Author Topic: Finally got bolus insulin.  (Read 1882 times)

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Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #15 on: 11 November 2016, 02:51:59 PM »
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.

Thanks liam, I didn't know what 'corrections' meant  :)

I have scattered about the house/gym bag/car small cartons of orange juice, they're 18 g carbs so a little high but worked well when I had my 1st hypo the other week  :)
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 #16 on: 11 November 2016, 03:53:07 PM »
If you want something faster than orange juice, which has to be first swallowed and then digested before the sugar gets into your blood, then pure glucose is the thing, in the form of glucotabs or Lucozade, as the glucose starts to get into your blood stream directly from your mouth.  However, we all have things we prefer over others. :)

I'm attaching a photo of my Libre reader which clearly illustrates the affect of 1 slice of toast, properly carb  counted.  As you will see, I was chugging along brilliantly at about 5 mmol/l with just my basal until the toast came along.  BGs later came back down to 4.5.
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 Quantum Learning

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Re: Finally got bolus insulin.
« Reply #17 on: 11 November 2016, 04:18:11 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!

You're right, I saw the diffference between 7 something and 11 something as a rise of 4 but it's actually nearer 3. Pretty sure it would've been much higher if not for the 1 unit but have nothing to base that on as normally I wouldn't dream of eating potatoes & flour. I obviously have a lot more to learn and have to change my mindset from diet contolled type 2 to someone on insulin, I'll get there with everyone's help I'm sure, thanks again all  :)
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 #18 on: 11 November 2016, 09:22:05 PM »
If you want something faster than orange juice, which has to be first swallowed and then digested before the sugar gets into your blood, then pure glucose is the thing, in the form of glucotabs or Lucozade, as the glucose starts to get into your blood stream directly from your mouth.  However, we all have things we prefer over others. :)

I'm attaching a photo of my Libre reader which clearly illustrates the affect of 1 slice of toast, properly carb  counted.  As you will see, I was chugging along brilliantly at about 5 mmol/l with just my basal until the toast came along.  BGs later came back down to 4.5.

Well that's weird  :o this post definitely wasn't there when I answered the last one at 4.18. I only found it now cos I was looking back to see which book you & Sedge had recommended. I'm not sure I've got the right one as I've 'looked inside' and the few foods that are there to see in the preview are only listing the calories?
www.amazon.co.uk/Calorie-Counter-Collins-Gem/dp/000731762X/ref=sr_1_1?s=books&ie=UTF8&qid=1478897805&sr=1-1&keywords=collins+gem+calorie+counter

When I used the OJ it brought my bg's up from 3.9 to 5.9 in 15 minutes which I thought was scarily impressive (reminded me why I've not drunk OJ in the last 4 years) would the glucotabs be even quicker? I have bought a packet but they're in my swim bag and weren't in the car when I needed them.

I'm absolutely shocked at what a slice of toast did to you & that's on a pump. Would you normally expect that or was there something else going on that affected it? Everything we read says it's the spikes that do the damage and that spike to me was massive. TBH if you get spikes like that with all your knowledge/experience I don't think I'll ever be able to eat toast  :(

I meant to say I bought Think Like a Pancreas on your rec and have read it but that was before getting the bolus so I need to read it again as I skipped all those bits  ;)
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 sedge

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Re: Finally got bolus insulin.
« Reply #19 on: 12 November 2016, 12:05:02 AM »
Quantum - it is merely the difference between a person still producing insulin and one that isn't.  10g of carb increases my BG by 3.0.  So say the toast was 15g carb - it would increase by say 4.5.  That's why if I want to eat a slice of toast - I need to inject the appropriate amount of insulin as a bolus before I start munching it.
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 Pattidevans

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Re: Finally got bolus insulin.
« Reply #20 on: 12 November 2016, 10:15:47 AM »
Q I just checked out the link to the calorie book and if you click on it to "look inside" and then click "surprise me" down the left hand side it eventually takes you to a page where it shows Cals, carbs, protein and fat amounts per 100g.  It's a later version of the book Sedge and I have.


