Ratio of insulin

[Ben Dolden]

hi there, any tips on when I should look to adjust my ratio of insulin and what I should look out for as the signs?

I carb count and measure carbs accurately. I'm currently on 1:1 ratio. Average wake up reading around 8, average mid day is 13 at the moment!

My mid day readings before I went back to work We're a lot lower So stress could be a factor in this but about neveous doubling the morning ratio.

Any tips?

 

[khskel]

Is that 1 unit of insulin per 1g of carb?

 

[trophywench]

It's probably 1u to 10g, 10g being one CP.

Ben - I always try no more than a 10% increase at any one time - in fact usually 5%. If you're on MDI just do the lowest overall percentage you can and gradually increase it whilst of course test test testing LOL until it seems about right.

Is your pre-lunch BG OK though - or would a slight basal increase on work days do it?

 

[KookyCat]

Hi Ben
The key as TW said is to look at how much your blood sugar rises after you've eaten, so before you do anything have a look at your pre meal and post meal readings. If you're pre meal reading was say 8 and two hours later you're rocking a 13 then more bolus insulin is probably needed, most of us look for no more than 2mmol/l increase after meals, and then a return to a similar figure as the pre meal reading within 4 hours. If you're pre meal reading was say 11mmol/l then I'd be thinking about a basal increase. When I first went back to work I had to increase my basal by a few units, because work is stressful and more sedentary, so my basic requirements just increased a bit. Also some people find their basal needs are different depending on the season.

When adjusting ratios I tend to go in 2s, no science behind it at all I just prefer it, so if you're doing 1 unit of insulin to 10 grams of carb I'd try 1:8 and then see how much improvement I got. If it looked good but needed a bit more I'd do 1:7 if it looked like I still needed quite a bit more insulin I'd go for 1:6. Always have the jelly babies at the ready, and adjust how you feel comfortable. If you're doing 1 unit per 1 gram of carb you're a bit more restricted but you might want to get a half unit pen (novopen echo if you use novorapid) so you can do 1.5 units per gram instead of having to double it. My gut is telling me it's your basal but that's just a complete guess without seeing your readings.

If you're not sure whether to tinker with basal or bolus you can always put some readings on here and we'all see if we can spot the trends. Just don't try both at once, that road leads to confusion 🙂

 

[Ben Dolden]

Is that 1 unit of insulin per 1g of carb?

1unit per 10g carbs

 

[Ben Dolden]

It's probably 1u to 10g, 10g being one CP.

Ben - I always try no more than a 10% increase at any one time - in fact usually 5%. If you're on MDI just do the lowest overall percentage you can and gradually increase it whilst of course test test testing LOL until it seems about right.

Is your pre-lunch BG OK though - or would a slight basal increase on work days do it?

Thank you. Pre lunch is generally ok. Seems to be better on days off

 

[Ben Dolden]

Hi Ben
The key as TW said is to look at how much your blood sugar rises after you've eaten, so before you do anything have a look at your pre meal and post meal readings. If you're pre meal reading was say 8 and two hours later you're rocking a 13 then more bolus insulin is probably needed, most of us look for no more than 2mmol/l increase after meals, and then a return to a similar figure as the pre meal reading within 4 hours. If you're pre meal reading was say 11mmol/l then I'd be thinking about a basal increase. When I first went back to work I had to increase my basal by a few units, because work is stressful and more sedentary, so my basic requirements just increased a bit. Also some people find their basal needs are different depending on the season.

When adjusting ratios I tend to go in 2s, no science behind it at all I just prefer it, so if you're doing 1 unit of insulin to 10 grams of carb I'd try 1:8 and then see how much improvement I got. If it looked good but needed a bit more I'd do 1:7 if it looked like I still needed quite a bit more insulin I'd go for 1:6. Always have the jelly babies at the ready, and adjust how you feel comfortable. If you're doing 1 unit per 1 gram of carb you're a bit more restricted but you might want to get a half unit pen (novopen echo if you use novorapid) so you can do 1.5 units per gram instead of having to double it. My gut is telling me it's your basal but that's just a complete guess without seeing your readings.

