Hi all, I have been getting a few lows after either lunch or dinner. I take 10 units lantus in morning and 24 evening. Humalog counting carbs/glucose scale. Type 1 13 years since diagnosed
Thanks in advance
If it has been happening several times after those meals, and the lows are at your post prandial test 2 hours after eating I would try reducing you I:C ratio by one or two for a few days and seeing how you do. In other words if you use 1:10, try 1:12 for awhile. Remember different meals can have different I:C ratios.
What is your TDD.
I require less insulin for my lunch and dinner meals...you may consider using a diffrent I:C for lunch / dinner. You may also need to correct your bolus depending on your BG at that time using a correction factor. It would be wise to basal test your Lantus, skip lunch and see what happens, skip dinner and see what happens.
Unsure my Todd. Take total 34 units lantus and on scale with humalog 60g/5,45g/5,60g/10 plus my blood sugar on scale.
Wow that's an interesting split on the lantus. I was taking 20/10 but have switched to 14/14 because I was having some lows after lunch and dinner. And once I got the basal under decent control I started working on the I:C ratios for lunch and dinner. But I waited a couple of days between each change to figure out if it was working or not.I always find if I try to change too many things at once it just muddies the waters. But could it just be that your carb count is a bit off ?
Not sure what you mean by those humalog numbers. usually Insulin Carb ratio is like 1:12 - one unit for every 12 grams. Is that what you mean by "60g/5"? Do you eat the same amount of carbs at each meal? It's better to just do it say 1:12 which then allows you to vary your carbs to eat any multiple of 12.
When you say "blood sugar on scale" do you mean a sliding scale: "if my blood sugar is this amount, I take this much more insulin". That's kind of an old fashioned way of doing it. Although at least you do the I:C ratio - some people do just the sliding scale. Rather than a sliding scale it's better to just find out your ISF. An ISF is how many points one unit of insulin drops your blood sugar. So for example my daytime ISF is 1:35. My target is 110, so let's say I'm 180 - I know I'm 70 points over target so I would add two units to my bolus.
I really recommend getting the book Using Insulin by John Walsh which will help you with all these things.
I will check the book out thanks. I am all new to this carb ratio thing, I was not a very good diabetic to be honest till now. my eyes were getting bad, my legs are in constant pain and very fast heart beat put me in the hospital, was a wake up call for me. I live in a town that does not offer much help. sigh. I used to take 80 units of Lantus, and a sliding scale, no carb counting. I lost a lot of weight and went back to the doctors asked him what I should take in the way of units. he told me to take whatever I was using before. I said would that not put me in the hospital? i used to way 160lbs down to 110lbs, now weight 120lbs. so came home read a lot in your forums and other places on the net about carb counting and splitting the doess etc.. so got me to takeing 10units in the morning of Lantus and 24 units in the evening. went to the diabetic center they put me on a carb system, I am allowed 60g of carbs in the morning and subtract the fiber divide by 5 then check blood and add from a sliding scale. Lunch it is 45g, dinner is 60g divided by 10
so breakfast would look like this 53carbs - 6 fiber = 47 divided by 5 = 9.4 blood sugar was 7.1 so i would take 10 units of insulin for my breakfast. I use myfitnesspal to calculate the carbs and fiber. since this new way however it seems all I am doing and they have me on kidney meds and crestor, I am wondering if the crestor is what is causing the pain in my legs and the headaches. I was on altace but had a bad reaction so they changed that medication. I go back tomorrow to the doctor but not till next month to the diabetic centre so I am so grateful that there is a place to talk this out and get help since I am feeling like I am on my own again. been trying to find a specialist out of town to help me. my doctor does not even know about humalog. hmmmm
I hope this explains a bit, sorry for the confusion. p.s. I test myself before I eat, and 2h after I eat before bedtime, and whenever I feel lows coming on, but lately I have not been getting the sweats or anything my eye sight goes where I have a bright white spot that is the only way I know now when my sugar is low. I am always high above 10mmol in the morning then either lunch or dinner about 2h I drop to about 3.6-3.2 so never know if I should adjust my lantus or humalog and if humalog adjust the lunch or dinner or both, since this is not all the time but at least 2times a week. thanks all for all your ideas, going to check out that book. it is Canadian? I bought a book the other day called think like a pancreas, a practical guide to managin diabetes with insulin, by gary scheiner.
I am new to this ratio system, seems to be working for the most part but takes up so much time in doing it. when I wait more than 5 hours to eat my sugar will drop low, the diabetes center put my lantus at 10 morning 24 evening, they wanted me to take all of it at one time but that never worked for me, I started to split the dose and was 10 morning 15 evening, DC put it up to 24 in the evening, still wake up with highs over 10 in the morning, then 2-3 times a week lows after lunch or after dinner, but not always. if I eat every 4 hours. if I wait for 5 hours I drop quickly.
I use my fitness pal to log my foods, seems more accurate then others I have checked out. so I log my food then subtract the fiber and do the math. so I think my math is correct (use calc)lol. they have me on 60g of carbs in morning and have to divide that by 5 lunch 45g divide by 5 and dinner is 60g carb divide by 10 so would my I:c be 5:60, 5:45, 10:60? bit confused with the logo and the diabetes centre does not explain this, just looks at my work and says do this. sigh.
