Recent Posts - DAFNE Online

Mar 24, 2014

Simon 578 posts

Many congratulations! All the best to you and your family Very Happy

Mar 24, 2014

mum2westiesGill 502 posts

Topic: General Discussion / My Recent BGs - comments wanted please

Comments wanted on the above please - 17.03.2014 - 23.03.2014

Please can I have some comments on the above readings

Off to see the dietician tomorrow to make sure I am counting carbs correctly. The method I use is carbs & cals book/app & also food packaging labels

Mar 24, 2014

tcmonkey80 41 posts

Topic: General Discussion / Done it :)

Thank you Warwick Smile

Mar 24, 2014

xJeanx 8 posts

Topic: General Discussion / How do I do BI check?

Thanks for your reply Warwick.

I am on multiple daily injections of short acting insulin and twice daily injections of long acting insulin (in a morning before breakfast and in an evening before bed).

I have read how some people have carb free meals to check that their background insulin is correct but wanted to make sure I was doing it right before giving it a try. Would I go for a full 24 hours without any carbs and without any short acting insulin?

Thanks.

Mar 24, 2014

Warwick 423 posts

Topic: General Discussion / How do I do BI check?

Are you on once-per-day BI, or multiple injections of BI?

If just the once, then the easiest way is to compare your before bed readings with your before breakfast readings (assuming no CPs or QA at bedtime or overnight). If they differ by more than 1.5, then it indicates that your BI may need adjusting.

Cheers,
Warwick.

Mar 24, 2014

Warwick 423 posts

Topic: General Discussion / Done it :)

Congratulations. Lots of type-1s have delivered perfectly healthy babies, so focus on that fact rather than the potential negatives :-)

All the best.
Warwick.

Mar 24, 2014

Warwick 423 posts

Topic: General Discussion / Help please! High morning BG

Hi Lucy,

I'd suggest from what you have said, that increasing your evening BI would be appropriate. Increase by 10%, and then leave for three days to see how much of a change it makes.

Often BGs will increase in the morning due to dawn phenomenon - the rush of hormones that increase insulin resistance, but this tends to occur after 3 a.m. The fact that you are higher than desirable at 3 am, indicates that you can increase your evening BI without necessarily experiencing overnight hypos.

You may or may not have dawn phenomenon. If you start getting 3 am readings in a good range, and then before-breakfast readings in a high range, then DP would be indicated. For now, from what you have said, it appears just to be a lack of evening BI.

Mar 23, 2014

Lucyx78 11 posts

Topic: General Discussion / Help please! High morning BG

Hi
I would appreciate some advice please as I am struggling with morning BG.
I Have been going to bed around 8-8.5 and waking up around 13-17mmol. I have done a couple of 3am checks and I have had readings around the 10-11 mark. I am absolutely baffled as to why it is happening but it is really frustrating me. I do 17 units of BI at bed and the same in the morning (I'm on levemir). Do I continue to monitor and increase my BI at night 10-20%? Any advice would be appreciated. Thank you

Mar 23, 2014

tcmonkey80 41 posts

Topic: General Discussion / Done it :)

Hi everybody, I just wanted to let you all know that I am 3 months pregnant Smile

)
Both baby and me are doing really well.

My sugar levels are well controlled with the help of my pump (couldnt have done this without my pump). I have had 2 scans already and the baby is growing at a nice pace, fingers crossed we dont end up with a large baby Smile

I need to stop reading websites on complications on diabteic pregnancys, i have a great care team behind me and i am sure the baby will be perefect.

Very Happy

Mar 23, 2014

xJeanx 8 posts

Topic: General Discussion / How do I do BI check?

Hi everyone,

Does anyone know if there are any rules/ guidelines on how to do a background insulin check? I know it involves having carbohydrate free meals but not sure over what period of time I should do this for and how often to do blood glucose tests. Is this now taught on DAFNE courses?

Just off now to have a look at the online handbook.

Thanks in advance.

Jean

Mar 23, 2014

Warwick 423 posts

Topic: General Discussion / BI and morning BG

Nice one. :-)

Mar 22, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Hi
My BG before bed last night was 5.8, I increased BI to 50 units and did a 3am test to find it holding steady at 5.6. At 9am it was 5.6 and at lunch it was 5.5 and before tea 5.8.

