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Permalink Reply by Debbie on March 15, 2009 at 10:19pm

Geeze I don;t know im still trying to figure all this out myself,,,,I take 46 units of Lantus at bed time now(just had to raise it),,,I do 1:15 at breakfast...1:12 at lunch....and 1:10 at supper of Apidra..I also do Symlin if I eat a meal that has more than 250 calories or 30 carbs. When I have the Symlin I cut my Apidra by 50%. I am T2 and not on a pump so YOU proally need someone that is pumping to answer this. I was told to have 45 total carbs per meal and 15 total carbs for snacks..total of 180 carbs a day. Every body said,,ut ohhhh way too many carbs so have cut down and trying to reach a total of about 30-35 carbs a day or less! Doing pretty good at it so far! Good luck with your pump,,everyone here swears by it!..Just look around there are many here who have great advice!,,,MelissaBL...Kirsten...Gerri.....etc..God Bless,,,Deb

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Permalink Reply by nel on March 15, 2009 at 10:27pm

I am glad to read you will be pumping soon ...your carb ratio( 's ) easier to define, initially lots of fasting etc. etc. and ultemately less insulin ...I have 4 ratio's during the day ..I am surprised to read you are using NPH at bed time , why not Levemir as you do in the morning ?? ...maybe reason why you have lows in the afternoon ...insulin stacking ???
My observation : you may want to tell your Endo , that you like to be coached , how to correct and how to control your dosage ...in my view diabetes is a chronic disease , that has to be self managed with the help of the Health Team ...they are " our consultants " .Hope you get the BEST pump trainer and keep on following up with the person till you feel really comfortable in changing your basal/bolus settings. Happy pumping kiddo ....John Walsh's Pumping Insulin on the coffee table !!

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Permalink Reply by Gerri on March 15, 2009 at 10:38pm

Other than your exercise lows, how are the rest of your readings, including your between meal ones? If your 2 hour post meal numbers are good, than your ratio is correct. If you've got consistent lows before meals, your Levemir may be too high. You can try by slowly decreasing (by 1/2 units) your dinner Novolog to see if this helps the evening lows.

Most people tweak doses constantly, just do it slowly to see what happens. My endo told me to try new doses for three days to get an idea of pattern.

The way to decrease your insulin doses is to decrease your carbs, whether you're on the pump or MDIs.

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Permalink Reply by Terry Keelan on March 15, 2009 at 11:08pm

First of all, don't play games with your endo. If you're not going to follow his advice, get a different endo.

He/she has you on a 1:4 ration for breakfast and lunch and a slightly lower ratio for dinner. Your calculations seem about right.

As for going low after exercise - it's to be expected. Adjusting your insulin to account for it is difficult when you're using MDI's but will be easier when you start on the pump. You would then make adjustments to your basal rates, which have nothing to do with your insulin to carb ratios. In addition, if you're exercising for less than an hour, pump adjustments won't make a big difference.

If you are going low after exercising then by all means eat something. Non-diabetic athletes do it, why not you? It not only makes perfect sense, it's also THE way to treat a low. If you want to prevent going low during exercise, eat something before you start, or reduce your lunchtime insulin. How much? Who knows? It's trial and error time. Try reducing it by 10% at first and adjust from there.

But tell your Endo. What's he there for anyway?

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Permalink Reply by Leo2 on March 16, 2009 at 12:58pm

To get control, I find using small numbers helps a LOT. If you're constantly fixing lows, reduce your basal insulin by 1/2 a unit in the morning. Keep it for 3 days, then reduce again or remain the same as needed.
Reduce your bolus at the meal before exercise - and if that puts you high, the next day keep the bolus the same and just before exercise take a couple glucose tabs. And if all that reduces your lows - over 3 days - (keeping track of time, meal carb, test result) don't fear reducing 1/2 unit until you're at 100 all the time.
You'll be SO happy to be rid of the NPH in this mix when you're pumping. And you'll be able to figure an exact I:C ratio per meal if you stick repetitively with one number carbs for a meal over a few days. The lower, the easier to figure. Then you can raise it from there.
You don't say what your weight is, but if you're 105 lbs, 1.5 grams glucose tab raises you 10 mg/dL; if you're 140 lbs, 2 gms glucose tab raises you 10 mg/dL. And remember because it's glucose, it raises you more quickly. 15g snacks are not all the same. Once you know how many glucose tabs you need, you can convert that into what kind of a snack you need with exercise to keep you even. Treadmill and vacuuming are not the same exercise and require different amounts glucose to cover, but by keeping records, you'll have it smooooth!
You will be SO HAPPY pumping!

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Permalink Reply by josephine on March 16, 2009 at 1:40pm

I have pretty much the exact same problem, maybe lower the Levimer, but do chat to your endo, if you ever became ill and ended up in hospital things could become kinda confusing. I understand that its hard to get them to undrstand all the ins and out, but he just wants you to be well. I keep going low, its really frustrating, I don't want to eat more snacks.

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Permalink Reply by Maureen on March 16, 2009 at 3:19pm

The right I/C ratio is the ratio that gives you good control of your bgl's, regardless of how little or how much insulin that is.

Terry Keelan's reply is spot on.

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