Going low after meals could either mean your basal is too high during that time or that you overbolused for the meal. Sometimes it is easy to tell the difference, if your lows are occuring more than 5 hours after the meal that suggests a basal issue. If the lows occur within 2-3 hours of the meal, that suggests a meal overbolus. These aren't fixed rules, but they can help you identify the difference.
I found the book "Using Insulin" really helpful as a resource, it explains things very well.
Although I am a T2, like others here, I find I am very insulin resistant in the morning, so I use a totally different breakfast ratio, resulting in a bolus several times larger than would be needed for the same meal at lunch or dinner. And like you, I split my bolus and take a larger split at night to try to help my constant morning highs.
Simply the act of asking these questions and trying to improve yourself will make you better.
Do you chow down on some glucose for the lows? Are the lows followed by high bg's like 3,4,5 hours later?
For many of my meals, Humalog will "kick in" too fast. Especially meals high in protein/fat and low in simple carbs. I have learned know that for certain foods (e.g. low carb pizza) that I have to take the insulin maybe a half hour or an hour after the meal or I'm going to have a hypo.
"How can I be having a hypo? I just ate!" is a very frustrating place to be. I remember when I first figured out the patterns, but until then, oh so frustrating.
Good old Regular (R) never had this problem for me. But I usually don't keep R on me anymore, I'm usually out there with Humalog.
It's also possible that your Lantus doses are getting out of whack, and your large evening Lantus dose is "kicking in" the next afternoon. Folks have these model curves of when insulin will kick in, but it doesn't always work that way. Especially... for large doses of Lantus (24 counts as large in my book) the absorption will be delayed. If your Lantus is being split 10/24 that sounds like a runaway feedback loop to me.
Your TDD would be Lantus Total + Humalog Total = TDD (Total Daily Dose)
yeah unsure about my lantus but well I only have the resources that I have. sigh. not great here at all. got two doctors fighting about if I am type 1 or type 2, have my family doctor that knows nothing about humalog which the other doctor put me on and the diabetes place, well although trying is not explaining to me what they are doing even though I have asked. they are just wanting me to learn the carb thing but not telling me about ratio's or what any of it means just tell me do this and gives me a card to follow. ugh. very frustrating, been trying to find a specialist out of town but well, has not happened lately since nobody wants to step on anyone's toes. wanted a pump awhile back but was denyed by the specialist since he is the only one on call. hmmmmm hence why I wanted to join this forum and learn. thanks soooooo much for all the replys and helping me out.
my lantus is 34 (10am + 24pm) unsure what my humalog is as it keeps changing with what I eat, but breakfast i divide by 5 same for lunch and dinner i divide by 10 to whatever carbs i am eating, 60g for breakfast 45 lunch and 60 dinner plus whatever my blood sugar is on sliding scale.
That is a good book as well; most of us read one or the other. It should explain I:C ratio in a way that is much simpler than what your doctors taught you. Also, 60 grams is an enormous amount for breakfast and especially if it includes cereal can be very hard to bolus for. You might consider lowering your breakfast carbs and then just using your I:C ratio as 1:12 which is equal to 5:60. You shouldn't have to eat a set gram of carbs, but should have more flexibility. The book will explain it.
Think Like a Pancreas is the first book I downloaded on my kindle to help me understand how this all works. It is a bit more directed toward the pumping crowd, but it still has some very important information that we all can use. You are basically using an insulin/carb ratio or I:C but you have been taught to do it backwards. It is more carb/insulin in that you are allowed 60 grams of carbs at breakfast (and I agree with Zoe this is a lot of carbs to pack in to breakfast) but you divide backwards from that to come up with 10 units of insulin. For me I find the I:C ratio makes more sense and requires a lot less math. My I:C ratio for breakfast is 1:5 so if I was going to eat 60 grams of carbs I would have to take 12 units of insulin. Your I:C ratio for breakfast is probably pretty close to 1:5 as well, but you arrive at the number differently and with a lot more math.
You may be completely correct about the Crestor causing muscle cramps. I have found that simvastatin causes all sorts of aches, pains and muscle cramps and lipitor does not. While most stupid doctors will say 1 statin is the same as another statin for some patients a different statin can make a huge difference in the quality of life and the amount of painful side effects.
As far as weight loss and needing less insulin. I asked that exact same question of my CDE (certified diabetes educator) who is also a nurse and is also someone I really respect. I was curious because when I first started taking Lantus about 10 years ago my dose was 30 units at 9 pm at night. I weighed close to 200 pounds at that point. Fast forward 10 years and I have lost close to 50 pounds yet my lantus dose has not changed appreciably. What Mary (the CDE said) is that lantus dose is not for the most part based on patient weight, it is based on patient experience and blood sugars. Now obviously this is different for pediatric cases, but for us adults they calculate a range based on weight and then you are a guinea pig for the most part to see what works for you.
As you have read on here, it is not a one size fits all world. My reaction to lantus can vary considerably to your reaction to it. My I:C ratios are tailored to me, to my history, blood sugars, and may also be impacted by if I have any residual beta cells still functioning or any number of other things.
Gary Scheiner is a CDE and a Type 1 diabetic. A few weeks ago they had a video chat with him on TuD and it was great to have a chance to ask questions.
All I can say is ask questions here, but be your own advocate. If you don't understand something that is going on with your meds or care then make sure you get an explanation. Don't trust that everyone who has a "doctor" badge actually knows how to treat you. You really need to be able to treat yourself and learn everything you can about D. Because TuDiabetes means in Spanish "Your diabetes" and that is exactly what it is.