Help with insulin and ratio

Hi

My name is Derek from Edinburgh, 46 yr old Type 1 for 17 years.

Graduated from DAFNE over a week ago and I think it is great as previously I had never been told about carb counting or basal/bolus.
I am very overweight and finding it really difficult to lose weight over the past few years.

It was discovered I am very resistant to insulin and am on a 4:1 ratio and correction on a 1:1
upto a max of 8 units.
As I can't contact the ospital until prob Tuesday I am hoping someone can give me some help with my insulin ratios etc because I have been running high despite taking a lot of corrections.

I have been on Porcine neutral and Isophane for the past 3 weeks, prevfiously on Humalog and Humilin Isophane for about 15 yrs. The reasonh for change to animal insulin was because I was always high at breakfast, and they put me on Lantus to see if that would help but it made me feel crap.
I had read on Diabetes uk how others felt the same on lantus and improved on animal insulin.

Sorry if I seem to have gone on a bit lol.

Derek

Hi Derek,

Sorry, you don't appear to have had any feedback since your post on 24th April (people too busy with bank holidays & weddings no doubt )

I'd advise you to just keep going, following the step-wise approach as you appear to be doing. One thing I would comment on is that with Isophane Background Insulins it is best to try to take your evening dose as late as possible and I notice (maybe just coincidence) that your morning BGs have tended to be higher when you've taken your BI earlier the previous evening.

I wouldn't be surprised if you end up needing a higher ratio in the morning, compared to other times of the day as your BG does go up between breakfast and lunchtime even on 4:1, but re-evaluate this once you're taking your night BI later more consistently.

Another useful thing to do to assess your morning BI is to try missing a meal (or doing carb-free). This is a good strategy to ensure you're doing right in increasing ratios, rather than needing more BI.

Good luck,

Carolin

Hi Carolin

Thanks for your reply. I have noticed my breakfast BGs being high and wasn't sure whether to increase BI. I increased from 14 to 16 and then I tried 18 last night but it bwas stilll high this morning 12.9. Thanks for informing me about the best times to take BI at night, I will take it later tonight. The conhfusion I have is when |I wa on Humiklin Isophane ws told to take it at dinnertime and with that being an isophane.

So I suppose best time is at bedtime?

I am taking 20 units of Isopohane first thing in the morning (9am), would you say that is correct time?

This morning at 9am I was 12.9, had 3.5 cps and took 14+10, also 20 units of BI and by 1.30pm my bs was 9.8!! thought I would have been a lot lower than that.

I will try a 5:1 ratio tomorrow at breakfast and see how that goes, allso a carb fre meal at lunchtime.

best regards

Derek

Hi Derek...................I would of suggested you ignore the maximum correction unit of 8, as I have been successful taking more, fortunately you have not needed to exceed 8, and yet your still high.....

Are you confident your BI is correct......by looking at you results from bed to morning the majority of them are steady or going down with only a few rising. You should try 3 consecutive days eating your evening meal then having no carbs till breakfast the next day, you should then see what your current PM BI dose is doing, it may need tweaking, however you may need to increase your AM BI, this unfortunately need some testing, so more carb free meals im afraid..................getting more BI in might let you drop your QA ratios............

I seen you were using an analogue and animal insulin, have you been told to do this, using one would be a good place to start to see whats most effective, you may need both though, I can only speculate....

Being on a 4:1 all day is quite resistant, have they offered any other oral medications to help with this, increased muscle activity will help with that. Even the smallest of movements like lifting a small weight, going for a walk............

I hope we can help you a bit...........

Hi Derek,

With BI that you take twice a day (i.e. anything other than Lantus), it's recommended that you take your first dose on getting up in the morning and your second dose as you go to bed. The main thing to be careful of is that the doses are no closer than 7hrs apart.

This will mean that you get an overlap of the doses through the morning, however this is beneficial to help counteract the Dawn Phenomenon.

Most health professionals who do not 'use' DAFNE (and some who do it has to be said) don't understand how to get the best out of the insulin regimen in Type 1 diabetes, so don't feel that you've missed out or been misinformed. I think the majority of people (apparent from the posts on here) realise that what they've been taught previous to DAFNE often has to be 'unlearned' when they begin to apply DAFNE principles.

I'm sure you'll get there in time,

Carolin

Hi carolin

|Thanks for your help

Better result this morning 6.6


Derek

Good result Derek, keep them coming..........