated and needing a week’s course and a university degree. It’s not!

You shouldn’t be doing the ratios by 1 and 2 units like you’ve written. You just need to work out how many grams of carbs 1 unit of your bolus (meal) insulin covers.

As @rebrascora says, you need to have your basal dose right else that will mess everything else up, but presuming it is, choose something easily countable eg baked potato, and eat the same for a few nights until you’ve got an idea of your ratio. I do potatoes in ounces because it’s pleasingly simple: 2oz raw potato weight=10g carbs, 4oz=20g, etc, etc.

It’s likely that you’ll need different ratios for the three meals, eg 1:12 for breakfast, 1:20 for lunch, 1:25 for evening meal (those are example figures only). Keep your meals similar until you’ve perfected your ratios. Get a half unit pen too as that makes life easier. It honestly isn’t complicated 🙂

It’s never too early to carb count IMO. I was taught at diagnosis, as was everyone else years ago.
 
rebrascora said:
Hi and welcome.

If you want my honest opinion, I would say that you are trying to be far to precise with your ratios and unless your basal insulin is holding you incredibly steady all the time, then ratios of 1:26 or 2:36 are just "pie in the sky". Even with a half unit pen (hopefully you have one of those... a NovoPen Echo Plus... but if not ask about it, as you are obviously very sensitive to insulin at this stage and need to be able to adjust at half unit levels.) you are going to struggle to be sufficiently precise to dose to that sort of ratio. I would maybe aim for 1:20 and see how you go with that. You may find that you need more for bigger meals and then we sometimes just add an extra unit or two if the carb count is above a set number of carbs. So for instance, if it is about 50g carbs my normal ration may not work and I might need an extra unit.

Most of us find we need more bolus insulin at breakfast time so you may need a higher ratio of insulin to carbs in the morning.... say 1:15 or maybe 1:10 even and some people need 1:5 or even 1:2. It is very individual.

Personally I find that I can stick with the standard 1:10 ration throughout the day BUT at breakfast time I add 1.5-2units extra to deal with Dawn Phenomenon (DP) or Foot on the Floor Syndrome (FOTF), rather than use a higher ratio., This is because, if I don't eat any breakfast, I will still need to inject that small dose of Fiasp before I get out of bed to deal with the rise caused by our liver releasing glucose to give us energy for the day ie DP/FOTF. In reality our basal insulin should cover this rise but practically speaking it isn't possible to dose MDI (multiple daily Injections) basal insulin to this level of precision, so you need to compensate a bit with your bolus insulin.

I am very conscious that a lot of this may well be going over your head with you being so newly diagnosed but there is a lot to learn and understand and in the honeymoon period it can very difficult to settle into a set carb ratio that consistently works, so using a very approximate and easy to calculate ratio like 1:20 which is somewhere between the 1:26 and 2:36 you mention would be close enough.

Do ask about a half unit pen if you don't have one and probably 2 if you don't need much basal insulin either.

Out of curiosity, which basal insulin are you using and how many units? Have you done any basal testing before you started working on your ratios because if your basal dose isn't as close to keeping you level as possible, then your ratios are pretty meaningless. If you don't know how to do a basal test, there is a sticky post in the Pumping and Technology section of the forum, but if you can't find it, do ask.

Just want to say that the first year is not easy because there is so much to learn and even if you get to grips with all the theory of it, your body will be quite different in practice. Add in the unpredictability of the honeymoon period and it is really more a question of just doing the best you can to get through it without worrying too much about being overly precise or "perfect". Good enough is good enough with diabetes. Life is hard enough without trying to work with a 26 times table. 🙄 Working in 20s or 15s or 10s is much more doable and then round up or down as you think appropriate.

If you were on a pump and needing to be more precise and your basal profile was holding you lovely and steady every hour of every day, then your are able to be more pecise with dosing and it can pay off, but on MDI, injecting basal and bolus in whole units or even half units, the adjustment possible is just too basic to make enough difference to worry about 5g, 6g or even 10 g of carbs here and there, which is why you may be told that you don't need to bolus for a snack of up to 10g carbs.

If there is anything you don't understand about what I have posted above, please do ask as I am well aware I have posted a lot of info and you may not be aware of some of it.
Click to expand...
 