So delighted with today's readings, near perfect. Here's hoping they remain stable and consistent. Will update as I continue

Mar 22, 2014

GR8 5 posts

Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses

Hi dunkers7

Thanks for the tips. Not much of a drinker or dancer so usually just chatting and drinking.

Can manage spirits no problem just trying to figure out the beer

Thanks

Mar 22, 2014

dunkers7 24 posts

Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses

Hi GR8,

I wasn't carb counting at this point, but in general, I've found bottles of beer raise BG a lot initially then they drop a little later, assuming no QA taken. 3CP sounds about right for Corona.

Possibly worth thinking about what you're doing when out too though. How practical taking QA is, if you're likely to be dancing for long periods, that kinda thing?

I drink very little now, but when I was a student and in the drinking quite a lot phase, I found spirits a lot easier to manage in social situations since they drop BGs a lot more than they raise them.

Mar 22, 2014

Warwick 423 posts

Topic: Questions for HCPs / BI insulin running out

Hello Justin,

I switched the other way a few years ago from Humalin to Lantus, and I don't remember it being a problem,although at the time, I was on BI only due to the honeymoon period.

Are you taking breakfast around 7 am? If so, then one answer may be to increase your breakfast QA ratio a bit, and push your morning BI time out to 10 am, giving you an extra few hours at the other end of the day before it runs out. This would hopefully coincide with dinner, and you can increase your QA slightly then to get you to your 10 pm BI dose.

Another alternative would be asking to switch back to Lantus, or onto another BI like Levemir (although if you were switched off Lantus, then there may have been good reasons for doing so).

Lastly, you could split your BI into three injections, with the existing two as is, and a third around midday to see you through to your evening dose.

With Lantus, although it is billed at 24 hours, I found that it lasted about 20, and increasing my dinner QA led to hypos. Splitting my Lantus dose into a morning and evening dose solved the issue.

For that reason, that third option may be your best option. There would be a bit of trial and error though as to what each BI dose should be. Ideally, you would want to take each dose about 8 hours apart, and then work out if taking a third of your total daily BI for each dose was appropriate.

Mar 21, 2014

GR8 5 posts

Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses

Hi

I have just completed the DAFNE course and am just going over calculations for QA insulin to counteract the carbs in beer, etc...

I am not a regular or big drinker but will occasionally have a few beers when out.

DAFNE state that a pint of lager counts for 1CP. With this in mind I went to look online at carbs in bottles of beer (in particular Budweiser and Corona). Budweiser came back with each bottle is 30g of carbs/ 3CPs. This seems quite high in comparison to rating for a pint of lager.

If I was to half my QA insulin ratio and go with these higher figures and they are not correct I am likely to increase chance of delayed hypo, especially if I had a few beers.

Does anyone have any advice or experience of carb counting for bottles of beers?

Thanks

Mar 21, 2014

Justinjroberts 9 posts

Topic: Questions for HCPs / BI insulin running out

I am currently on Humalin I as a BI insulin, taking it at 7am/7.30am and again at 10pm. It covers my levels over night but the last two evenings yesterday and today I experienced a spike into double figures at 5pm, it seems that the BI is only lasting for 10 hours!

To correct I had to take Novorapid but very high doses, last night 15 of Novorapid brought my levels down from 15 to 8 and I exeperienced no hypo and ate nothing. I am fairly new to Humalin I having been switched from Lantus four weeks ago. Has anyone else experienced this as I am not keen on having to take such high levels of Novorapid to rectify with such little affect.

Mar 20, 2014

dunkers7 24 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Thanks Warwick,

Yes good point about lunch and makes sense on the BI.

The plan was always to do some BI testing at lunch time to establish whether reducing BI is the right thing to do. Today, I didn't hypo so some BI testing actually happened. Looks like that morning BI is just about holding now.

Bigger picture is, that's an overall drop of 11 on my morning BI dose since starting the DAFNE course last month, so that really has been a big change. Getting there!

