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Unusual Carb Ratio

F

Florry

Member
Relationship to Diabetes
Type 1
I wondered if any members who are Carb Counting are on a ratio of 1:36 for breakfast please?
 
Hi and welcome to the forum.

1:36 does seem very insulin sensitive for breakfast time, when many of us experience a bit more insulin resistance than at other times of the day.
Are you newly diagnosed?
How did you come about this ratio? Was it a nurse who calculated it or yourself?
Not saying a 1:36 ratio can't be right as we are all different and what works for one person may well not work for another.
What are your other meal ratios? Are they similarly sensitive to insulin?
 
Thanks for the quick response.
I have been diabetic for 42 years and struggled for at least the last 10 years. So sought help privately at first. Over the last 6 months I was advised to use 1:24 breakfast followed by 1:12 midday then 1:16 for evening.
1:24 breakfast was too powerful for breakfast so I was then told NOT to inject at breakfast.
I tried that which over the 24 hour period appeared still to be too powerful.
My next advice from the Endocrinologist was to use 1:48.
This was not enough insulin so I returned to 1:36 which is exactly right.
Over the last 6 weeks I was told by the same Endocrinologist that I had been referred for a pump but I didn’t meet the NICE criteria to get a pump because HbA1C not high enough nor disabling Hypos.
 
What insulins do you take @Florry ? And are you sure your basal dose is correct? If you basal were too high for you now, then that could help explain your meal ratios.

Also, have you had a recent coeliac screen, as undiagnosed coeliac disease can cause malabsorption which can cause lows and/or small amounts of meal insulin.
 
Thanks again
I am using 15u Tresiba in evenings which is exactly right, I have been on 16u which was too powerful.
I don’t think Coeliac is a problem but I am sure something isn’t right as i am struggling with chronic pain in both hands and shoulders
 
Florry said:
I am using 15u Tresiba in evenings which is exactly right, I have been on 16u which was too powerful.
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I am intrigued by your use of the word "exactly" as I have never had two days alike enabling me too my BG to stay exactly flat overnight and only rise when I eat during the day, every day and night, or my meal time bolus to be exactly right and return to my target after 4 hours without fail.
My surprise may be from being an engineer and expecting exact things to be exact.

The great thing about Tresiba is how flat it is. The downside of Tresiba is how flat it is if your day and night time needs vary. This is where half unit pens may come in handy - I assume you have whole unit pens because you only mentioned 15U and 16u whereas I would be tempted to try 15.5u.
 
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Florry said:
Thanks again
I am using 15u Tresiba in evenings which is exactly right, I have been on 16u which was too powerful.
I don’t think Coeliac is a problem but I am sure something isn’t right as i am struggling with chronic pain in both hands and shoulders
Click to expand...

Like @helli my basal needs vary, so it’s only exactly right for that period of time. When you say you’ve struggled for around 10 years @Florry what exactly do you mean? Have you had hypos?

Coeliac disease is often ‘silent’ in people with Type 1 - ie no stomach symptoms - so the only way of checking for it would be a blood test. In addition, if you are having hypos and your insulin needs have greatly reduced, then I’d want Addisons ruled out too (another cause of low sugars and minimal insulin needs).
 
Hello Inka, I’ve had so many hypos I’ve bought shares in lucozade.
On my journey I was injecting the 15u Tresiba in the morning and was pushed by DSN to get to my correct mealtime ratios. They were then 1:16 breakfast, 1:18 midday and 1:20 evenings.
At that point I was told that my insulin needs were very little and that I was being referred for a pump.
This appointment failed to happen, probably because I didn't meet the criteria.
I believe I should have been offered a pump.
Instead from that point I was told to inject in the night.
As you are aware the ratios will need to change too.
I clearly show that 1:36 is similarly very little insulin.
I believe I will be left here using 1:36: 1:12 midday and 1:16 evenings without the need for a pump.
Thanks for sharing advice
 
helli said:
I am intrigued by your use of the word "exactly" as I have never had two days alike enabling me too my BG to stay exactly flat overnight and only rise when I eat during the day, every day and night, or my meal time bolus to be exactly right and return to my target after 4 hours without fail.
My surprise may be from being an engineer and expecting exact things to be exact.

The great thing about Tresiba is how flat it is. The downside of Tresiba is how flat it is if your day and night time needs vary. This is where half unit pens may come in handy - I assume you have whole unit pens because you only mentioned 15U and 16u whereas I would be tempted to try 15.5u.
Click to expand...
Thanks Helli, that’s worth discussing
I use a half unit pen for Novorapid for meals and the 1 unit pen for Tresiba.
I am still on 1:36, 1:12 and 1:16 to see if they can work for several days.
 
@Florry With so many hypos I’d be pushing for the two tests I mentioned. They’re both associated with hypos. To be clear, I’m not saying you have either of those conditions but they need ruling out if they haven’t been already.

One of the criteria for a pump is something like ‘disabling hypoglycaemia’. A pump would allow you to do tiny, more precise doses.
 
Thanks for excellent tips on Addisons, this is very interesting.
I am also told though I don’t meet criteria for pump because I don’t have disabling hypos or high HbA1c
 
If the hypos are affecting your quality of life, they can count as disabling @Florry I’d also add the fact that you’re very sensitive to insulin asa reason why you should have one. On a pump,you can give yourself fractions of units which means you can calculate a more precise dose.
 
@Florry Do you have a CGM (Constant Glucose Monitor), usually either Libre or Dexcom sensors which are applied to your arm or tummy to give you constant readings?
 
That’s excellent @Florry I hope you’re finding it helpful. I have the G7 and it’s been amazingly accurate and really helpful.
 
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