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Offline Quantum Learning

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Finally got bolus insulin.
« on: 10 November 2016, 01:14:00 PM »
I had my 3-4 week phone call from my DSN and decided to ask for rapid acting insulin as it appears that with even a small amount of carbs my bg's now go up a lot  :(

I'm still on 20-30g carbs a day (usually) but that gives me very little leeway when we eat out which with the Xmas season almost here is more likely. I would also like a bit more flexibility in what I can eat at home for example I'm making a rabbit stew tonight and would like to have some potato in it rather than just a small amount of carrots/swede/onion as usual. In fact I hardly ever make a stew anymore as I find them too concentrated with just the aforementioned small amount of carrot/swede/onion. (I detest celery).

My DSN was a little reluctant to agree to the bolus and wanted me to wait till I see the endo for my 1st appt in Jan but said she appreciated I could do with some more flexibilty in what I can eat. I have assured her I will be v.careful and as I'm happy with LCHF most of the time I won't be using it every day. She was very complimentary in what I am already doing and said she was grateful at how I am actively trying to manage my D compared to most of her other D patients. She said she was a little worried and felt she was not supporting me enough with the change of insulin regime but I explained about the amount of help I get from this forum which reassured her.

I've googled about bolus insulin and it said that 1 unit will deal with between 12-15g carbs and I was wondering if someone could tell me the name of that carb counter book that Patti swears by as I will now have to start serious carb counting if I'm going to bolus, rather than what I do at the mo which is I don't actually eat any carbs other than what is in veg or salad.

One other question I have which she raised also is whether my increased sensitivity to carbs is in fact down to following a v.low carb diet for so long?

She also said I may have to decrease the amount of basal but as I don't intend using the bolus every day I'm not sure how that will work.
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline nytquill17

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Re: Finally got bolus insulin.
« Reply #1 on: 10 November 2016, 02:49:15 PM »
Wow, what a lovely conversation with the DSN! So glad you seem to be having some positive health care experiences at long last. Long may it continue!

I have heard mixed results, I think, about the effects of a VLC diet on carb tolerance. The standard thinking is that it increases carb tolerance because it "rests" the pancreas a bit. But - and I can't recall now where or who said this - I have a vague idea that I have heard of people tolerating carbs less well after going low-carb. Trouble is that you can't really sort out the intervening factors like time (specifically, someone whose insulin production is packing up search what they do, like a T1.5 or someone with other factors in play in their inner workings, will find that they tolerate less carbs after going on a VLC diet not because of the diet, but simply because during the time they were on the diet, they were still losing insulin production). Basically, when it comes to anything diabetes, all we can really talk about are tendencies and probabilities. The majority of people who go on a VLC diet *tend* to see more carb tolerance, but any given individual might actually see less.

When it comes to bolus insulin, insulin to carb rations (I:C ratios) are much, much more variable than what is apparently reported on Google! Just like with basal insulin, bolus insulin needs vary by person and by time of day. On a molecular level, they are the same after all! The difference is essentially in how quickly they are absorbed from under the skin. Most people find that they need different ratios for different meals, usually needing more insulin at breakfast, least at lunch, and somewhere in the middle for dinner. But again this is what people *tend* to need and your individual situation may well be different!

So for example my own ratios are 1:4 at breakfast (that's 1u of insulin per 4g of carb), 1:7 at lunch and 1:6 at dinner. So say I ate 20g of carb - if I ate it for breakfast, I would need 5u, for lunch I would need 3u and for dinner 3.5u. Obviously when you can only work with whole units, or in my case half units, the math isn't always super precise, you have to decide whether to round up or down - if i had been very active during the day I might only take 3u at supper instead of 3.5 for example, it's a judgment call!

Most people when starting out are "given" the ratio of 1:10, mainly because that makes the math easier while you're getting the hang of carb counting and everything, and also because that's a fairly "safe" starting place - it's better to start high with ratios ( = less insulin taken per meal) and gradually tighten them down ( = more insulin per meal) as you get the hang of things, rather than to start off too severe and have lots of hypos on top of everything.

As to decreasing basal - when both basal and bolus doses are titrated correctly, they shouldn't interfere with each other. Your basal dose should in principle be titrated to meet your metabolic needs between meals; it should NOT be titrated with the intention of reducing post-meal spikes. If you have been using basal to reduce post-meal spikes then yes, it will need to be "backed off" because that is what the bolus insulin will be doing too, and if you have both insulins doing the same job, the job gets done twice over which may mean a hypo for you! In theory, if you are eating such that you don't need bolus insulin to cover your food, this should not affect how much basal insulin you need on that day because your basal insulin needs (and thus your dose) should have nothing to do with what you eat or don't eat. In practice, of course, things are a bit more complicated - for example if you were not eating at all (as opposed to eating, but VLC), you could still find your BGs rising even though your basal dose works perfectly on days you do eat, because fasting causes an increase in counterregulatory hormones.

