Higher CP value meal - Should higher than normal QA doses be split?

I have mentioned before that maybe QA:CP ratios break down at certain levels of CPs. Or may be when the QA dose is high (relative to the normal dose) it acts much faster than the CPs ??

I have just had an unexpected drop in BG to 3.7 mmol/l just over an hour after dinner. The only differences about this meal and QA dose from my norm were:

* Time since previous meal and QA dose was 5 hours exactly (I normally have more than 5 hour break - to be 100% sure no residual QA still in action)

* The QA dose was over 10u. My normal QA dose for dinner is between 7u and 9u most of the time.

I cannot this time say it was the cycling in the afternoon - because I had such activity on the previous 2 days and the issue did not arise then,

I am wondering now that a QA dose of 10.5u (10u+0.5u correction) for me has dropped the BG faster than the 11 CPs I had for dinner. Previous evening's meal was 9.5 CPs wih QA of 8.5u. Similar meal - difference was today there was 1 CP of Quince Paste/Jelly and 1.5 CPs of Oatcakes compared to 1 CP of Blueberry pancake yesterday. Rest of the meal the same as yesterday.

Please have a look at the diary and tell me what you think

BI = Lantus, QA = Novorapid

Thanks

Edit: Added bedtime BG to diary. 14.7 mmol/l Repeated the test and it was 15.1 in the other hand !!!!

My theory now is that the 10.5u QA at 19:00 went woosh and got all used up within the first 2 hours leaving the CPs with no QA left. There is no other explanation. Fault in Novorapid action? Known issue? Can happen??

Despite DAFNE rules I have applied some QA correction at bedtime. Only 1u - surely DAFNE rules on correction on spike after hypo needs to have some limits.

Hi
I've posted on this subject , briefly I found that when I took more than 10u of QA my body didn't seem to use it, I never looked at the detail why.
I moved to splitting any large CP meal by 3. The last being the correction if needed, my BG would level off at My target after 4 to 5 hours after the last injection, but what was more important to me, I didn't' have lows or highs the following day.
Before Dafne I had large CP meals but only a few. After Dafne I'm having up to 20 + CP meals all the time with good target hits, also since I started running again the control is even better with my insulin amounts only a 1/3 of what there where before Dafne
So for me splitting the QA works.

Type 1 42 yrs

Thanks youone for that. I have now read through the related topic "Dealing with large carb meals" and see that you and Warwick split the dose. I will now try to restrict the CPs in my meals so that I do not exceed 10u of QA or split. I also agree with comments made on that thread about getting misleading measure of BG if done after 2 hours of QA Novorapid dose - I do not measure again unless 5 hours elapsed unless I am feeling hypo coming on or sometimes a spike in BG 1-2 hours after some meals.

If I split I would do the second dose based on the initial BG pre meal measurement and the CPs for the meal rather than measure again again - leaving a correction to the measurement 5 hours after the meal. But this would lead to a potential problem for me - as to get any real accurate BG measurement I find i have to wait for 5 hours to pass after a QA dose. It is bad enough at the moment having to stay awake till 1am to do that. So I don't know... Probably better option is to keep my evening meals at 11 CPs max (I am on a QA:CP ratio for evening meal of 0.9:1)

Hi
I note your remarks.
I had a MacDonald's meal on Saturday which was 20cp
By BG was 8.2 before meal at 6pm
I took 10mmol at the start of meal and another at 7pm
I peaked 90mins later at 11.4
At 11pm I was 7.4
In the ,morning at 5.30am I was 7.2
In this case no correction was needed because it stated on their site the meal was 20cp
So I could match close With the QA.
I think large carb meals are OK if you've got a ture CP amount to match too

Type1 42 yrs

That is very good.

I would be happy with 2nd QA dose being no more than an hour after the first - I would still be ok with my personal 5 hour rule for measuring BG not before 5 hours elapsed after a QA dose.

I will try and do that - With this I can go to a Pizza Express again and eat a whole Pizza !

Thanks

SA2010 said:
That is very good.

I would be happy with 2nd QA dose being no more than an hour after the first - I would still be ok with my personal 5 hour rule for measuring BG not before 5 hours elapsed after a QA dose.

I will try and do that - With this I can go to a Pizza Express again and eat a whole Pizza !

Thanks

I think after reading the above comments it is whatever works for that individual. I have just had my tea which consisted of a frozen pizza and a magnum ice cream. I find that when I eat a pizza I have to increase my ratio from one and a half to one and two thirds because if I don't the next morning I am normally higher than usual.my total q/a dose for the above was 21.5 units of which I took all at once. rightly or wrongly I don't concern myself with my bedtime bg reading because 5 hours have not elapsed by then i.e. if it is to high.it is the breakfast bg reading that I tend to refer to.as we all realise DAFNE is great because it gives us more freedom to eat what we want. for me personally by splitting q/a doses for large cp meals just makes the whole thing a bit more complicated and its not easy to get right at the best of times. I remember a old saying from my previous job

K.I.S.S.-KEEP IT SIMPLEY SIMPLE

I don't know - i will reserve judgement on this Paul.

I do know though that I am very sensitive to small changes in insulin dose - 1u out and there is an impact - so I would never dream of injecting 21u - anyway not with my current insulin sensitivity and to just go to bed without measuring - at the moment I do not risk that - whilst I am still able to stay awake 5 hours after dinner, Maybe when I get older I will not be able to do that but now i can and I am doing it,. By the way the 5 hours went past 2 and half hours ago - i just carried away doing things ! But definitely going to bed now

Biggest fear is getting a hypo whilst a sleep so I make sure I am close to 8.0mmol/l before bedtime (for me 7.0 to 8.5 at bed time I take no action for)

Obviously I am not benefiting from all the freedoms following DAFNE but what is the point in doing a bedtiime measure when the QA is still working and active,