Author Topic: How do work out my insulin needs when I'm not eating carbs?  (Read 573 times)

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Offline Quantum Learning

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BG's have gone mad again, assuming it's because I haven't been able to exercise much since before Xmas. I'm using more & more corrections but am barely able to keep them below 10. For example this am they were 15.4 so I corrected with 12 units, 2hrs after zero carb b/fast they were 12.8 had nothing else to eat only coffee with double cream, just tested and 9.3. My question is I will be eating roast lamb slices with a bit of salad for dinner in about an hr but how do you work out how much insulin to inject if your meal is very low carb? I'm working on a ratio of 1:8 for carbs and corrections 1.5/1mmol if that helps.
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, Doxazosin 1mg, Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Online Pattidevans

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #1 on: 10 April 2017, 10:37:42 PM »
Q

I have a ratio of 1u:6g and I am T1, so you could increase your ratio.. it's all very individuaL  Though I am having to decrease all insulin since the weather has warmed up and I have been walking more.

What I would ask you is about your insulin.  How long has it been out of the fridge?  When I was on injections I found things more responsive if I kept my insulin in a Frio.
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: How do work out my insulin needs when I'm not eating carbs?
« Reply #2 on: 10 April 2017, 11:43:04 PM »
I use the same ratio regardless of the carb quantity. I use 1:10. So if I ate under 10g carb I wouldn't take any insulin unless needed a correction.
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline nytquill17

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #3 on: 11 April 2017, 01:40:02 AM »
It depends. I often find that a no-carb meal (or nearly so) still seems to need some insulin. Whether this is due to confounding factors (background needs happening to increase around the same time? stress reaction? who knows!), or me miscounting the carbs (a lot of low carb veggies still does add up to a good 10g or more), or protein conversion or... it's hard for me to pin down. But ultimately I still often do take a unit or two for a no-carb meal.

I think the only thing you can really do is to do it enough times that you have a feel for how your body tends to react in those situations and then respond accordingly. Which means the first few times you'll probably flub it - and every now and then thereafter, too!
T1 DX 1995
Levemir + Novorapid
 
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"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
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Offline Quantum Learning

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #4 on: 11 April 2017, 02:19:46 AM »
So in other words, just keep correcting and ignore the food? As most of my meals are below 10g anyway. I didn't know what to do for my dinner (pre 9.3) so didn't do anything and 2hrs after was 11.9. Just tested now, 5hrs later and it's down to 7.5 but I'm not sure why. This has been a pattern of sorts the last few days actually, high BGs when I wasn't expecting them but also lower BGs when I wasn't expecting them too, most confusing.

I usually just keep the insulin at room temperature but have just been away for the weekend and kept it in the Frio all weekend and so far haven't taken it out.

I feel I am still guessing as far as ratios are concerned, with the help of 'Think like a Pancreas' I based it on body weight but don't eat enough carbs (usually) to have worked it out properly yet. I am definitely under dosing when I am away from home as I'm never sure when or if my pancreas is going to join in and that last hypo was horrible scary  :(

As an example of how bonkers my BGs have been over the weekend we were staying in a pub and I liked the meal I had Friday night so much I had it again on Saturday but BGs were quite different  ??? Couldn't resist the dauphinnoise potatoes as they are particularly good there so decided to have some and bolus.
Friday before meal 7.8 bolused 10 units 2hrs after 11.1 bedtime 10.3 so corrected with another 6 units and woke next am to 10.8 so corrected with 6 units. So not bad but obviously under bolused.
Saturday night same meal, before 5.9 upped bolus to 12 this time but 12.8 2hrs after. Bedtime 18.2  :o so corrected 12 units.
Thinking back I was in quite a lot of pain saturday night after trundling along a bumpy tow path so maybe that was the difference. Also I never know when the meter is being accurate so have to test 2 or 3 times sometimes to see. Told me I was 16.8 the other night, tested again and 12.8, don't know how I'm supposed to get it right when the meter is so inaccurate. When I complained to the DSN about it she said well but you knew it wasn't right so that was ok but that was before I was bolusing. Think I might tell her this is unacceptable next time I see her.

