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Still a little confused

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miguel81

miguel81

Well-Known Member
Relationship to Diabetes
Type 1
After what - 4 decades - I am still unsure about bolus injections. I'll try and keep it short.
If my sugars are high before injecting for my dinner I don't have a problem BUT if they are low I get concerned about the amount of NR I should inject and tend to inject a much lower number of units than I possibly should. If the reading is low should I just ignore it and inject for the carbs that I am going to eat? A few nights ago my pre-dinner reading was 4.1, I was planning to eat a pasta meal and only injected 2 units of NR. My BS the next morning was high. I am worried that if I inject too much NR then I shall have a repetition of the nocturnal hypo that I had a few days ago. I know that there is no 'rule of thumb' as we are all so very different but I would like to know if I should inject based on what I am going to eat rather then a low reading screwing up my decision to inject a much lower amount of NR - thank you.
 
I’d always start from the calculation of how much bolus I thought I needed for the carbs I was about to consume. BUT then I’d factor in what I really wanted my blood sugar level to be after the meal had digested.
I know that for me, (after trial and observation over several years) one unit of insulin in the absence of any food, lowers my blood sugar by 3mml/L.
So, starting at 4.0, if I wanted to be around 7.0 (which is normally what I go to bed on) after the bolus had run out, I’d lower it by one unit for the meal. (If it was breakfast or lunch, I’d want to be around 5.5 by the next meal, so I’d give myself a half unit less with the meal, to allow for a 1.5mml/L difference by the next meal.)
 
Me too. But I would injet after the meal rather than before it, or even during the meal. I would not want BG to go even lower,
 
What meter do you use? My daughter’s expert meter makes adjustments so that she has her usual carb ratio if she’s in target but it adds more if she’s over. Especially for something like pasta 2 units sounds very low. If you want to make an adjustment because you fear you may be heading downwards then knock 10g of carbs off your calculation instead of guessing the dose.
 
Michael12421 said:
I use a MyStar extra.
Click to expand...
I am not familiar with that machine, but you could certainly ask for one that does take account of your BG as well as the carbs you are about to eat. As you suspect if you are below your target, you need to knock out a bit of insulin at a meal in order bring it back to your target afterwards.

As @Robin says the amount you need to knock out is worked out by trial and improvement. It might help to make a note of your readings for a while in order to help get this sorted for you.
 
Thank you for your replies.
I have no choice of what machine I use, I have to use the one designated by the local Health Authority.
 
I would agree that you have likely underestimated the carbs in your pasta meal, Michael. 40g carbs would be the very minimum amount in your average microwave pasta meal and they are not huge portions.... not suggesting you were eating a microwave meal as I know you are a good cook but just as a guide line. Do you have a copy of Carbs and Cals to help you estimate carb content? If you were 4.1 and looking to go to bed on a 7 which I think should be the minimum you should aim for at the moment considering the awful night time hypos you have been experiencing, then assuming a 1unit insulin to 10g carbs, then 3 units probably would have been more appropriate in that situation, but you also have to take into account how much "vine pruning" or other activity you have done that day and adjust bolus and basal a little to account for that.
If I were you I would be quite happy aiming for a week or two of steady fasting readings in the 8-10 range and then look at adjusting it down a bit after that.
 
I'd suggest going back to basics by doing that basal test we discussed, then basic easy to carb count and easier digested foods to test your carb ratio is definitely what your assuming it is xx
 
I'll first of all mention that Michael lives in rural Spain and has to rely on the local Spanish health service so any number of things we find really helpful simply aren't available to him - hope he won't mind me saying this but he doesn't have a huge amount of dosh at his disposal either - hence quite likely couldn't afford the strips for an 'Expert' meter even if he could get one.

Michael what I would have done is to have my jab for that meal later than normal ie halfway through or after eating (dunno how long eating it would usually take) but same as someone else said, 1u of Novorapid reduces my BG by 3.0 mmol so I would have knocked a unit (or half a unit if you happen to have a half unit pen) off the calculated bolus, to allow for the 4.1 test result from before eating.
 
Thank you all. Barbara - no I don't have a copy of Carbs and Cals and I would not know how to use it if I had. I would also have to take into consideration things like physical activity which are difficult to quantify. Jenny - you are so right. The health authority here does its best but we have nothing like the support available in the UK. By using the designated meter I am able to buy the strips for them at a cost of €1.50 per 50 strips (to buy them without a prescription costs €84.00) the low cost is because the Junta heavily subsidises them. Tomorrow is a quiet day here so I will spend some time using Google and see what I can find out about Carbs and Cals etc.
Once again thank you so much everyone.
 
Hi again Michael. The Carbs and Cals book is a pictorial means of estimating the amount of carbs on a plate of food, so it is really straightforward to use. Hundreds of pictures of plates or items of food and the carb content for them. It also has lots of other nutritional info but the carbs are really all we are interested in as diabetics. Many people here on the forum treat it like their bible. Personally I find it less useful because I eat very low carb and I have a copy which is mostly collecting dust. If you want to PM me your address, I will happily send it out to you. Alternatively I believe there is an app of it which you can download to your phone, but I'm not tech savvy enough for that.
 
That is so kind but this new forum layout is difficult for me to find out how to send a PM. I click on your post but it gives me no information about this. Oh, the joys of old age and inexperience.
 
Michael, if you go to the top right hand side of your screen you will see a box with your avatar and username. Next to that is an envelope symbol and then a bell symbol (which shows alerts with a red number). Click on the envelope and a new page will open up. In the top right hand side of that page there is a bold blue box which is labelled "Send private message"
Click on that and enter my username and a title and then input your address in the test field.... or alternatively (light bulb moment!!.... duh!) I will send you a message and then you can just reply to it.
 
Just click on the person's avatar or name and their details pop up, including a box for sending PM's
 
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