Mar 20, 2014

Garry 328 posts

Topic: General Discussion / BI and morning BG

If you go back to your diary you can edit individual entries by clicking the time of the entry which gets you into an edit screen. Please take little notice of between meal BGs.
These are good for information, as they may help you understand your normal QA uptake times, but if you compensate for these additional results you will stack up QA doses with the outcome that you see. Slowly, slowly. Wait until the meal time and compensate then, if necessary.
Try not to make lots of changes.
Change one thing at a time and see what happens over a few days and then decide whether or not the change is beneficial. The graphs produced by the diary can be helpful here.
Keep up the Ketone checks too, if greater than 13 or 14 mmol/L. You can enter the actual value from your meter but your diary only shows true. Keep an eye on them as a run of high BGs, plus ketones, normally give me forewarning that I'm going to feel sick tomorrow or the day after.
Regards
Garry

Mar 20, 2014

Garry 328 posts

Topic: General Discussion / BI and morning BG

For me, a snack is normally less than 2 CPs and depending on my result immediately before would determine what to do.
If normal, or little lower BG at time of snack, I'd usually let it ride to the next meal and if necessary compensate then. I do the pre-meal blood and...for me...pre-meal insulin. I find I need take my insulin before a meal in order to get the Humalog QA active enough in my system, to trim off post-meal spikes in BG.
If high before, when contemplating a snack, I wouldn't have the snack.
If taking an extra meal I would use the ratio appropriate for that time of day. My ratios currently are: - 2, 2.2 and 2:1, breakfast, lunch and dinner respectively, so not much varaition at the minute. In the past however they have been plenty of changes, the widest range used was 3, 2.5 and 1.5:1 across the day. You will find that you may need adapt and make many changes over time. As long as the results are good...that's fine.
Bear in mind though that if you take matching QA for an extra meal and then eat your normal meal within 3 or 4 hours you have to expect an elevated BG. Don't add any compensation QA for the normal meal as you'll likely to be stacking QA doses up which may crash you later.
Regards
Garry

Mar 20, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Warwick

Agree and understand everything you say. I am confident it is DP, as my week doing DAFNE actually lowered my BI from a previous dose of 56 units and the reason for this was a pattern had emerged which showed it was oulling sugars down in the daytime. However, to validate I will do a couple of 3am tests.

I do have good hypo awareness and yes I do wake at night when having a hypo although I am usually quite severe. Having said that it is very rare when this happens.

My results in the daytime are really confusing at the minute, sometimes they are hovering in the early teens and then seem to drop before tea. But I agree, getting the BI cracked is the key to everything else. If it is the DP, what do I need to do to get better morning readings, or do I just accept it for what it is?

Also would be grateful for any advice on my question of snacking and ratios from an earlier post.

Thanks all for the advice so far, really appreciated.

Mar 20, 2014

Warwick 423 posts

Topic: General Discussion / BI and morning BG

The basic strategy of DAFNE is to get the BI right first, and then tackle QA ratios. Trying to do it any other way just gets frustrating.

I'll ignore Saturday, when you had a hypo before bed and carbs and so it will have affected the morning readings.

The rest of the readings show that your morning readings are always higher than your before bed readings. There can be two reasons for this:

1) Your BI is too low and increasing it will fix this.

2) You have Dawn Phenomenon (along with most of the rest of us), and if you increase your BI, you will likely hypo during the night while waiting for DP to begin about 3-4 a.m.

Given that you already increased your BI recently, you may want to wait another few days to check whether things change for the better or not. If they don't, then I recommend putting up your BI by another couple of units.

If you could do a couple of 3 am tests too, it would be helpful in identifying if your BGs are good at 3 am and about to spike due to DP, or if they are high then too, in which case it should be safe to increase your BI.

Make getting your BGs before bed and before breakfast within 1.5 of each other, and you can then worry about ratios etc after that.

Do you have good hypo awareness? Do you wake at night when you have a hypo?

Cheers,
Warwick.

Mar 20, 2014

Warwick 423 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Hi Dunkers7,

One thing to be careful of is that if you reduce your morning BI, you may eliminate your lunchtime hypos, but your afternoon reading may start to spike instead, so do be careful there.