Up till now I've preferred to eat VLC and it seemed to work well without any insulin but it seems that's not the case any more so I will try the 2 units and see what happens. I am reluctant to do this as I'm still putting on weight but can't stand these high BGs.
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, Doxazosin 1mg, Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #5 on: 11 April 2017, 08:49:36 AM »
I don't know if it helps, but here's a food conversion to glucose chart which might shed some light on no carb meals http://www.diabetes-support.org.uk/info/?page_id=438


Sounds like pain could be a factor too and the other thing is that not having a reasonably accurate meter when dosing boluses is ridiculous.


The other thing that comes to mind is that just recently I've had to alter my basal due to the change in weather.  Perhaps you might need to do that?
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: How do work out my insulin needs when I'm not eating carbs?
« Reply #6 on: 11 April 2017, 10:38:13 AM »
Thanks for that Patti, not sure I've seen that before, very interesting. It appears that because of the time it takes protein & fat to turn to glucose my own 2nd response insulin used to be enough to deal with it but not any more I'm afraid.

I was also wondering about changing my basal but I usually see lower bg's in the summer or when it warms up. I think it's just the pain. Had a relatively good night & woke to 9.8 so at least it's under 10  :)
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, Doxazosin 1mg, Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline Moby

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #7 on: 12 April 2017, 09:57:33 PM »
My ever so wise consultant was amazed that I used to take insulin when I ate salad, despite there being carbs in tomato onion radish, slice of low gi bread, mayonnaise and a couple of goujons,  she was adamant I shouldn't  dose for it.

Mind you she also said testing at 1hr was pointless and corrections were not ' evidenced' in t2's

We had a meeting a few weeks ago where I told her what she wanted to hear and nodded at appropriate intervals.

I've always found that when you tweak your insulin and it starts working,  summat crops up to stuff it all  up again! Illness, stress etc etc....
bw
Moby

T2 since 2002.
metformin 2000mg. humalin I and humalog
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Offline GrammaBear

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #8 on: 12 April 2017, 10:08:10 PM »
My ever so wise consultant was amazed that I used to take insulin when I ate salad, despite there being carbs in tomato onion radish, slice of low gi bread, mayonnaise and a couple of goujons,  she was adamant I shouldn't  dose for it.

Mind you she also said testing at 1hr was pointless and corrections were not ' evidenced' in t2's

We had a meeting a few weeks ago where I told her what she wanted to hear and nodded at appropriate intervals.

I've always found that when you tweak your insulin and it starts working,  summat crops up to stuff it all  up again! Illness, stress etc etc....

Moby - I would have liked to be a 'fly on the wall' when you had your meeting with your consultant.  I wonder if they realize that we really don't agree with them and just nod at appropriate intervals so as to appease them?  My last meeting with my consultant had her advising me to eat more carbs per meal so I wouldn't go hypo.  I wasn't quick enough to nod in agreement, so now she thinks I should eat still more carbs. 

After I've tweaked my insulin and encounter still another issue with it, my husband says "Didn't you just fix that"?  Me:  "Why, Yes I did and it didn't work, would you like to fix this issue for me"?  Whereupon he quickly exits the room for parts unknown.  :)
Type 1
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Dexcom G4 CGM Sep 2007
A1C 6.5%~ Sep 2017

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #9 on: 13 April 2017, 09:04:00 AM »
I should have said also that I only bolus a tiny bit for protein so long as I am having some carbs - as in rounding up e.g. If I have a bacon and egg sandwich on 2 slices of Burgen I round up from 24g for the carbs in the bread, to 30g.  However if I had bacon and egg I.e. Protein with no carbs, I'd have to bolus for 12 - 15g.
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: How do work out my insulin needs when I'm not eating carbs?
« Reply #10 on: 13 April 2017, 11:34:05 AM »
I should have said also that I only bolus a tiny bit for protein so long as I am having some carbs - as in rounding up e.g. If I have a bacon and egg sandwich on 2 slices of Burgen I round up from 24g for the carbs in the bread, to 30g.  However if I had bacon and egg I.e. Protein with no carbs, I'd have to bolus for 12 - 15g.

How did you work out 12-15g for bacon & egg? I've always treated my breakfast as zero carb and although it's becoming obvious I need to bolus for VLC that seems a lot?
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, Doxazosin 1mg, Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

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Re: How do work out my insulin needs when I'm not eating carbs?
« Reply #11 on: 13 April 2017, 06:07:58 PM »
Just trial and error Q.  That's what seems to work.  YMMV
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