Sedge, I did bolus insulin before eating the toast (OK immediately before, whereas I usually need to bolus ahead for anything with bread).  I was flying around like a loony and had exactly 10 minutes before I had to be on the road to the hospital.  The toast was Vogel soya and linseed bread at 14g per slice.  It generally toasts better than Burgen.  I had a smear of Peanut butter on it and bolussed for 20g carb, 4u according to my pump handset.  By lunchtime I was back down to 4.  As a contrast I had a roast dinner last night, roast pork with lots of lovely crackling, mashed sweet potatoes, runner beans, Kale sautéed with lardons and topped with goat's cheese followed by a fruit platter with Mango, paw paw, half a pear and berries and never went above 7.5.


I'm not trying to hijack Q's thread, I just wanted to put things into perspective regarding what insulin does and doesn't do.
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 Quantum Learning

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Re: Finally got bolus insulin.
« Reply #21 on: 12 November 2016, 12:14:55 PM »
Q I just checked out the link to the calorie book and if you click on it to "look inside" and then click "surprise me" down the left hand side it eventually takes you to a page where it shows Cals, carbs, protein and fat amounts per 100g.  It's a later version of the book Sedge and I have.


Sedge, I did bolus insulin before eating the toast (OK immediately before, whereas I usually need to bolus ahead for anything with bread).  I was flying around like a loony and had exactly 10 minutes before I had to be on the road to the hospital.  The toast was Vogel soya and linseed bread at 14g per slice.  It generally toasts better than Burgen.  I had a smear of Peanut butter on it and bolussed for 20g carb, 4u according to my pump handset.  By lunchtime I was back down to 4.  As a contrast I had a roast dinner last night, roast pork with lots of lovely crackling, mashed sweet potatoes, runner beans, Kale sautéed with lardons and topped with goat's cheese followed by a fruit platter with Mango, paw paw, half a pear and berries and never went above 7.5.



I'm not trying to hijack Q's thread, I just wanted to put things into perspective regarding what insulin does and doesn't do.

I noticed that they're selling some older versions of the book, would one of those be better? Do you know what year yours was published?

So as far as the toast goes it was just a matter of the time you bolused? So getting the timing right is as important as the dose in a way?

p.s. dinner sounds lovely, be round yours later  ;)

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 #22 on: 12 November 2016, 02:20:16 PM »
Timing is definitely an important part of it. But also, there are some things injected insulin simply can't do, especially when you don't produce much of your own. Definitely you can eat more carbs with insulin than without it! Definitely I can choose to have a treat sometimes, knowing that I can take insulin for it such that it won't be a total disaster. But it doesn't give me leave to "base my diet around starchy carbs" on a daily basis, as current dietary advice suggests, without some kind of consequences on my BG. I do tend to eat moderate carb rather than full-on low carb, but even with the best planning of dosage and timing, I would not expect to be able to eat potatoes and bread and things without seeing some kind of a rise! Ideally no more than 2-3 points but, uh, stuff happens :P
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 Quantum Learning

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Re: Finally got bolus insulin.
« Reply #23 on: 12 November 2016, 03:03:08 PM »
Just looking forward to my 1st mince pie in 4 years  :P hope the insulin will minimise the rise  ;)
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 #24 on: 12 November 2016, 03:14:21 PM »
It should! But whether or not it actually does - enjoy it! :D
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 #25 on: 12 November 2016, 04:24:30 PM »
Be warned - it will hit your BG faster than HS2 ......... there's so much 'syrup' in shop mincemeat it's completely unavoidable to get a spike.  Just looked at a box of Tesco's bought yesterday and each one is 32.2g of carb - but that will hit far quicker than my lunchtime sandwich since there's nothing hardly with the carb (bit of fat in the pastry)  to slow it down at all.

In the strict interests of science - I'll eat one now and keep testing.

I'll report back later !
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 Lucy

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Re: Finally got bolus insulin.
« Reply #26 on: 12 November 2016, 05:04:42 PM »
I would say getting the timing right is important yes. Pre bolusing can help reduce spikes but my advice would be to take it slowly with increasing the timing of prebolusing or it can go wrong the other way. Attach my bg from this morning. Was having breakfast elsewhere and i thought it would hit fairly fast so i bolused early, turned out to be 30 minutes early. The grey dots are my dexcom sensor readings every 5 minutes, the red dots are finger bg readings, blue dots are insulin and white dots are carbs.


