I’m in the process of waiting for my endo to get my test results and recommend a change in treatment. (and also in the process of determining of I am Type 2 or 1.5). I currently only take Lantus and Glucobay before meals, but am anticipating getting put on short-acting (bolus) before meals as I have high numbers post prandial.
My old doctor (not an endo) had tried me on Apidra and he just told me to take 5 units 20 minutes AFTER each meal, nothing about what I was eating. That lasted 3 days when I had a hideous low which scared the crap out of me. I know (especially if I am a Type 1) I will have to go back to bolusing so I’m trying to learn more about it. (as well as learning to eat lower carb so I don’t need as much).
It seems like most of you have learned to do the Insulin/carb ratio and dose based on what you are about to eat. So my first question is: Did your doctor give you the ratio or is that something you learned to do yourself from books and from trial and error?
My second question is that I have a friend with Type 2 insulin dependent diabetes and he does his insulin very differently. He tests before his meal and then injects based on a sliding scale. (A range of doses based on a range of possible blood sugars). He only modifies this dose for what he is about to eat in a general way, like if it is a fairly high carb meal he will increase the dose a tad. Does anyone do it that way or is the I:C ratio much better?
Thank you in advance!
Zoe
The ratios are pretty much refined by trial and error. The I:C ratio is originally guessed at by your TDD by using the 500 rule… divide 500 (some use 450) by your typical TDD and that will give you a place to start in terms of how many grams of carbs one unit will cover.
It’s pretty close for me with lunch and dinner, but I need more insulin to cover carbs in the morning.
Usually your doctor will start you on a conservative dose based on weight/or test results. Then your dose will be adjusted often in the beginning based on blood sugar readings, and carbohydrate intake. If you are diagnosed in DKA, your dose will often start off high and will be gradually decreased as your blood sugar comes back down to normal. Also, the doctor will usually try and keep it as simple as possible, and he/she should tailor your insulin to your preferences and abilities. You should tell him/her what you are willing to do and not do (how often will you check you BG… how many shots you are willing to take etc…)
Later on in your diabetic life, once you are more comfortable taking insulin, you will be adjusting and tweaking your insulin on a continual basis. “Using Insulin” by John Walsh, and “Think Like A Pancreas” are excellent guides to adjusting your own insulin doses.
I think when you first start out on insulin, it is best to trust your doctor’s recommendations. They have a lot of experience, and they err on the side of safety. Insulin is a pretty powerful tool, and certainly demands respect.
I take 10 units of Lantus. I started out on 25, then went down to 20, 15 and 10. On the higher doses I was having hypos before mealtime, but I still have highs after eating. When he tried me on the Apidra, 5 units kicked my butt (and I was eating probably too many carbs). So let’s just guess 3 units per meal, that comes to 19 per day, let’s say 20 into 500 is 25, so does that mean my ratio would be 1:25? But I hear most of you talk about like 1:5!
So I’m assuming everyone does ratios? Nobody does like what my friend does, based on the glucose before the meal?
Lows can be quite scary. Never heard of anyone bolusing after a meal, unless they had delayed stomach emptying (gastroparesis), or some other gastric problem.
I:C ratio is the way to go. Counting carbs isn’t difficult & matching insulin to food is effective once you know your ratio. Sliding scale isn’t accurate. In addition to I:C ratio, you’ll be taught how to correct highs with additional doses, which is similar to a sliding scale. You’ll know how many units of insulin will bring your BG down to a target number. Your doctor should also tell you how to correct lows. For example, 1 carb sugar will raise my BG 10 pts. Everyone is different.
Many endos start, depending on weight, level of activity, etc., with a usual dose of 1 unit of insulin for each 15 carbs & then adjust from there. As Sarah said, it’s a lot of tweaking by trial & error. Not to discourage you, but ratios can change over time & also according to time of day. I have different ratios for breakfast, lunch & dinner & others seem to do the same. Hormones, stress, illness, infections can play havoc with BG & require higher doses.
The best thing you can do is keep good records to help your endo fine tune your doses. My endos gave me forms. Record what you eat (how many carbs) for each meal with your BG before meals, doses, BG 2 hours after meals, BG first thing in the morning & right before bed.
