Ratios etc

Hi Everyone First post Trying for some advice & encouragement Although long term Type 2 Diabetes Team have got me ona DAFNE regime Problem is that after nearly 30 years of taking very large amounts of insulin ( too much) I am tryingv to get to a realistic insulin-carb ration Iam following instruction & working on 1 unit: 3 gms CHO ratio Can't seem to get into single figures very often Situation complicated by long term Urinary Tract Infection & antibiotics. No infection showing up at present but today both pre breakfast & pre lunch BGs are over 13 Took prescribed ratio of insulin @ breakfast plus 7 units as corrective dose Thought this would be enough as DSNurse suggests ony 1 unit to bring BG down 3 mmol Disheartened that BG is over 13 still Tempted to think that either ratio is not right for me ( weight, insulin resistance?) &/or corrective dose needs to be higher for me. Any comments welcome Thanks
Taking Novorapid as described Split dose Levemir 66 am & pm currectly & Metformin
Also taking Ramipril Butenamide & Bisoprolol

Welcome to the site and forum.............

Being Type 2 on insulin can be very tricky, and using DAFNE principals may not be suited for everyone....

But it seems that your insulin production may have stopped pretty much all together and/or resistance is high.

From a type 1 perspective I would recommend testing before every meal and recording it, this may not be possible for you, are you able to get strips easily?

Are you confident your background is right............?

Do you ever experience hypos..........?

As your blood sugar rises, the more resistant you become to insulin and therefore need more correction to bring you down, everyone is different in terms of how much 1 unit brings you down...........1 unit dropping you 3 is probably whats happens to someone who is at a normal blood sugar and who can use insulin effectively, in your case I doubt this is enough...........

eg........If I was at 17.5, I would take 12 units to get back on target......

Thanks novorapidboi26 for swift rtesponse. I do test before most meals & sometimes 2 hours after Regarding basal Levermir: I was taking 60-40 then 60-60 the 66-66 when infection was present Can't remmeber how the nurse calculated that doseage Don't think I've ver experimented in any way to arrive @ correct amount. Hypos are rare mostly my BGs are too high not too low! Means my hbA1c is usually between 8-9 It has improved since I started carb counting/DAFNE I was on Byetta for a couple of months with insulin. Made me too sick but I did lose 10 kilos in weight which has helped. I think you are right regarding correction dose I probbaly need a larger amount in view of insulin resistance. I am suret hat the Diabetes Team have been aiming to reduce my insulin since I was often taking far too much Novorapid without it doing me much good! The aim has been to get the doseage more accurate & appropriateThe specialist dietician who was part of the DAFNE team suggested I stayed with the1:3 ration ( with the aim of reducing it furrther) & use corrective doses if BGs are too high Maybe I should do that but increasewhat I take as a correction Thanks I shall keep on keeping on & hope for better numbers! Cheers D

the key to DAFNE is writing everything down so you can pin point your needs at specific times.................do you know what your insulin production is like, if any..........

I'm with Novarapidboi, I think your major issue is being Type 2 you are battling with Insulin Resistance not just a CP ratio. Your DSN should be aware of this and taking this into account but I'm not sure they are fully. As pointed out when your BG is high a normal 1unit QA to 3mmol doesn't really apply and everyones requirements are different. I know its frustratiing and that its not a simple job getting your BG under control but just keep at it and eventually it will start to happen. Patience is the key, which is one of the key DAFNE principles. Often people make a change and think at their next blood test things will have changed. It doesn't unfortunately happen that way and any change you make will take a few days to take effect.
For me your DSN should be concentrating on the Background dose and getting that right. If you keep having to do corrections the whole time that points towards BI not being right. However as you say, your other problems could be having an affect even if all seems well at the moment. Just keep going, you are not alone. All of us on here at one time or another have had problems getting things back in control and sometimes it feels like its a hopeless cause, however it almost always comes right in the end if you stick with it. So keep the faith and if you want any more help or just support keep posting on the site.

hi..i am new to this site but am wondering about the 'if you were 17.5 then a dose of 12 would get you back to normal'?....i have been instructed always to take 1 unit to get me down 2 numbers......so if my blood weere 15 then to get to say 5....then 5 units of novorapid would in theory do the job.....i understand it doesn't always work like that.

but please tell me if i have got this wrong...but 12 units for a 17.5....wouldn't that throw you into severe hypo? as 12 would get you down a possible 24 numbers and therefore well past a blood of 5 - ish?

sorry if i have got this completely wrong....but i needed to ask....thanks

This is purely my own personal experiences............................

But my theory behind these corrections is that the higher your blood sugar the less effective 1 unit of insulin is, ie.....higher resistance...........

As a general principle:
1 unit of quick-acting insulin lowers blood glucose by 2-3mmol/l. For blood glucose levels above 11mmol/l this rule does not necessarily apply.

This statement can be found here........just realized you wont be able to access this link if your not signed up as a graduate, sorry........but its there believe me.......

So I actually investigated how much 1 unit dropped me by at different levels and came up with 4 categories of blood glucose readings and a matching drop by 1 unit...........

Everyone is different in terms of their response to 1 unit, but for me at a level of 17 or above, 1 unit only drops me by 1mmol/l...............so to return to 5.5 from 17.2 I would need to drop 12mmol/l, hence the 12 units..........

It seems to work for you, but when your blood sugars decrease, wouldn't your insulin resistance change? So giving 12 at 17, the first 7 or so unit will take you down to ten, at what point your insulin resistance will decrease and you now have a dose of insulin and the next 5 units (working at 1 unit taking down 2 blood sugars) may take you down to zero.

Wouldn't it be preferable if this high and working off these rules, to give yourself an initial dose at 1:1 to bring you to 10 and then a further dose once down to take you down the rest (on the assumption 1 takes you down 2 instead of one)

I think that's getting a bit to complicated for me, I can understand what your getting at though, but I believe trying to master this is pushing the boundaries........we dont know how long our sensitivity/resistance to insulin lasts on an hourly basis...........

I suppose you could say the same for insulin/carb ratios...........I need 3 units to every 10 grams for breakfast, so why then do I not go low for lunch as my resistance to the insulin decreases to 2 units to every 10 grams