Going below a 1:1 ratio

Hello there. Just did DAFNE a few eeks ago and am now off on my own. During DAFNE everything was going well, keeping stable on a 1:1 ratio cross the board. Reduced my background insulin from 36 to 24 during the week. Was sufeirng hypo's in the morning but not anymore which is great.

However, I am now suffering hypo's before dinner. I can wind up around 10 before lunch and then 2.5 before dinner. I have lowered my background more since then (to 22) but nothing seems to be happening, and my bloodsugars from night to morning seem to be steady so I dno't beleive it is the background. I know that a 1/2 to 1 ratio isn't something that should be done, so I thought I would get other opinions on it first.

I am trying to run my sugars at higher range of DAFNE targets to regain hypo awareness at the moment. I usually go from 7 to 10 between breakfast and lunch, and I am happy with that at the moment, once I get awareness back, I may change the breakfast ratio.

By way of additional information, this did not occur during DAFNE traniing and only occurred when I went back to work. (curiously dinner hypo's don't appear to happen at weekends). My first thought was that my work counted as excercize (in which case a half ratio may be appropriateaccording to DAFNE rules) however, my work isn't exactly intensive, being office based, interviewing people, and it does not explain why I raise from morning to lunch, then decrease from lunch to dinner (as I do not do more work in the morning than I do in the afternoon)

Hey there........

I wouldn't discount the background being off slightly, the dose may be right, but the distribution of the insulin may be out........a way to deal with that is to split your background dose, so a possible scenario for you may be 9 at 7:00am and 13 at 7:00pm, this strategy can compensate for the livers ever changing amounts of glucose secretion......

As you fear your weekends may differ from the week down to activity levels being less at the weekends, I would say that you should try a 0.5:1 ratio, I am aware of a good few people, one who was in my class on DAFNE who are on this ratio...........its undesirable purely because half units are a pain and could complicate things but ultimately you can do whatever is necessary........

Speak with your team, they can give you more professional advice on what to do, especially with your attempt to regain hypo awareness....................

Thanks a lot. I did consider the bit about background insulin (that I may have to split it), however I take the background after dinner, and it wouldn't make sense if the background insluin was running out for the blood sugars to decrease. If it was rising before I take my background insulin I would, but as my blood sugars are going down before I take it I can only assume it is still working (well, may have to do a few more no carb lunches to check that out)

We have a review in 3 weeks so I can discuss it then. Will try fiddling around for the moment with the half ratio. Thanks a lot.

You have the right ideas definitely, however some find that dropping their background to stop lows may send them high at some other point in the day, hence the need for a split............

But I would try going for the 0.5 ratio, if your comfortable, speak to your dsn if you need too..............

I have had to change my dinner time ratio from 1-1 down to 0.5-1 and it dose seem to be helping me. But in the mornings I am on 3-1.
I got a 0.5 unit pen and that has helped as going from 2-1 down to 1-1 things were just back and forth I was high and then low and still could not get it right and even with the 1-1 I was still going low and hypo before bed but things are better with the 0.5. I also changed my night time Lantus from having it at 20.45 to having it at 18.00.
Speek to your team and see if you can get a 0.5 pen
I was the same and did not have hypo awarenness but I have it back now so good look Aneirin.

I am on 0.5:1 ratio for my 3 doses of QA insulin, I have a half unit pen and find it most useful. Ask your HCP if you can have one.

See, lots of people do it.......

Robby, I take it your very sensitive to insulin, or maybe naturally skinny........lol.............whats your background dose like, if you dont mind me asking.........

Thanks, I feel a lot better about doing it now. Trying it today to see what happens. Will ask about a half pen.

Good luck, keep us informed..............