Makes sense that you were having hypos between meals with a too high Lantus dose. Basal insulin, unless in really huge doses, won’t effect post meal highs.
Since you’re newly diagnosed & not sure yet of your diagnosis until you get the test results, you may only need small doses of bolus insulin. You may be quite insulin sensitive, not terribly insulin resistant, &/ or in your honeymoon phase where your pancreas is still producing some insulin.
Everyone I know does ratios. Sliding scale is rather old school.
Thanks, Gerry, for the great explanations. Unfortunately I’m dealing with Third World Doctors which means I will probably have to educate them as much as vica versa. The after the meal plan was a regular doctor here and I will be seeing an endo now. But First World countries are no guarantee either because my friend on the sliding scale is seen at the VA. I myself was diagnosed Type 2 two years ago and nobody thought to do any tests at all!
I know one thing: If using our brain regularly is protection against Alzheimer’s I’m good to go until age 90 because I am learning more new information than I have in years!
It is daunting, even in a not Third World country, so I can only imagine what you’re up against. VA doctors are notoriously bad & I hope you can help your friend. Also hope your endo is good. Do you know what tests were done? Should have been a GAD antibody test & C-peptide for starters. If possible, get your thyroid tested as well (free T3 & free T4) because many diabetics have thyroid problems. Hypothyroidism is very common in women, even non-diabetic women. Our fun endocrine system!
Hugs & kudos for taking control of your health! I’ve read enough discussions here to know that everyone everywhere has gotten substandard treatment & bad recommendations from doctors, nurses, dieticians & CDEs. Great that you’re researching & learning. It can be overwhelming. Yea, will keep your brain young for years!
In addition to the good books mentioned above, get Dr. Richard Bernstein’s “Diabetes Solution.” Chapters from his book are on-line at www.diabetesincontrol.com. Click on archived writers. I also like www.dsolve.com.
Diabetes is all about self-management & self-care. Knowledge is power couldn’t be truer for our situation.
I’ve learned more on Tu D than I have from doctors. My first endo wouldn’t agree to me taking two basal doses (right before bed & another first thing in the morning), so I did it on my own. Of course, he was also encouraging ADA 45-60 carbs per meal as my BG was on a roller coaster & I felt awful. I went low carb against his advice. Later I found an endo who supported my decision.
If you are honeymooning that actually sounds about right. If you really are a type 1, you won’t fall into the smaller ratios until you’re not making any insulin at all, which can take quite a while - for me it was nearly 18 months.
Like Sarah said ratios are trial and error. My dinner ratio is 1:13 meaning if I took 5 units of Apidra (which I do use) I would have to eat 65 grams of carbs. Now if you have Lantus in your system as well this is also going to have an effect on your BG. Basically if you ate a salad with some protein and vegi’s then you are definitely going to go low. If you ratio was 1:25 then you would have to 125 grams of carb, 5 units of Apidra is a lot at almost any time and when I see my pump saying I need more than 4 units I always do a double take because going low is no fun and dangerous.
Maybe try 1 unit and check your BG 2 hours after eating and see how you are doing that way if you need more then you can increase it.
Thanks all. I actually was diagnosed in 7/07 so I have had time to lose pancreas function. I was stable on oral meds only for about a year, which is what led me to question being Type 2 at all. Thanks to research on here and elsewhere I sought out c-peptide and antibody testing. I was able to get the c-peptide but antibody tests are not available in Guatemala. My c-peptide was .38 so I know I’m not producing much insulin. My endo said she didn’t trust the labs in the town I live and had me do it all over again and I am awaiting the results and her recommendations. She wanted to throw a bunch of oral meds at me but at least when I said, “Nope, been there, done that. Let’s wait for results before making changes.” she said ok. Thanks for the heads up on thyroid, Gerry. I actually was hyperthyroid 17 years ago and had my thyroid destroyed by radiation; I now take thyroid replacement and that was the first thing I thought about to account for my diabetes being out of whack. But my thyroid numbers are in target range so that’s when I started thinking about Type.
