Ok so I seem to be getting my breakfast and lunch under control. I take 4u of levemir when I wake up in the morning and right now i'm taking 1:6 of novolog for breakfast my number is still somewhat high but i'm giving it one more day before I go to 1:5 and I'm always down to a pretty low good number right before lunch so I feel like the basal insulin in the morning is good. Lunch I'm at 1:13 for Novolog and also seem to be doing well with my number and it's at a good number before dinner as well. Now with dinner this seems to be where my problem is and I can't figure it out. My ratio for dinner is 1:10 Novolog and my 1 hr number and 2 hr number are great but i've been checking and by 3 hours it's going up and by the time I go to bed it's high. Like example my bs was 90 1 hr 102 2 hrs and by bedtime it was 156, I don't get it.I take my other half of leveimir at 8:30 4u. I don't feel like I should increase the morning levemir because I feel like if I do then I'm going to end up going low between breakfast and lunch or between lunch and dinner... I don't know what to do? suggestions>?thanks
Yes, you are right. If you are fine on your post prandial 2 hours after dinner and then start going up towards bedtime, it is your basal that's responsible. So, yes, I would try increasing the morning Levemir to 5 units. Another option is to take it a bit later. You don't say what time you take your evening dose, but they don't have to be exactly 12 hours apart.
If 5 units in the morning makes you go low, and taking it later doesn't help than another option is to switch from pen to vial and get syringes that have 1/2 units. Getting basal right on MDI is not an exact science unfortunately; you have a lot less options than with a pump where you can have different rates at different times of day.
But I do want to say congratulations on getting your breakfast and lunch numbers down. It sounds like you are doing a great job and have come a long way from when you first came on and said "the doctor said to take 1:15"!
Zoe has made some good suggestions. I just want to throw one other possibility into the mix. If you are eating a high protein, high fat dinner the carbs in your dinner might not hit for three or more hours. I can go high 4-5 hours post when I eat a dinner that includes a medium to large piece of farmed salmon. One way to handle this problem on MDI is to hold back on some of the dinner insulin and take it an hour or two after starting your meal. You won't have quite as good one and two hour post numbers but you'll be able to cover some of the late surge.
It sounds like you're doing great.
Maurie
Well the thing is i'm 150 or 160's when I go to bed but then just 3 hrs later..say 2am because i've been setting my alarm for then to see by then i'm already between 130 to 110 by morning i'm anywhere between 100 and 110. I've been taking my levemir at 8:30 at night and 8:30 to 9 in morning. So If I increase the morning dose to 5u will this make me go low? My lunch numbers are usually between 80 to 120 at 1 and 2 hrs after lunch...well depending on what I eat I have had 1 high in there with the ratio but usually not sometimes even in the 70's at 1 hr and then goes up a little by 2 hours i'm afraid upping it will make me go low...Should I change the ratio for lunch with the novolog or will that make me go high? I want to fix the dose so I don't go high 3 hours after bedtime but don't want to go low before or after lunch...ugh I'm nervous to try now lol. thanks everyone for the advice.
Also how can I figure out how much 1u of insulin drops me?
There is no telling if you will go low if you increase your morning levemir to 5 units until you try it. You may also try taking it a little later to see if that helps. No, why would you change your lunch I:C ratio if your pp is fine?
As for how you figure the ISF - same as I:C ratios - trial and error. When you are quite high try one unit and then see how much it brings you down in say 3 hours. If that doesn't drop you too low do that whenever you are high and keep records. Then you will start to see how much one unit drops you. Be sure you have no IOB when you do it.Also, I wouldn't suggest doing it at bedtime for now; you need to be able to test and see what happens.
So to have no insulin on board I would give myself the ISF 4 hours later? Because isn't there insulin in you 4 hrs after giving the novolog? I'm confused on that part I guess.
Also if I take it a little later should I leave it at 4u or still increase to 5u?
I agree with Sally, do one thing or the other.
Ok I'm going to try moving the time and waiting and hour later. Thank you!
We all have different durations of action for our insulin. I count mine as three hours though it might be a tad more.
Have you thought about fat content of these particular meals? If your dinner is higher in fat than lunch or dinner, it might affect you as described because the fats aren't letting those carbs hit you until the insulin is leaving your system.
Yea it shouldn't be fat content. I have some meat but most of my carbs are veggies and nuts.
Question so say my 2 hr number is high and I decide to test how much 1 unit of insulin brings me down say I wake at 7am at 2 hrs i'm high at 9:30 and I give myself a unit of insulin, if I eat lunch at 12:30 wouldn't I still have insulin in me and wouldn't that be like stacking? I plan on testing to see how much 1 unit works next week if I have any highs but i'm scared of going low.
You always have to take into account the IOB. So I count my duration as 3 hours. So if I took 3 units (for a nice round number) at 7:30 for breakfast and I was high at 9:30. I would know I still had a unit insulin on board and would take that into account if I wanted to correct. (Sometimes that means I don't correct at all if I'm not too high because there is still enough insulin to lower me). If you do correct with a unit at 9:30, then at 12:30 it will be gone if you use the 3 hour figure. If you use 3 1/2 or 4 you would have a fraction left. With shots all you can do is round up or down accordingly.
As for going low, as part of trial and error you may go low. That's how you know when you've taken too much insulin and gear your computations back down. it's not the end of the world; just be slow and conservative in your changes and just test frequently and use glucose tablets to bring you up if you're low.
Denise do you have an iPhone by any chance? There are some really good apps for helping you dose for carbs and correction. Oh course you still have to keep track of your insulin on board, but I found it a big help when I was doing MDI.
I wish I remembered the one I used, it was really good, but there are several out there, you can put your target range, your correction factor, your carb ratios etc. And just plug in your blood glucose reading and how many carbs you are eating.
no I don't have an iPhone :(