Thanks to you all for such quick and detailed responses. I have done a basal test but only during the day and it seems steady with following the fasting etc but need to do again overnight. I take 4units of Tresiba at night. Have not managed to do more basal testing due to having to wake at night and get up early for work but need to do at the weekend maybe. I don't have a half unit pen but that sounds great. Good to have someone to talk to. My numbers are mostly within target of 4 to 10 hut on a very low carb intake sp far. Am a bit too nervy maybe of going high or low. Still a bit bamboozled by the sudden diagnosis!
 
rebrascora said:
Hi and welcome.

If you want my honest opinion, I would say that you are trying to be far to precise with your ratios and unless your basal insulin is holding you incredibly steady all the time, then ratios of 1:26 or 2:36 are just "pie in the sky". Even with a half unit pen (hopefully you have one of those... a NovoPen Echo Plus... but if not ask about it, as you are obviously very sensitive to insulin at this stage and need to be able to adjust at half unit levels.) you are going to struggle to be sufficiently precise to dose to that sort of ratio. I would maybe aim for 1:20 and see how you go with that. You may find that you need more for bigger meals and then we sometimes just add an extra unit or two if the carb count is above a set number of carbs. So for instance, if it is about 50g carbs my normal ration may not work and I might need an extra unit.

Most of us find we need more bolus insulin at breakfast time so you may need a higher ratio of insulin to carbs in the morning.... say 1:15 or maybe 1:10 even and some people need 1:5 or even 1:2. It is very individual.

Personally I find that I can stick with the standard 1:10 ration throughout the day BUT at breakfast time I add 1.5-2units extra to deal with Dawn Phenomenon (DP) or Foot on the Floor Syndrome (FOTF), rather than use a higher ratio., This is because, if I don't eat any breakfast, I will still need to inject that small dose of Fiasp before I get out of bed to deal with the rise caused by our liver releasing glucose to give us energy for the day ie DP/FOTF. In reality our basal insulin should cover this rise but practically speaking it isn't possible to dose MDI (multiple daily Injections) basal insulin to this level of precision, so you need to compensate a bit with your bolus insulin.

I am very conscious that a lot of this may well be going over your head with you being so newly diagnosed but there is a lot to learn and understand and in the honeymoon period it can very difficult to settle into a set carb ratio that consistently works, so using a very approximate and easy to calculate ratio like 1:20 which is somewhere between the 1:26 and 2:36 you mention would be close enough.

Do ask about a half unit pen if you don't have one and probably 2 if you don't need much basal insulin either.

Out of curiosity, which basal insulin are you using and how many units? Have you done any basal testing before you started working on your ratios because if your basal dose isn't as close to keeping you level as possible, then your ratios are pretty meaningless. If you don't know how to do a basal test, there is a sticky post in the Pumping and Technology section of the forum, but if you can't find it, do ask.

Just want to say that the first year is not easy because there is so much to learn and even if you get to grips with all the theory of it, your body will be quite different in practice. Add in the unpredictability of the honeymoon period and it is really more a question of just doing the best you can to get through it without worrying too much about being overly precise or "perfect". Good enough is good enough with diabetes. Life is hard enough without trying to work with a 26 times table. 🙄 Working in 20s or 15s or 10s is much more doable and then round up or down as you think appropriate.

If you were on a pump and needing to be more precise and your basal profile was holding you lovely and steady every hour of every day, then your are able to be more pecise with dosing and it can pay off, but on MDI, injecting basal and bolus in whole units or even half units, the adjustment possible is just too basic to make enough difference to worry about 5g, 6g or even 10 g of carbs here and there, which is why you may be told that you don't need to bolus for a snack of up to 10g carbs.

If there is anything you don' understand about what I have posted above, please do ask as I am well aware I have posted a lot of info and you may not be aware of some of it.
Click to expand...
 
Think I'll try the suggestion re potato thanks rather than keep comparing one type of carb to another.
 
Its never to early to carb count! Also bear in mind as you put weight on, you may need more insulin. If uou can. It took a lots of work for me to put on weight on low carb (which is, essentially, the atkins diet)
Also, a word of caution....i started after diagnosis doing low carb, i felt it made it easier to stay in range...but, over time, i needed more insulin.
Then, i got kidney stones, didn't feel like eating and gave up on low carb to tempt myself to eat. My ratio went from 1 to 3.5 to 1 to 20!
Long term, low carb can reduce insulin sensitivity, but you are so insulin sensitive right now, i don't think you need to worry for a while.
A half unit pen is a great idea, it really helped me
 
Wonky said:
I need 1unit of fiasp for app.26g carbs and 2 for 36g so am always adding up to these counts as multiples don't seem to work.
Click to expand...
If those are at different times of the day, time of day makes a difference for most of us.