Basically, as with everything, start slow and cautious and see what happens to you, then adjust from there. :)
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Finally got bolus insulin.
« Reply #2 on: 10 November 2016, 03:23:54 PM »
Yep - what she said!  LOL

For home cooking - I swear by the Collin's Gem CALORIE counter book - costs about £3.99.  Gives values of thousands of different foodstuffs per 100g/100ml.  It gives Cals, Carbs, Fats, Protein and Fibre for each item.

 They also do a 'Carb counter' book - however that gives things it thinks are helpful eg '1/3 of a baguette' - however as you have no idea what size of baguette they measured a third of - you still haven't a clue!

For 'eyeballing' a plate of something out and about, there's a book called 'Carbs & Cals' which also has an App if you're into such things - but that's far more expensive and of limited use in the kitchen.

Sooo anyway - test, then eat something with a small amount of carbs which you've calculated the carbs for, and if I were you I'd err well on the side of caution - eg 1u per 20 or 25 g ?  Then see what happens to your BG - obviously if it starts to plummet then you know that's too much - but you won't really know whether it's dealt with them or not until 4 hours  have past, since most fast-acting insulins work for 4 hours if not longer.

For me I'm fairly sensitive with none of my own, so it starts to work after 10 mins.  Mike (EDUAD) finds it takes a fair bit longer before it starts to kick in - so he needs to jab before he starts eating whenever he can - everyone's different.

Good luck with your experimentation !
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Venomous

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Re: Finally got bolus insulin.
« Reply #3 on: 10 November 2016, 07:21:53 PM »
Exciting! Let us know how you get on.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.

Offline Liam

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Re: Finally got bolus insulin.
« Reply #4 on: 10 November 2016, 08:45:11 PM »
Hope it helps. I'm sure you will need to tweak the basal now you are going to be using it as intended. Please don't think I'm getting at you at all about that, I know it is how medics use basal insulin for type IIs. They are so worried about hypos and the greater amount of work that they really hold out on bolus insulin as long as the can.

I'd stick to 1:10 to start with (this is what the start everyone on pretty much) and make rapid changes each time something isn't right. Normally I'd want days of testing for a change myself but really you aren't going for perfect right now, just close enough that you can then use days worth of data to make changes. Don't be too shocked to find in a couple weeks that everything needs tweaked again. I mean once you have something getting you pretty close to in target numbers you'll be wanting to do full basal testing and likely find that upsets results short term.

Please keep us updated as much as you can stand :) We'll help you as much as we can.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline GrammaBear

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Re: Finally got bolus insulin.
« Reply #5 on: 10 November 2016, 09:22:01 PM »
I like what Venomous said:  "Exciting" and do let us know how things go for you.  I'm happy for you.
Type 1
Tandem Tslim pump Oct 2015
Dexcom G4 CGM Sep 2007
A1C 6.5%~ Sep 2017

Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #6 on: 10 November 2016, 10:01:38 PM »
Thanks everyone.

Tonight's experiment didn't work too well but I really enjoyed the stew with potatoes, 1st one in over 4 years  :) TBH I had no way of knowing how many carbs were in the portion I ate as I made it for 2 and only injected 1 unit for my portion. I did add 2 tbsp of flour to the 1.5 pints of stock and there were potatoes as well as carrots and swede. OH had his usual 2/3 and I had the rest. BG's before eating were 7.9, 1hr after 11.3 (gulp) 2hrs after 10.7 and 3hrs after 8.8. At first glance it seems the 1 unit didn't do anything but then maybe it would've been a lot worse without it, I have no idea as I wouldn't normally dream of eating like that.

To answer a few queries, I haven't been using the basal to control bg's after meals as I know it doesn't work that way and the DSN left it entirely to me to adjust which I kept doing till my recent hypo. Bg's have been back up to 8's & 9's since but my neck pain has been particularly bad & close family stresses through the roof so I was reluctant to increase it although not happy with those numbers. The last few days my pain has decreased & family stuff has improved and bg's are dropping again, 6.6 fasting this am and generally 7.4/7.8/7.9 all the rest of the day. The GP did actually offer me the bolus insulin about 6 months ago but I insisted I could manage on basal alone with my LCHF diet. Recently I have been wondering if the basal is struggling to work as well as it should and my sensitivity to carbs seems to have got worse not better so I decided to ask for the bolus.

I am hoping for the tests to find out which type I actually am as the pattern of my D does seem to suggest type 1.5 but have to wait till Jan for my 1st endo appt and don't know if they will do the tests anyway. I am aware I have massive IR which is obviously suggesting type 2 but believe it could be down to my sedentary lifestyle, chronic pain and general stress.

