after how many units of fast acting insulin per day becomes dangerous?
or total insulin per day must we not go over?
There's no 'fixed' amount. Each person's insulin need is a ratio, x amount of insulin to y amount of carbs. Generally the weight and age and activity level are what doctors look at but it's not exactly a fixed number. A little bit of insulin can be very dangerous if it's not supported by food. This also is complicated by needing to have basal insulin "Balanced". If, for example, your 6:00 AM basal shot runs out of gas at 5:00 AM the next day, you have an unsupported hour and your BG will likely run higher when you get up?
If, OTOH, your basal has a "peak" (it's supposed to be flat but some people report peaks with it, sometimes more pronounced than others...), 10 hours after you start, your BG will run down at 3:00 AM, just in time to liven up your drive home from work. Sometimes it's hard to differentiate between "leftover" bolus insulin and basal events of one sort or another.
I agree with AR, DW. My heart goes out to you because you are looking for exact numbers and I remember when I started I was too. I wanted somebody to tell me, "take this number of insulin units". Just like with pills, "take one 20 mg tablet twice a day". When I realized it didn't work that way and I was going to have to figure out my own personal I:C ratio, basal dose and ISF I felt very overwhelmed, like I was expected to be a doctor without having gone to medical school. But it does get easier after you spend some time getting data and start to see what works for you, then it becomes routine.
The amount of fast acting insulin that is dangerous is the amount that brings you too low. But that amount may be very different for me, you and the next person. The only way to find out is to keep tweaking your ratios until you get to where you are in range most of the time. But you have to stop thinking "exact numbers" and start thinking I:C ratios and ISF. That will allow you to eat what you want, bolus the right amount and if you are high, correct it with the right amount of insulin.
Yes, so just like the "1:15 I:C ratio" the various formulas you see (and there are many of them!) are good starting places from which to figure your own. But, unfortunately many people see them as absolutes. I can't tell you how many times I hear, "So we use 1:15 to figure our bolus?" and even "my doctor told me to take 1 unit insulin for 15 carbs". Nope. Just a starting point. There are so many factors that determine dose:age, weight, activity level and degree of insulin resistance/sensitivity and carb sensitivity. Then there are hormonal cycles and the phases of the moon and the wind velocity...ok, I'll stop! The best formula to me is "trial and error". Start safe and wiggle from there until you find what works for you.
i took 8 units of bolus before dinner this evening and i was at 8.5 mmol/l. Then 3 hours after dinner i measured again and i was a little high, 16.6 mmol/l.
so i took a correction shot of 3 units bolus. Now i will wait 2 hours and measure again.
But i will have a talk with my endo this week, and tell her that with metformin and insulin i did not have these highs after meals.
it's not normal, my insulin dosage keeps going higher every day.
The other "component" of BG would be food. What are you eating? The "ratio" bit is pretty important? If you are eating like 72G of carbs w/ 8 units, a "ratio" of 9G of carbs/ unit is "implied" but a result of 16.6 (298?) would imply that the ratio was off? If you had more carbs, the ratio changes but the conclusion is the same and the ratio would likely need adjustment? If you are just blasting away, it's hard to calculate the ratio precisely (plus, there's also the consideration of what basal insulin might be influencing things, whether up or down?) but the data you are getting can still be used to say "ok, 9-1 doesn't work, let's try 7-1, if that doesn't work, try 5-1..." or whatever. It's very challenging. It can be advantageous to use smaller "doses" of food as, in my experience and that of other people trying lower carb solutions, the ups and downs are less pronounced so you don't get the "trashed" feeling from running up and down all the time?
i just checked and i just went down to 13.1 with 3u bolus.
How long after the shot was that, 4 hours? While 2 hours is a good test, it may have taken it a while to work. There’s like 6 hours of duration on 'log according to manufacturers but I use 4 hours in my pump, ignoring the “spare change” after that. Depending on the food/insulin “imbalance” leftover from dinner (?), it may have gone up a bit more and then down as the shot started to deploy? 13.1 is moving in the right direction.
