High BG

I am 66 years old and have had type 1 diabetes for 49 years. I recently attended a DAFNE course and I am having a few problems regarding what to do. I am now on BI Lantus both in the morning and at bed time. My BG at evening meal and bed time are both high averaging about 15. I have been slowly increasing my morning BI dose by about 2 units every 3 days and am now on 12 units am and 20 units bed time. My BG in the mornings have been ok. I am using ratio of QA to CP of 3:1 at all meals. I have no ketones with the high readings.

Do I continue to slowly increase my morning BI until the BG levels drop? Will they eventually drop by doing this?

Hi, We probably need a bit more info to give sensible advice. What are your BG's normally in the morning and at lunchtime ? Have you tried a carb-free day ?
The idea is if you don't eat anything then your BI should hold your BG at roughly the same level. I appreciate a carb free day is not always easy but it will help to identify what the issue is. Given that all your ratio's are the same at 3:1 it does suggest your BI in the morning might not be enough for you, although this is not definately the case. Generally people find their insulin requirements are higher in the morning rather than the evening. It seems you are going high in the evening which is the opposite.
The alternative to carb free is to keep increasing your BI as you are i.e 2 units every 3 days, which allows the change to have an effect. Don't worry too much that you haven't got it just right yet. It can take a while even with all the extra knowledge DAFNE gives you, just keep at it and let people on this site know how you are doing. You will always get plenty of advice if you ask for it

Carb free background testing is what you need as mentioned by marke.

Results from carb free testing will confirm what your BI dose should be for the AM and PM separately....

When this is at the right dose, you can be confidant in your approach to your insulin/carb adjustment.

It would seem you are quite resistant to the insulin with your ratios being so high, these may go down if you find your BI dose needs increased.

So get some carb free periods under your belt and see what your blood sugars do with no influence from food or QA....

Thanks for the replies so far.

Hi
You are approaching this in the correct way. You are methodically going through what you've learnt on the course and your 49 years of own experience you've collated.
I in these situations try to remove all the confusing items such as estimating the cp's you take
Maybe take the next week as a trial period only use known cp amounts ie Known weight or you've weighed taking the matching Qa to your chosen ratio to match.
If after day three (since lantus IMO takes some time to adjust ) and your happy with your BG readings being constant make an adjustment if needed.
I was talking 40 units of lantus once a day before I went on the course, now I,m on 32 'but I went down to 25 at one point' doing a carb free meal showned my BG was not constant by going up hence I'm now taking 32 once a day.
It took about 3 weeks of controlling my cp Weights for it to settle to a constant level.(BG) then I could adjust my ratio of QA humanalog.
I,m now within my set range of 6.5 to 8, since I drive I always ensure I'm above 6.
off topic I have always enjoyed a carb free meal mainly a very large Spanish omelette
I'he been a type 1 for 41 years age 52
I'm confident that you will reach your target. Since like me we have both managed for over 40 years take your time record your tests, look for a pattern and adjust if needed.
I try to think QA insulin is in response to what I eat and how much exercise I done
BI insulin is for how my body is working.
Hope you have a good week