Will carry on experimenting with definite carb counts and see what happens but don't want to increase my carb intake by much as I'm already putting on weight since changing to lantus (Toujeo).
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline Pattidevans

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Re: Finally got bolus insulin.
« Reply #7 on: 10 November 2016, 11:46:24 PM »
Quote
I swear by the Collin's Gem CALORIE counter book - costs about £3.99.  Gives values of thousands of different foodstuffs per 100g/100ml.  It gives Cals, Carbs, Fats, Protein and Fibre for each item.

That's what I use.  Sorry been more or less AWOL today due to hospital appointments, followed by friends dropping round this afternoon (directly after we got home and finished a very late lunch) and staying until we more or less got dinner on the table!
Quote
OH had his usual 2/3 and I had the rest. BG's before eating were 7.9, 1hr after 11.3 (gulp) 2hrs after 10.7 and 3hrs after 8.8. At first glance it seems the 1 unit didn't do anything but then maybe it would've been a lot worse without it, I have no idea as I wouldn't normally dream of eating like that.
Honestly, I woke to a number in the 5s at 7.30 am and  (probably due to the unusual run around like a maniac until 9.30) I was in the 9s before brekkie.  One slice of toast (Vogel Soya and Linseed @ 14g per slice) with butter and by the time I got to the diabetic clinic I was in the 13s!  So count yourself lucky with the 11.3!

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Lucy

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Re: Finally got bolus insulin.
« Reply #8 on: 11 November 2016, 12:00:52 AM »
I am glad you got the bolus you requested. Normally people are started on 1u:10g carbs, but you could as you did just start with 1u and work up, if your meals have a fairly consistent amount of carb. I use 1:10 at breakfast and lunch and 1:20 at dinner, and 25u basal. Given you require 80u a day of basal i'm not surprised that 1u of bolus didnt do much for you but it is safest to start small and buildup, just keep experimenting.
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline Pattidevans

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Re: Finally got bolus insulin.
« Reply #9 on: 11 November 2016, 10:08:51 AM »
Much more sensible head on this morning, so I have re-read your posts Q.


I don't know if you think that bolus insulin will keep your BGs completely flat after a meal, but it doesn't do that unfortunately.  What it should do, is to bring your BGs back to where they were before the meal by the time it has expended itself.   Or, if a correction has been added in it will bring you back to your target range.  As Sedge said, most rapid acting insulins will last between 3.5 and 4.5 hours before they are out of your system.  It's not linear though, the insulin "peaks" then gradually tails off.  If you go to our website and click on "insulin profiles" down the left hand side you will see what I mean.


I have recently been lucky enough to wear a Freestyle Libre sensor for a month.  This reads your BGs continuously and when you wave the reader over the sensor (which you insert into your arm) it shows a continuous line which represents where your BG has been.  I also belong to a Facebook group called "Abbott Freestyle Libre Users" and there is much conversation (illustrated with pictures of their readers) about the peaks after meals that people did not realise were happening until they got the Libre.  The conversations centre mainly around how to eliminate these peaks.  The trouble is that "rapid acting" insulin isn't nearly as rapid acting as you would wish.  It takes up to 45 minutes for it to kick in (varies for different people).  I have been able to see, by injecting and then watching the line of the Libre, (without eating) that it takes between 35 - 40 minutes to fully ramp up for me.  The problem is that if you take more to eliminate the post meal rise it can make you hypo later on.  Some people find that they can eliminate the rise by injecting about half an hour before eating, whilst others go very low carb.  Injecting ahead of time works for me, but you have to be very careful that you do not get distracted and not eat at the planned time.


Without a tool like the Libre it's hard to see what I am talking about, but I will try to upload some pictures.  Meantime I would try to relax a bit and not get too wound up about the spikes.  It's a totally different science to managing T2 on a low carb diet.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline himtoo

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Re: Finally got bolus insulin.
« Reply #10 on: 11 November 2016, 10:30:17 AM »
if you are going to start using carbs like potatoes in some dishes -- I would recommend weighing

so for me that stew would mean making the stew in 1 pan and boiling the potatoes separate
weighing your portion then add them to the stew

this will give you an accurate value to bolus with ( yes a bit more of a PITA ) but that is the sort of work one needs to do when starting to count carbs 
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #11 on: 11 November 2016, 10:35:52 AM »
Quote
I don't know if you think that bolus insulin will keep your BGs completely flat after a meal, but it doesn't do that unfortunately.  What it should do, is to bring your BGs back to where they were before the meal by the time it has expended itself.   Or, if a correction has been added in it will bring you back to your target range.  As Sedge said, most rapid acting insulins will last between 3.5 and 4.5 hours before they are out of your system.  It's not linear though, the insulin "peaks" then gradually tails off.  If you go to our website and click on "insulin profiles" down the left hand side you will see what I mean.