Another option may be to keep the BI the same, but perhaps have lunch half an hour earlier, or at least do a test half an hour to an hour earlier than lunch and take carbs if it is indicated.

Mar 24, 2014 Simon 578 posts	Topic: General Discussion / Done it :) Many congratulations! All the best to you and your family

Mar 24, 2014 mum2westiesGill 502 posts	Topic: General Discussion / My Recent BGs - comments wanted please Comments wanted on the above please - 17.03.2014 - 23.03.2014 Please can I have some comments on the above readings Off to see the dietician tomorrow to make sure I am counting carbs correctly. The method I use is carbs & cals book/app & also food packaging labels

Mar 24, 2014 tcmonkey80 41 posts	Topic: General Discussion / Done it :) Thank you Warwick

Mar 24, 2014 xJeanx 8 posts	Topic: General Discussion / How do I do BI check? Thanks for your reply Warwick. I am on multiple daily injections of short acting insulin and twice daily injections of long acting insulin (in a morning before breakfast and in an evening before bed). I have read how some people have carb free meals to check that their background insulin is correct but wanted to make sure I was doing it right before giving it a try. Would I go for a full 24 hours without any carbs and without any short acting insulin? Thanks.

Mar 24, 2014 Warwick 423 posts	Topic: General Discussion / How do I do BI check? Are you on once-per-day BI, or multiple injections of BI? If just the once, then the easiest way is to compare your before bed readings with your before breakfast readings (assuming no CPs or QA at bedtime or overnight). If they differ by more than 1.5, then it indicates that your BI may need adjusting. Cheers, Warwick.

Mar 24, 2014 Warwick 423 posts	Topic: General Discussion / Done it :) Congratulations. Lots of type-1s have delivered perfectly healthy babies, so focus on that fact rather than the potential negatives :-) All the best. Warwick.

Mar 24, 2014 Warwick 423 posts	Topic: General Discussion / Help please! High morning BG Hi Lucy, I'd suggest from what you have said, that increasing your evening BI would be appropriate. Increase by 10%, and then leave for three days to see how much of a change it makes. Often BGs will increase in the morning due to dawn phenomenon - the rush of hormones that increase insulin resistance, but this tends to occur after 3 a.m. The fact that you are higher than desirable at 3 am, indicates that you can increase your evening BI without necessarily experiencing overnight hypos. You may or may not have dawn phenomenon. If you start getting 3 am readings in a good range, and then before-breakfast readings in a high range, then DP would be indicated. For now, from what you have said, it appears just to be a lack of evening BI.

Mar 23, 2014 Lucyx78 11 posts	Topic: General Discussion / Help please! High morning BG Hi I would appreciate some advice please as I am struggling with morning BG. I Have been going to bed around 8-8.5 and waking up around 13-17mmol. I have done a couple of 3am checks and I have had readings around the 10-11 mark. I am absolutely baffled as to why it is happening but it is really frustrating me. I do 17 units of BI at bed and the same in the morning (I'm on levemir). Do I continue to monitor and increase my BI at night 10-20%? Any advice would be appreciated. Thank you

Mar 23, 2014 tcmonkey80 41 posts	Topic: General Discussion / Done it :) Hi everybody, I just wanted to let you all know that I am 3 months pregnant ) Both baby and me are doing really well. My sugar levels are well controlled with the help of my pump (couldnt have done this without my pump). I have had 2 scans already and the baby is growing at a nice pace, fingers crossed we dont end up with a large baby I need to stop reading websites on complications on diabteic pregnancys, i have a great care team behind me and i am sure the baby will be perefect.