11.7 this morning when i woke up.
i think i am not taking enough for the amount of carbs i eat or i am insulin resistant.
Even though i took a 3unit correction dose i still remained high.
i think my ratio is more like 5 carbs / unit.
Maybe i am not drinking enough water or not exercising enough.
I still feel that i was doing better when i had both metformin and insulin combined.
so now since i woke up with 11.7 (210.6mg/dl).
i am having coffee with 2 toast and peanut butter, it says 16g of carbs per slice, so x2, it's 32g carbs.
so what dosage you recommend? i was thinking
32 divided by 5, so 7 units plus 2 since i am already in the 210mg/dl and i want to bring it down.
A C-peptide in June? Damn, that's a long wait. Are you being tested for GAD-65 or Islet Cell Antibodies ?
It is really a shame that adult type 2's are not tested for these antibodies as they are a very good indicator of the possibility of Type 1 onset. If so, the sooner you start on Insulin, the better.
Like most doctors, my primary care Dr. had no clue and it nearly cost me my life. I kept being given pills when really I needed insulin. I lost ten pounds in three days and that was my wake up call to seek other medical advice. The endo I went to told me I was about a week or two from going into a diabetic coma.
I strongly advise type 2's who have not been tested for antibodies to do so.
Thanks for that link SM, that really helped me understand ratios.
I think i was not giving myself enough insulin.
i was off by 2 or 3 units per dose and i was starving myself to keep my BG low and then i felt worse because of no energy.
my total daily dosage is about 40 units, but i realize it should be more like 45-50.
Now i got to figure out if i have to increase the Lantus, because i wake up a bit high and i been taking 21 units at bedtime.
Sounds like you're getting the idea! Keep up the good work. It does sound like you have some insulin resistance, so even if you do end up being diagnosed type 1 you might talk to your doctor about keeping you on the basal/bolus regimen and adding back the Metformin because that helps with the resistance
Hmm, I'm not going to try to figure out where a reply to DW's last post would end up here however I'd wonder if it's high all the time, it might be a basal shortage as much as a ratio shortage? If you wake up at 11, that would be higher than I'd perhaps want to be although I am a bit of a nutjob about things? Sometimes the AM can be "fasting" in that you haven't eaten but there's a couple of things (dawn phenomenon and the somoyogi (sp?) effect) that can also contribute to elevated BG in the AM?
With all due respect,DW, two pieces of toast and peanut butter is blood sugar rocket fuel. Bread converts to glucose very rapidly with a concurrent spike in BS. I have not had a piece of bread in months. In fact I have eliminated grains virtually completely and am gleefully watching my A1c, my meter readings, and my insulin requirements all decline.
It's not easy limiting fast acting carbs from the diet. It's also not easy having to go on dialysis, et. al. My taste buds are not as important as my eyesight, my kidneys, and my nervous and circulatory system. I believe you would benefit from learning the difference between fast acting and slow acting carbs.
i know it's way too long, i need to know sooner, i can't stand not knowing. It stresses me out.
yeah it's kind of confusing, sometimes there is no reply button, lol.
But it's whole grain wheat bread, not white flour.
what you recommend as slow carb breakfast?
I eat eggs w/ spinach and broccoli for breakfast about 5 days/ week. In my experience, I don't think that whole grain bread is much easier to digest than donuts or Cap'n Crunch, despite the other health benefits of thicker bread. I haven't had much of that for a long time.
For a Type 1, whole grain vs white flour doesn't make that much difference; carbs are carbs. The morning is when many of us have the least tolerance for carbs. I would suggest eating eggs for breakfast - you can add sausage or bacon, cheese, vegies, etc and have very few carbs.
some of us do eat bread and some don't. If you do, then I would stick to one piece, not two and fill up on other things.