10:05 i bolused 5u. bg was high 5s but had just woken up and was in a rush so expected it to rise.
10:35 i ate and guessed as 30-40 carbs.
10:50 my cgm said i was 3.6. I decided to wait a few minutes before testing as was busy and didn't want to leave the room of the event i was at to go and test. (I needed to leave to wash hands). Also I had eaten white toast with scrambled egg 15 mins before so thought it would be increasing fast anyway.
10:55 and 11:00 cgm said 2.8 Thought oops i better test its still going down, went to sort it out.
11:05 Tested BG which was in the 3s so had a 15g fast carbs and got back to what i was doing.


That sorted it out but it was annoying that i'd just got the timing wrong as i didnt expect the low. So if you start prebolusing i would start with 5 or 10 minutes before hand and be aware that different foods may need different timings on insulin.
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #27 on: 12 November 2016, 06:06:43 PM »
Quote
In the strict interests of science - I'll eat one now and keep testing.

LOL I'll wait till nearer Xmas, I've waited this long another few weeks won't make much difference, be interested to see the results of your test though  :)
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 #28 on: 12 November 2016, 06:07:37 PM »
I would say getting the timing right is important yes. Pre bolusing can help reduce spikes but my advice would be to take it slowly with increasing the timing of prebolusing or it can go wrong the other way. Attach my bg from this morning. Was having breakfast elsewhere and i thought it would hit fairly fast so i bolused early, turned out to be 30 minutes early. The grey dots are my dexcom sensor readings every 5 minutes, the red dots are finger bg readings, blue dots are insulin and white dots are carbs.


10:05 i bolused 5u. bg was high 5s but had just woken up and was in a rush so expected it to rise.
10:35 i ate and guessed as 30-40 carbs.
10:50 my cgm said i was 3.6. I decided to wait a few minutes before testing as was busy and didn't want to leave the room of the event i was at to go and test. (I needed to leave to wash hands). Also I had eaten white toast with scrambled egg 15 mins before so thought it would be increasing fast anyway.
10:55 and 11:00 cgm said 2.8 Thought oops i better test its still going down, went to sort it out.
11:05 Tested BG which was in the 3s so had a 15g fast carbs and got back to what i was doing.


That sorted it out but it was annoying that i'd just got the timing wrong as i didnt expect the low. So if you start prebolusing i would start with 5 or 10 minutes before hand and be aware that different foods may need different timings on insulin.

That's very interesting, thank you, that CGM was very useful then  :)
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 sedge

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Re: Finally got bolus insulin.
« Reply #29 on: 12 November 2016, 08:05:18 PM »
Oh - that's been a surprise - not anywhere near as bad as I assumed it would be.

First thing to note though - I did need a new cannula in as it had been in 2 days and I always find they go off after that - ie I stop absorbing the insulin as quickly - but Oh damn - I need a new cartridge too - can't be bothered I'll just do it later, after lunch .... MISTAKE LOL

Messing about this morning so didn't test till half 11, oops - but anyway it was 4.6 so that was fine.

Before lunch 1.35 - 8.3, oh well I'll do it after.  Lunch my usual 30g carb but instead of the usual 3 units, the pump calculated I needed 3.85u with the 0.95 extra to correct the high BG, so I had that.  Roll on to mince pie test time.

I have to change the cannula and put a new cartridge in so it's 4.45 when I'm ready to jab and eat - by this time my BG was 13.5 so under normal circs I would most certainly not have eaten the pie.  However ..... pump said I'd need 5.30u so that's 3.2u for the pie plus a 2.1u correction.  Did that.

At 5pm I was feeling really nauseous anyway, so tested.  Surprise surprise - it's 11.2.  At 5.45 it's 8.8 and when I tested before eating again at 7.15 - it was down to 5.0 - and I had 35g but of course still had insulin on board from the pie jab - so it reduced the usual 3.5u to 2.40u.

Where the heck did the spike go !
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