Mar 23, 2014 xJeanx 8 posts	Topic: General Discussion / How do I do BI check? Hi everyone, Does anyone know if there are any rules/ guidelines on how to do a background insulin check? I know it involves having carbohydrate free meals but not sure over what period of time I should do this for and how often to do blood glucose tests. Is this now taught on DAFNE courses? Just off now to have a look at the online handbook. Thanks in advance. Jean

Mar 23, 2014 Warwick 423 posts	Topic: General Discussion / BI and morning BG Nice one. :-)

Mar 22, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Hi My BG before bed last night was 5.8, I increased BI to 50 units and did a 3am test to find it holding steady at 5.6. At 9am it was 5.6 and at lunch it was 5.5 and before tea 5.8. So delighted with today's readings, near perfect. Here's hoping they remain stable and consistent. Will update as I continue

Mar 22, 2014 GR8 5 posts	Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses Hi dunkers7 Thanks for the tips. Not much of a drinker or dancer so usually just chatting and drinking. Can manage spirits no problem just trying to figure out the beer Thanks

Mar 22, 2014 dunkers7 24 posts	Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses Hi GR8, I wasn't carb counting at this point, but in general, I've found bottles of beer raise BG a lot initially then they drop a little later, assuming no QA taken. 3CP sounds about right for Corona. Possibly worth thinking about what you're doing when out too though. How practical taking QA is, if you're likely to be dancing for long periods, that kinda thing? I drink very little now, but when I was a student and in the drinking quite a lot phase, I found spirits a lot easier to manage in social situations since they drop BGs a lot more than they raise them.

Mar 22, 2014 Warwick 423 posts	Topic: Questions for HCPs / BI insulin running out Hello Justin, I switched the other way a few years ago from Humalin to Lantus, and I don't remember it being a problem,although at the time, I was on BI only due to the honeymoon period. Are you taking breakfast around 7 am? If so, then one answer may be to increase your breakfast QA ratio a bit, and push your morning BI time out to 10 am, giving you an extra few hours at the other end of the day before it runs out. This would hopefully coincide with dinner, and you can increase your QA slightly then to get you to your 10 pm BI dose. Another alternative would be asking to switch back to Lantus, or onto another BI like Levemir (although if you were switched off Lantus, then there may have been good reasons for doing so). Lastly, you could split your BI into three injections, with the existing two as is, and a third around midday to see you through to your evening dose. With Lantus, although it is billed at 24 hours, I found that it lasted about 20, and increasing my dinner QA led to hypos. Splitting my Lantus dose into a morning and evening dose solved the issue. For that reason, that third option may be your best option. There would be a bit of trial and error though as to what each BI dose should be. Ideally, you would want to take each dose about 8 hours apart, and then work out if taking a third of your total daily BI for each dose was appropriate.

Mar 21, 2014 GR8 5 posts	Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses Hi I have just completed the DAFNE course and am just going over calculations for QA insulin to counteract the carbs in beer, etc... I am not a regular or big drinker but will occasionally have a few beers when out. DAFNE state that a pint of lager counts for 1CP. With this in mind I went to look online at carbs in bottles of beer (in particular Budweiser and Corona). Budweiser came back with each bottle is 30g of carbs/ 3CPs. This seems quite high in comparison to rating for a pint of lager. If I was to half my QA insulin ratio and go with these higher figures and they are not correct I am likely to increase chance of delayed hypo, especially if I had a few beers. Does anyone have any advice or experience of carb counting for bottles of beers? Thanks

Mar 21, 2014 Justinjroberts 9 posts	Topic: Questions for HCPs / BI insulin running out I am currently on Humalin I as a BI insulin, taking it at 7am/7.30am and again at 10pm. It covers my levels over night but the last two evenings yesterday and today I experienced a spike into double figures at 5pm, it seems that the BI is only lasting for 10 hours! To correct I had to take Novorapid but very high doses, last night 15 of Novorapid brought my levels down from 15 to 8 and I exeperienced no hypo and ate nothing. I am fairly new to Humalin I having been switched from Lantus four weeks ago. Has anyone else experienced this as I am not keen on having to take such high levels of Novorapid to rectify with such little affect.

Mar 20, 2014 dunkers7 24 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Thanks Warwick, Yes good point about lunch and makes sense on the BI. The plan was always to do some BI testing at lunch time to establish whether reducing BI is the right thing to do. Today, I didn't hypo so some BI testing actually happened. Looks like that morning BI is just about holding now. Bigger picture is, that's an overall drop of 11 on my morning BI dose since starting the DAFNE course last month, so that really has been a big change. Getting there!