If you're not sure whether to tinker with basal or bolus you can always put some readings on here and we'all see if we can spot the trends. Just don't try both at once, that road leads to confusion 🙂

Thank you. You've been a great help. Appreciate it

 

[Radders]

Hi Ben
The key as TW said is to look at how much your blood sugar rises after you've eaten, so before you do anything have a look at your pre meal and post meal readings. If you're pre meal reading was say 8 and two hours later you're rocking a 13 then more bolus insulin is probably needed, most of us look for no more than 2mmol/l increase after meals, and then a return to a similar figure as the pre meal reading within 4 hours.

I keep seeing this target of no more than 2mmols/l rise 2 hours after meals and I wonder how many of us with type 1 generally see much higher spikes than this? Unless I go virtually carb free, there is no way I can achieve this. At two hours my insulin still has half its action remaining so if I am at only 2mmols/l up at this point, I will certainly hypo in the following 2 hours unless I snack or I was too high to start with. One unit of insulin lowers my level by 6mmols/l so that would mean I would have to restrict carbs to what I can cover with 2/3 unit. I have actually started delaying part of my meals to try and reduce the spike but it's not always possible. Does anyone else manage this?

 

[Robin]

I keep seeing this target of no more than 2mmols/l rise 2 hours after meals and I wonder how many of us with type 1 generally see much higher spikes than this? Unless I go virtually carb free, there is no way I can achieve this. At two hours my insulin still has half its action remaining so if I am at only 2mmols/l up at this point, I will certainly hypo in the following 2 hours unless I snack or I was too high to start with. One unit of insulin lowers my level by 6mmols/l so that would mean I would have to restrict carbs to what I can cover with 2/3 unit. I have actually started delaying part of my meals to try and reduce the spike but it's not always possible. Does anyone else manage this?

I rarely manage it. (Unless I've had scrambled egg for breakfast, or something with lentils for supper). I try to keep within the parameters of my Libre, and I've got the upper limit set at 8.5. Like you, unless I have a zero carb meal, or bolus at least half an hour before meals, I'm not even going to achieve this. And I'm on holiday at the mo, so it hasn't been possible to do this all the time either. I had a pub lunch today, and even though I was good and had grilled fish, veg, and a few new potatoes, ( and a couple of forkfuls of OHs risotto) I still went up to about 9.0 because I couldn't pre bolus .( I won't tell you what happened after the cake yesterday! )My last HbA1c was 6.4, which is as low as it ever gets.

 

[grovesy]

I keep seeing this target of no more than 2mmols/l rise 2 hours after meals and I wonder how many of us with type 1 generally see much higher spikes than this? Unless I go virtually carb free, there is no way I can achieve this. At two hours my insulin still has half its action remaining so if I am at only 2mmols/l up at this point, I will certainly hypo in the following 2 hours unless I snack or I was too high to start with. One unit of insulin lowers my level by 6mmols/l so that would mean I would have to restrict carbs to what I can cover with 2/3 unit. I have actually started delaying part of my meals to try and reduce the spike but it's not always possible. Does anyone else manage this?

For Type 1 the recommendations are slightly different!
5-7 on waking
4-7 before meals and other times
90 minutues after meals 5-9.

 

[SB2015]

I keep seeing this target of no more than 2mmols/l rise 2 hours after meals and I wonder how many of us with type 1 generally see much higher spikes than this? Unless I go virtually carb free, there is no way I can achieve this. At two hours my insulin still has half its action remaining so if I am at only 2mmols/l up at this point, I will certainly hypo in the following 2 hours unless I snack or I was too high to start with. One unit of insulin lowers my level by 6mmols/l so that would mean I would have to restrict carbs to what I can cover with 2/3 unit. I have actually started delaying part of my meals to try and reduce the spike but it's not always possible. Does anyone else manage this?

Oh what a joy to read your post.
Yes I usually spike more than 2 mmol/l but have got them down quite a bit by working on the timing of my delivery of insulin and by reducing my carbs, but there are times when I just spike big time.
Thank you for putting this on here.

 

[Radders]

Oh what a joy to read your post.
Yes I usually spike more than 2 mmol/l but have got them down quite a bit by working on the timing of my delivery of insulin and by reducing my carbs, but there are times when I just spike big time.
Thank you for putting this on here.

So glad it's not just me!

