Dose adjustment due to GI

April 18, 2012 12:00

Johnstonai DAFNE Graduate
North Cumbria Integrated Care NHS Foundation Trust 2 posts

I've been Type 1 for 25 years but I'm new to DAFNE. I'm fairly well controlled apart from a few hypos and highs after eating meals with high or below average GI's. My normal evening meal QA ratio is 1:1 and I take my novorapid immediately before eating ( this seems ok normally ), however I'm trying to get my head around what to do with my ratio and/or QA injection times prior to any meal which has a high or slightly low GI, does anyone know the generic rules that need to be applied?
Am I correct in thinking that high fat and large meals also need some adjustment re: QA ratio or injection time.

Regards,
Andy

April 19, 2012 11:59

Jonathan Harris
The Leeds Teaching Hospitals NHS Trust 1 post

I don't know the answer, other than my own anecdotal evidence which is in line with what you are saying. Particularly after large meals (big Sunday lunches and curries!) I always seem to be high after. With regard to GI, again, I often muse that should I stagger injections/take more for long lasting carbs.

April 21, 2012 23:32

novorapidboi26 DAFNE Graduate
NHS Lanarkshire 1,819 posts

Its important to remember that the carb count and dose should never change, but you can play about with timing etc................

for most medium to high GI meals I can find myself taking my injection anywhere from 15 minutes to 45 minutes before eating, this brings the peak of the insulin quite close to the peak of the meal, for slower GI meals the peak will be later on, and much less severe, so an injection closer to the actual mealtime would be more suited, delaying the insulins peak................

Its all trial and error for each individual though as you know, so no real black and white rules as such................

For high fat foods, like pizza etc, there could be a delay in the peak, this can often cause hypos a few hours after eating, then highs nearing the end of the 5 hour insulin duration. This can ususally be dealt with a split dose, so some up front before eating, the rest later on, maybe an hour or two after eating, again, trial and error, everyone is different and some may need a 50/50 split, while others may need more or less up front etc......

so test and record when having these foods and make some decisions on how you react to the foods and when/how to take your insulin.............

April 18, 2012 12:00 Johnstonai DAFNE Graduate North Cumbria Integrated Care NHS Foundation Trust 2 posts	I've been Type 1 for 25 years but I'm new to DAFNE. I'm fairly well controlled apart from a few hypos and highs after eating meals with high or below average GI's. My normal evening meal QA ratio is 1:1 and I take my novorapid immediately before eating ( this seems ok normally ), however I'm trying to get my head around what to do with my ratio and/or QA injection times prior to any meal which has a high or slightly low GI, does anyone know the generic rules that need to be applied? Am I correct in thinking that high fat and large meals also need some adjustment re: QA ratio or injection time. Regards, Andy
April 19, 2012 11:59 Jonathan Harris The Leeds Teaching Hospitals NHS Trust 1 post	I don't know the answer, other than my own anecdotal evidence which is in line with what you are saying. Particularly after large meals (big Sunday lunches and curries!) I always seem to be high after. With regard to GI, again, I often muse that should I stagger injections/take more for long lasting carbs.
April 21, 2012 23:32 novorapidboi26 DAFNE Graduate NHS Lanarkshire 1,819 posts	Its important to remember that the carb count and dose should never change, but you can play about with timing etc................ for most medium to high GI meals I can find myself taking my injection anywhere from 15 minutes to 45 minutes before eating, this brings the peak of the insulin quite close to the peak of the meal, for slower GI meals the peak will be later on, and much less severe, so an injection closer to the actual mealtime would be more suited, delaying the insulins peak................ Its all trial and error for each individual though as you know, so no real black and white rules as such................ For high fat foods, like pizza etc, there could be a delay in the peak, this can often cause hypos a few hours after eating, then highs nearing the end of the 5 hour insulin duration. This can ususally be dealt with a split dose, so some up front before eating, the rest later on, maybe an hour or two after eating, again, trial and error, everyone is different and some may need a 50/50 split, while others may need more or less up front etc...... so test and record when having these foods and make some decisions on how you react to the foods and when/how to take your insulin.............