Do I adjust BI or QA first?

Evening all,
Can anyone help me to descide if I should be increasing my background Levemir or if I should increase my Novorapid ratio first?
I am look specifically at my breakfast background and breakfast insulin.

I've nearly always been on a 1:1 ration for my breakfast, normally getting me to about 5/6 mmols by a 12/12.30 lunch. Over the last few weeks my lunchtime reading has been about 8 mmol. Still not hugely high I know but more than I would like it to be.
I've already increased my background from 5 units to 6 units in the morning (split 6u at 8.30am & 6u 8.30pm)and am trying to decide if I should increase my quick acting ratio now or keep putting up my background by a unit and then monitoring it.

What are the general rules for increasing units? Background or quick acting first?
Many thanks for any guideance.

Someone...can not remember whom, told me that my BI ought to be about 2/3 of my total daily dose. This guideline worked well for me when I was eating 10-12 CPs a day. Sorry but I can not quote a definitive source. Helen

Three consecutive days high at lunchtime would suggest that you should up your insulin/carb ratio and for me personally this would be my first course of action, however I have established the correct doses of BI, am and pm.

So it really is up to you. When did you last test your BI doses.....? If its not been in a while, you just do a test one day, and you should see the results pretty quickly from the Levemir.

In theory, no dose changes should be considered until your background needs have been sussed out......

Thanks Helen, I've been told the same but it's not an exact science from what I understand.
Novorapidboi26, I'd forgotten about "testing" my BI first... this definately isn't right at the moment, am or pm!

I'll try that first, but not both BI's on the same day...

Thanks to all

Nikki H-C said:
I'll try that first, but not both BI's on the same day...

Hi,
Need a little help from anyone,I am taking Levemir for background insulin and NovoRapid for quick acting,I'm on a 2:1 ratio QA and then1:1 for lunch,tea and supper and then the Levemir twice a day 14 at breakfast and 16 at supper time, the problem I'm having is at supper time when it doesn't settle and the levels are high at breakfast time, tested during the night they are ok but by 8 a.m. they are on 13mmols and higher, before supper they run on 9mmols but then higher in the morning any suggestions?

If you eliminate the 2 most obvious variables, which are;

1. Your Evening Meal ratio
2. Your Supper ratio

Then you can go on with the background testing................so upping your dose and testing through the night............

It sounds as though you may have some dawn phenomenon.........are you aware of this?

When is supper? Are you always higher before this? That may suggest a dose is out, either dinner QA or BI, or both!!!

Hi Novorapidboi26,
I have upped the tea time ratio from 1:1 to one and a half to one and it steady one day and not the next although my working day doesn't change, and I have done the testing over night and it's steady so I gather the background one is ok and I was asked by my dsn to lower my quick acting to half to one ratio but I think thast it's not quite enough, and yes I have heard of the early morning phenomonon through this web site but I was always told that I was having night time hypos NOT a chance because I don't feel groggy in the morning's, so any other suggestions would be gratefully received.

The only way to be sure your not having overnight hypos is to test, every hour would be good, although a pain.......

My own personal theory is that dawn phenomenon starts a couple of hours, roughly, before you get up, so your body clock will be used to determine when this is............so for me, its starts about 4:00-4:30 as I get up at 6:30, so testing at 3am is the best time for me if I wanted to prove dawn phenomenon was taking place, as theoretically my BG would be fine at 3am, but then at 4:30am it would go up......this is proof, you should try a similar time to confirm........

you need to give your dose changes a few days, if you cant find a happy medium with the QA dose, then a small tweak of the BI should be considered.........

When were you told to drop your ratio to 0.5:1?

When you refer to being steady, what do you mean................your on target one day and not the next?

Its just that getting your BG steady between meals is possible, but not easy, going up then back down is normal, its getting that spike to be as small as possible that the tricky part..........

Just an update for you... I did my non carb dinner so didn't have any QA within 5 hours of bed time. I took my normal BI and went to bed with BS of 7. I woke up 7 hours later with BS of 12.

Whilst I didn't do a middle of the night check, I now believe that i definately have the ol' dawn phenomenon. Ho hum!