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
Ok I'm going to try moving the time and waiting and hour later. Thank you!
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 :(
Don't be scared of going low.
One unit of insulin is not going to have such a dramatic or rapid effect if you are high that you won't be able to detect it if you are tending to go low.
So you are high (and expect to stay high until the next meal). You take one unit of insulin and then you test at 1 hour and then at 2 hours. You can test more frequently (say every 30 mins) if you are really concerned to see what happens and when it starts to happen.
Say you test at 30 minutes and not much change, but a good drop at 1 hour, at 1:30 still going down, at 2 hours down again, but at 2 1/2 hours, not much further drop and 3 hours pretty much the same as at 2 1/2 hours. This would tell you that your main action from the insulin is somewhere in the range of 2 - 2 1/2 hours. Next time you may decide only to test at 2 hours, and 3 hours. The key here is monitoring so you know what's happening. Being your own science experiment.
If you are at say 180, and 1 unit of insulin drops you 40 points (this is an average starting assumption - just like your starting i:c ratio was 15), you are only going to go down to about 140 (or even if you were very sensitive you would only go down to say 100) - well outside any danger of going seriously low. (later on once you know how much 1 unit of insulin drops you, then you'll dose the units of correction dose appropriately). For now, it's just determining how much 1 unit drops you. This will also be useful later if you are high before eating, when you can take both a correction dose and your normal bolus (based on i:c ratio) before eating.