I think what I was hoping for as a newbie is that I would be able to increase my carb intake a little without horrendous spikes. Traditionally on my VLC diet I only get a rise of 1 or 2 after 1hr and it's back to pre-meal levels after 2hrs. I think it's going to take me a while to get my head round this.  :(
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #12 on: 11 November 2016, 10:43:12 AM »
if you are going to start using carbs like potatoes in some dishes -- I would recommend weighing

so for me that stew would mean making the stew in 1 pan and boiling the potatoes separate
weighing your portion then add them to the stew

this will give you an accurate value to bolus with ( yes a bit more of a PITA ) but that is the sort of work one needs to do when starting to count carbs

I think this is why I've resisted bolus till now  :(

I made the stew more like a lancs hot pot with the pots sliced thinly and cooked on top of the stew in a layer of coconut oil (should be butter but OH can't have it now). I have some very elderly stewing beef in the freezer which I will be cooking in this way but as OH can't have beef either it will be just for me so I can easily weigh any pots I put on top of that. It was just so nice to be able to eat the same meal together like we used to before he got ill.
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline Liam

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Re: Finally got bolus insulin.
« Reply #13 on: 11 November 2016, 11:12:27 AM »
Worth noting that when things are more or less right that 1 unit of rapid insulin will drop your BG by about 2-3m/mmol. Just thought nobody had posted about corrections. I'd work it out as 1 unit will drop you by 3 to start with just to be safe. Not sure of your numbers really so maybe you don't need to correct much?

Worth going over hypo rules again too I think. You want rapid acting carbs about all the time t treat them when they happen. Liquids are the fastest but not as practical to have all the time as things like glucose tabs. I like glucotabs myself as I have managed to train even my hypo ridden brain (mostly) to treat with the right amount. I find with liquids I tend to over treat. You want to take 15g of the rapid acting carbs and retest in 15ms. It is worth noting that a high after a hypo can be caused by the livers output and it can reabsorb, so after a hypo be careful about correcting highs.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline nytquill17

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Re: Finally got bolus insulin.
« Reply #14 on: 11 November 2016, 12:42:15 PM »
I'm not sure this has been said yet, but what you saw was a rise of 3 points after eating a meal with potatoes and flour in. That's actually quite reasonable for most people! A rise of 2-3 points after a meal is generally considered acceptable. As a T1, for some foods I can easily see a rise of 4-5 points even if I dosed my insulin correctly. Different foods hit your system faster than others and more importantly for the question of spikes, faster than the insulin. Patti has already discussed that a bit.

But the thing is, the numbers you got weren't all that bad. When judging the effectiveness of insulin at meals, what matters is not the actual numbers that you see but the distance between them. Yes, you saw double digits after an hour, but that's because you started at nearly 8 already. If hypothetically you had started at 4 or 5, you would have gone up to 7 or 8 and finished at 6! Without the insulin you may easily have seen a rise of 4-5 points or more, although that's pure speculation on my part, but the point is that you ate carbs! And it wasn't a disaster!

If you were to eat the same meal again you could try 2u and see what you get. That's another thing about starting to carb count and to adjust your bolus insulin, it helps to eat the same things in the same quantities a few times in a row to have a basis for comparison. Different days are always going to be different no matter what you do, but at least eating the same foods and amounts at first eliminates ONE variable from consideration!

Must have been such a relief to only cook one meal for once. Focus on that feeling and don't let your BGs get you down - like I said, anyway, they really weren't disastrous by any means! And you'll get the hang of this.

p.s. Carb count in a way that works for you. That is, if being ultra precise about everything all the time is just going to discourage you and lead to burnout, it's a better investment in the long run to not push so hard for precision and instead focus on "getting a feel" for how the insulin "handles" with different situations and different foods. Everyone is different about this. In the old days we didn't start out doing a lot of math. I came home from the hospital with a big notebook that listed a bunch of different foods and how much of each counted as a portion (one slice of bread, a half cup of peas, that sort of thing). You ate the number of portions you were "prescribed" in your meal plan and you took the insulin the nurse told you to take. Then as you got comfortable you would start doing things like subtracting a unit from your usual dose if you'd had soccer practice that day, or adding a unit if you wanted a bigger helping of something, and got the hang of it that way. The concept of "carb counting" with weighing and measuring everything very precisely and applying a ratio came in later. And we managed fine before then - admittedly carb counting actually makes it easier in the long term, but it can feel overwhelming when you start out. But it doesn't have to be permanent - it can help a lot to measure everything at first, while you're getting a feel for things, and then from there you may feel more comfortable guesstimating based on past experience. Some people prefer to measure everything all the time because they find that reassuring. I'm definitely in the guesstimator camp myself!
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."