Mar 20, 2014 Garry 328 posts	Topic: General Discussion / BI and morning BG If you go back to your diary you can edit individual entries by clicking the time of the entry which gets you into an edit screen. Please take little notice of between meal BGs. These are good for information, as they may help you understand your normal QA uptake times, but if you compensate for these additional results you will stack up QA doses with the outcome that you see. Slowly, slowly. Wait until the meal time and compensate then, if necessary. Try not to make lots of changes. Change one thing at a time and see what happens over a few days and then decide whether or not the change is beneficial. The graphs produced by the diary can be helpful here. Keep up the Ketone checks too, if greater than 13 or 14 mmol/L. You can enter the actual value from your meter but your diary only shows true. Keep an eye on them as a run of high BGs, plus ketones, normally give me forewarning that I'm going to feel sick tomorrow or the day after. Regards Garry

Mar 20, 2014 Garry 328 posts	Topic: General Discussion / BI and morning BG For me, a snack is normally less than 2 CPs and depending on my result immediately before would determine what to do. If normal, or little lower BG at time of snack, I'd usually let it ride to the next meal and if necessary compensate then. I do the pre-meal blood and...for me...pre-meal insulin. I find I need take my insulin before a meal in order to get the Humalog QA active enough in my system, to trim off post-meal spikes in BG. If high before, when contemplating a snack, I wouldn't have the snack. If taking an extra meal I would use the ratio appropriate for that time of day. My ratios currently are: - 2, 2.2 and 2:1, breakfast, lunch and dinner respectively, so not much varaition at the minute. In the past however they have been plenty of changes, the widest range used was 3, 2.5 and 1.5:1 across the day. You will find that you may need adapt and make many changes over time. As long as the results are good...that's fine. Bear in mind though that if you take matching QA for an extra meal and then eat your normal meal within 3 or 4 hours you have to expect an elevated BG. Don't add any compensation QA for the normal meal as you'll likely to be stacking QA doses up which may crash you later. Regards Garry

Mar 20, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Warwick Agree and understand everything you say. I am confident it is DP, as my week doing DAFNE actually lowered my BI from a previous dose of 56 units and the reason for this was a pattern had emerged which showed it was oulling sugars down in the daytime. However, to validate I will do a couple of 3am tests. I do have good hypo awareness and yes I do wake at night when having a hypo although I am usually quite severe. Having said that it is very rare when this happens. My results in the daytime are really confusing at the minute, sometimes they are hovering in the early teens and then seem to drop before tea. But I agree, getting the BI cracked is the key to everything else. If it is the DP, what do I need to do to get better morning readings, or do I just accept it for what it is? Also would be grateful for any advice on my question of snacking and ratios from an earlier post. Thanks all for the advice so far, really appreciated.

Mar 20, 2014 Warwick 423 posts	Topic: General Discussion / BI and morning BG The basic strategy of DAFNE is to get the BI right first, and then tackle QA ratios. Trying to do it any other way just gets frustrating. I'll ignore Saturday, when you had a hypo before bed and carbs and so it will have affected the morning readings. The rest of the readings show that your morning readings are always higher than your before bed readings. There can be two reasons for this: 1) Your BI is too low and increasing it will fix this. 2) You have Dawn Phenomenon (along with most of the rest of us), and if you increase your BI, you will likely hypo during the night while waiting for DP to begin about 3-4 a.m. Given that you already increased your BI recently, you may want to wait another few days to check whether things change for the better or not. If they don't, then I recommend putting up your BI by another couple of units. If you could do a couple of 3 am tests too, it would be helpful in identifying if your BGs are good at 3 am and about to spike due to DP, or if they are high then too, in which case it should be safe to increase your BI. Make getting your BGs before bed and before breakfast within 1.5 of each other, and you can then worry about ratios etc after that. Do you have good hypo awareness? Do you wake at night when you have a hypo? Cheers, Warwick.

Mar 20, 2014 Warwick 423 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Hi Dunkers7, One thing to be careful of is that if you reduce your morning BI, you may eliminate your lunchtime hypos, but your afternoon reading may start to spike instead, so do be careful there. Another option may be to keep the BI the same, but perhaps have lunch half an hour earlier, or at least do a test half an hour to an hour earlier than lunch and take carbs if it is indicated.