 

[Matt Cycle]

Agree with SB and Radders. I think the issue here is we're not comparing like with like. As a T1 with completely defunct beta cells it cannot be compared to someone else with some functioning or fully functioning beta cells, either 'T1' or T2. It amuses (and sometimes depresses) me when someone describes a 'spike' as 8.5 mmol/l. A spike to me is in the teens or twenties. 😱

 

[SB2015]

Agree with SB and Radders. I think the issue here is we're not comparing like with like. As a T1 with completely defunct beta cells it cannot be compared to someone else with some functioning or fully functioning beta cells, either 'T1' or T2. It amuses (and sometimes depresses) me when someone describes a 'spike' as 8.5 mmol/l. A spike to me is in the teens or twenties. 😱

I think that applies to a lot of the posts on here, and at first I found it daunting, as everyone seemed so much better at controlling their BG. Now I know to remember that we are all different and use the fantastic help that is available on here to do as well as I can.

 

[Sally71]

Same here... "Ideally" you shouldn't increase by more than 2 after eating, but that can presumably only happen if your pancreas still has some function of its own. We do our best to keep the levels down but often that just isn't possible, especially as I am dealing with a growing child and don't want her to miss out entirely on the treats that her friends enjoy without even thinking about it. To me too a spike is into the teens! It also amuses me (which is probably the wrong word, apologies to any T2s reading this, I don't mean to cause offence) when people complain that their morning reading was 8.5, what a disaster... If we could have readings that low every single morning then I'd be ecstatic!! We have just had one of those nights where she wouldn't go below 12 all night despite doing corrections, and I have no idea why 😡. If it happens again tonight then I'll do some basal adjustments, but it could be "just one of those days" ...

It's nice that whatever type we are, we can all help each other, but there are definite differences in how to manage them and what level of control can be achieved!

 

[SB2015]

It also amuses me (which is probably the wrong word, apologies to any T2s reading this, I don't mean to cause offence) when people complain that their morning reading was 8.5, what a disaster... If we could have readings that low every single morning then I'd be ecstatic!!

I stopped looking at the continuous thread for morning BG! Good for the chat but the levels people were achieving started to get me down.

 

[trophywench]

I stopped looking at the continuous thread for morning BG! Good for the chat but the levels people were achieving started to get me down.

You'll have noticed my almost total invisibility on THAT one SB - conspicuous by my absence, to coin a phrase ! In fact, I've long had a phrase of my own to reflect a 'nice' reading on my meter - 'Oooh lovely - I'm almost Human right now!' - so my hubby knows it reflects eg a 6.0 !

I don't seem to repeat that saying many times the same day if at all .......

 

[KookyCat]

Everyone has different challenges, I tend to plump with 2 hours as the spikometer reading because being delightfully sensitive to insulin its all over by that stage, but part of the joy of diabetes is learning to find the best compromise you can. I frequently spike into double figures, just a hell of a lot quicker than most. Of course some people find it harder to control their blood sugar. I'm one of them as it happens, I just find it harder to stay above the line than most. Ben if you're still reading this, it's a good thread to read because it can sometimes feel like everyone else has got perfect control, and they really don't, we're all just working with what we've got and trying the best we can to keep it together.

 

[Matt Cycle]

Another pet peeve of mine regarding this is exercise. I can't even blame it on anything I've eaten. For example I can go out on my bike and after say 5-10 miles, due to the liver dumping glucose, can get a spike of anything up to 15 mmol/l. There is nothing I can do about this. I know it will then start to fall. I'm certainly not taking insulin for it because I'll go hypo. It doesn't happen every time so there doesn't seem to be a pattern to it. I've spoken to my DSN about it and she said unfortunately it's one of those things. I suppose the only option is to not go out and sit around vegetating, well forget that, I'll take the occasional hit for the enjoyment of going for a ride and the long term gain that brings. Oh, the joys of Type 1 diabetes. 🙄

 

[KookyCat]

Same thing happens to me with dance classes, sometimes I go hypo, other times I get a good solid glucose kick, I'd guess it depends on how keen my liver is at that moment. Wouldn't dare attempt more insulin to rectify the kick because I'd be hypo an hour after the class (been there done that 🙄). It's very annoying really but I'm certainly not going to give it up. Tried everything, more food, less food, less insulin, more insulin and it just does what it wants...so I let it and just get on with enjoying the dancing.