If they're both for breakfast you might prefer to fudge it a bit (I find breakfast works out a bit easier if I have a carb counted dose for the actual breakfast plus a couple of units to handle the dawn phenomenon). (Or not. It's your diabetes, so try to find something that works and isn't too complex. I agree with others that "26" and "36" feel a bit precise, and trying to be that precise probably isn't worthwhile.)
 
Also, my ratio is different if its a work day or a weekend....
 
Welcome to the forum @Wonky

Sounds like you are off to a flying start, and keen to keep experimenting and trying things to attempt to keep your diabetes in it's box, rather than running rampant all over your life.

If you'd like a bit of grounding in all things T1, these two books are highly regarded on the forum:

Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas - Don't be put off by the title - this book is relevant to people of all ages! (just maybe skip the section on school :D)

Think Like a Pancreas by Gary Scheiner - A practical guide to managing diabetes with insulin

Additionally, if you like the idea of a DAFNE-like course that you can work through in your own time (though sadly without the benefit of the group discussion/interaction) you might like to try the free BERTIE course here:

www.bertieonline.org.uk

Good luck, and keep us posted with how your experiments go 🙂
 
everydayupsanddowns said:
Welcome to the forum @Wonky

Sounds like you are off to a flying start, and keen to keep experimenting and trying things to attempt to keep your diabetes in it's box, rather than running rampant all over your life.

If you'd like a bit of grounding in all things T1, these two books are highly regarded on the forum:

Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas - Don't be put off by the title - this book is relevant to people of all ages! (just maybe skip the section on school :D)

Think Like a Pancreas by Gary Scheiner - A practical guide to managing diabetes with insulin

Additionally, if you like the idea of a DAFNE-like course that you can work through in your own time (though sadly without the benefit of the group discussion/interaction) you might like to try the free BERTIE course here:

www.bertieonline.org.uk

Good luck, and keep us posted with how your experiments go 🙂
Click to expand...
Thanks for the encouragement and it's so nice to get so many replies and advice. Have been reading lots but also so good to get shared first hand experience
 
Tdm said:
Its never to early to carb count! Also bear in mind as you put weight on, you may need more insulin. If uou can. It took a lots of work for me to put on weight on low carb (which is, essentially, the atkins diet)
Also, a word of caution....i started after diagnosis doing low carb, i felt it made it easier to stay in range...but, over time, i needed more insulin.
Then, i got kidney stones, didn't feel like eating and gave up on low carb to tempt myself to eat. My ratio went from 1 to 3.5 to 1 to 20!
Long term, low carb can reduce insulin sensitivity, but you are so insulin sensitive right now, i don't think you need to worry for a while.
A half unit pen is a great idea, it really helped me
Click to expand...
 
Am definitely going to ask about the half unit pen and thanks for sharing re low carb diet. I have been tending to use this as an easier way to get used to things but think I need to get some more on board and do some more experiments to get the weight back
 
Plus...well, bread. I so missed bread! And chips. Since I stopped low carb i have eaten so much bread!
 
Tdm said:
Plus...well, bread. I so missed bread! And chips. Since I stopped low carb i have eaten so much bread!
Click to expand...
Mmm, makes me think of a chip sandwich even at this time of the morning.
 
Wonky said:
Hi All, am in month 4 of my type1 diagnosis. I've muddled through starting carb counting but am assuming as I seem to be in the honeymoon period it's not at all uniform so finding it a bit awkward. I need 1unit of fiasp for app.26g carbs and 2 for 36g so am always adding up to these counts as multiples don't seem to work. I haven't got further and a little nervous in knowing what level to go for next. Am trying to put on a bit if weight also as I lost a lot on the run up to diagnosis. Any advice as dsn says too early to carb count but how else do I asses insulin needs? THANKS PS DAFNE course not available in my area!
Click to expand...
If you want to do a course, there is an online one called Bertie which is very good .
 
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