I was just recently started on 4 units of Lantus in the Morning and a ratio of 1 unit per 30 carbs of novolog (I have a junior pen so I can do half units) with lunch and dinner. Since starting I noticed that my sugars are no longer all over the place, however I seem to be remaining above 150 even after a few hours of no food. Is this normal? Has anyone had this problem? I am now reaching 200 a lot more than I would like to. I am thinking about doing more Bolus than necessary to counteract the raise. Any advice? I would hate to go low, but at this point I would prefer that to a reading of 290.

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You need to proceed slowly and make changes, then wait for a couple days and see how it goes. Most doctors can only approximate a starting dose and then there is a process of "tweaking" that most of us learn to do on our own in a methodical trial and error.

When are you seeing highs? If you go up a lot after you eat, and your blood sugar two hours after eating is significantly spiked, then your I:C ratio is too generous. Most of us need more insulin in the morning. My own I:C ratios, for example, are 1:5, 1:10 and 1:21. If I tried to bolus 1:21 for breakfast, I'd be way high!

But before you work on I:C ratios you need to see that your lantus is covering you for the "in between times" - waking, bedtime, and several hours after food (or before the next meal). It's not useful to "just bolus more than necessary" if your basal isn't adequate. For example if you are 150 before your meal, where can you go but up? I would try going to 5 units of Lantus and seeing how you do for 2-3 days.

For the bolus, again, slow and cautious! If you are consistently too high using 1:30, try 1:25 and see how you do for awhile. Again, you may find you need more insulin for breakfast.

I just reread your post and see you said "with lunch and dinner". What about breakfast? You need to bolus whenever you eat according to the carbs you are having. If I didn't bolus for breakfast I would spend the entire day chasing highs. Your lantus that you take in the morning is your long-acting or background insulin. It does nothing for breakfast coverage.

I highly recommend the book Using Insulin by John Walsh.

Hi Zoe, this is completely off-topic to the OP but I am curious how you determined such a wide variation in I:C ratio? I think I read somewhere (maybe Walsh) that I:C ratio should not have a huge variation throughout the day, and that if there are then it's probably a basal issue rather than I:C ratio. (Not questioning you, just curious as 1:5 and 1:20 is a huge difference!)

I don't know that my variation is that unusual, Jen,because I think many of us are more sensitive to carbs in the morning. But who knows; for me, it works. I can't remember exactly how I started out - whether I used that 1:15 and then worked up and down or not, but basically it's been trial and error. I think the span between them has been pretty consistent. I actually did up my basal a bit for the period two hours after breakfast because I hated that my ratio was so low then. I've been tweaking my basals periodically, to change any patterns of highs and lows between meals, but my I:C ratios haven't needed to change for quite awhile.

How about you? Are your ratios the same for all meals?

Well, mine have changed a lot because of some "insulin resistance" (or something!) going on for the past few months, and they also shift throughout the month due to hormones (as does my ISF and basal). So my ratio earlier this month was 1:6, but now it's 1:9 just from hormones shifting. When I wasn't "insulin resistant" it used to be more like 1:11 and 1:14 throughout the month.

But generally no matter where I am during the month, I use a ratio that is 1:2 lower in the morning; so if I'm using a 1:8 ratio during the rest of the day, I'll use a 1:6 ratio at breakfast. My basal rate is also highest from 3:00 AM until 10:00 AM to cover my dawn phenomenon (and I think they might have to go even higher, as I tend to rise if I get up and don't eat right away).

Yes, yours sound much closer than mine. I've been reading your talking about insulin resistance; it does sound like it makes things harder! And I'm really glad to be post menopausal so I don't have to deal with the flux from hormones. I do seem to have some kind of cycles, where I'm incredibly stable for a week or so then more variation for awhile. But all in all I think I have it pretty easy. I'm not like some people who "stay between 80 and 110 all the time" (yikes!), but I'm lucky that I don't have extreme variations. Like I always say - the luck of the draw.

I don't do it with breakfast because usually my sugars are really high in the morning and my breakfast is either tiny or non existent. I feel like my sugars only go up, even after hours of not eating. It's really frustrating!! I had no idea that my lantus should be keeping me at a base line (I am new to this). I sent an email to my endo and asked her what I should do. I'm cautious to change my doses without approval because I am at school and going too low would be difficult to treat in class.

It sounds like you have DP, which makes your blood sugars be high in the morning till you eat, so the best thing is to eat a low carb/high protein breakfast, and add a correction in for the high blood sugar. I'm not sure if you are learning to do corrections yet.

No corrections yet :) What is DP?

DP is "dawn phenomenon," which is increasing BG in the morning as our bodies wake up.

For me, it's best to eat a little something--an ounce of cheese, maybe--when I first get up. That seems to help hold off the DP until I have breakfast an hour or two later. Skipping breakfast isn't good for me, at all, now that I'm diabetic. If I skip breakfast, my liver will dump glucose and my BG will rise. But eating a very low-carb breakfast that's high in protein will keep that spike from happening. So, I eat bacon and eggs or a cheese omelet--something like that, with no more than 4-5 grams of carbohydrate.

To know if you have to increase bolus or lantus or both, you have first to focus on your basal (lantus).
Try one day to skip your lunch and see if BG stays at a number, or goes low or up more than 30 (just to have a number).
It doesn't really matter at which number you stay: lantus has to keep you at a fixed BG (it's never that really fixed, but just say +-30 around a number).
If you are high, lantus has not the "role" to lower your BG, that's the duty of a correction bolus.

Another day get your lunch but skip your dinner and look the same: does your BG stay even in the evening and at night ? Do you wake up at a BG near the BG of the evening ?

From these tests you should see if lantus is right, and if it covers you day and night.
If it's OK, you can increase your boluses.
If not, first set the basal because when you change it everything else changes (boluses and correction factors).
You could have half day good and night wrong with lantus in the morning: someone split lantus in 2 doses. First measure than think about it and talk with your doctor.

From your page it looks liek you are recently diagnosed. Forgive me if you already know what I tell you.

First, you should have different carb ratios at different times of the day. Some people have 2 and others have 3.
Second, I have 3 different basal requirements every month. Two of them are each for 2 to 4 days per month and the third is the rest of the month. I didn't figure out how to control that well until I switched from Lantus to Levemir. Levemir works better for me, but we are all different.

If I skip breakfast and take no humalog, I will go up about 150 to 200 points the first 3 hours I am awake. If I have some protein, like an ounce of cheese or 1/4 c nuts, or an egg, it stays pretty stable and I need no insulin. Also, If I sleep in on the weekends, I take between one and 2 units of insulin, depending on what my bg is when I wake and test. Then I go back to sleep.

Lastly, lack of sleep and walking around with a backpack full of heavy books will challenge every diabetic, so make sure you always have something with you. I majored in engineering, so my backpack was always heavy and my schedule quite irregular.

I was just started with 1 carb ratio. I will definitely talk to my endo about getting other ones. I don't understand how my blood sugar can increase without eating anything.




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