Dear schmoop,
i am not a doctor just another diabetic trying to help from my experiences. i only a Minimed 508 pump, which is an old pump by today's standards. i have never see an electronic carb counter and i belong to the ADA and get their magazin Diabetes Forecast and have never see one advertised there, though that doesn't mean they aren't available. i do my carb counting from books and after a while you get to remember your favorite foods and the carbs per serving.
Your bolus should only cover what you eat and you determine that by counting carbs. The carb/bolus ration determines how much insulin you get per carb. Your basal rate is what your body needs 24 hours a day to keep your blood glucose in line. From what you describe, it seems to me you need to adjust your basal rates. Are you using a pump? That is the best way to make this happen.
To correctly dose insulin you need to work or both your basal rate (show acting insulin dose), and your carb to insulin ratio. You also need to work out tour correct timing for dosing.
Buy or burrow the book Using Insulin or Think Like a Pancreas. They both explain how to do this.
In short:
For basal testing you need to fast and take your basal insulin and see if it keeps your blood sugar stable or if it rises. If it risers even without eating your dose needs to be increased.
It sounds like you need a specialist that can help you with both carb counting and your insulin intake. Any changes in your insulin intake can take time to adjust. The fact that you are testing so much shows that you are trying to take care of your diabetes. Have you talked to your doctor about the highs and lows? Has your doctor talked to you about going to the pump? There are so many varibles that come into play here. I would suggest speaking to your doctor.
Hi again, Kneazlelady,
I'm also a long-time diabetic and not a physician. I've been pumping for about 9 years -- first with a Disetronic (which I loved dearly, and thought I could never love another pump as much), and now my beloved Cozmo (which I quickly came to love & be humbled by). It's terific you're working with a CDE... and you're reminding me that I'm overdue to make an appt with mine!
to configure the target, sensitivity and the insulin to carb ratio and then the pump does the math for us after enterting the BG and number of carbs eaten or 0 carbs if he is just doing a correction, but not eating.
We can set different basal patterns, as well, because his schedule is different on a school day compared to a non-school day.
Since I am unsure what capabilities your pump model has it is hard to answer this.
What has been going on with your BG's lately?
The best thing I ever did to get and keep my diabetes under better control was to switch from multiple daily injections to an insulin pump. A pump is not for everyone and takes a lot of commitment, but it is the closest thing to a functioning pancreas the medical community has developed. It is certainly worth the time to research and talk to your son's endocrinologist and diabetes educator about. I would love to hear how your son is doing.
In addition after starting the pump and following a low carb diet I lost 35lbs the first year without really trying. It was merely counting the carbs I was eating and making sure the insulin dose corresponded to the food. I must admit that I did not eat a lot of carbs because my control was so much better without them. And with better control I felt so much better so that was my motivation. I hope this gives you some inspiration to try the pump. I truly believe you will be glad you did.
I have type one diabetes and an insulin pump. Have had diabetes since the age of ten and am 20 now. I've been on the pump for about 4 years. I can honestly say I love being on the pump. It's so much more convenient, and my diabetes control is much better. Even when I wasn't doing bgls as much as I should have and was taking poor care of my diabetes as a teen it kept my levels much more stable then they ever were on needles.
m not a medical professional, just the parent of a kid with diabetes, and I definitely feel your pain. My daughter went on the insulin pump last fall, and managing her a1c isn't any easier. Simply going on a pump doesn't make managing diabetes easier, it just makes it easier to deal with corrections without needing shots. The carbs still need to be counted accurately, the basal rates still need to be on target, and the person with diabetes still needs to exercise.
This can be done by carefully adjusting your insulin doses and combine with eating a low carb diet (the low carb will reduce your insulin requirements and thus also protect you from going too low or high).
I recommend the book diabetes solutions by Dr. Richard Bernstein. HE describes how to get excellent control using insulin and lwo carb diet. Even if you don't end up going as low carb as he recommends, you can still use what he teachers and a lower carb approach to get good control.
You need to work on getting her carb to insulin ratio corrected. That should help solve the problem drastically. This ratio can easily change with age activites and stress and other factors. It will NOT remain the same your whole life. Wise to reevaluate from time to time as needed. An easy but not highly accurate way to do this is to take a reading and take a specific amount of Insulin and then about 3 hours later take a new reading. Divide the count change by the number of units taken.
I too struggled at first with insulin doses (which I also tried to adjust myself), trying to understand carb counting, etc. And I too gained wight steadily for years. I know how frustrating it all can be but trust me, what you're experiencing is very common, yet it doesn't have to be this way. What you need is to take control of your diabetes with a team of specialists: an endocrinoligist, Certified Diabetes Educator, and a nutritionist.
Gave a correction bolus, 30 minutes later 600, another correction bolus another 30 minutes another 600, another correction bolus after a site change(insulin pump) and a big correction bolus, still about 500. Now about 30 units of insulin later my blood sugar has only improved by 150 mg/dml. I have heard of insulin resistance due to lack of exercise but surely not this sudden and extreme.
Thanks for the info, I have considered that maybe my "honeymoon phase" was ending or perhaps I was ill, but wouldn't that mean that I'd also need to increase my basal rate? I'm only taking .2 un insulin an hour, but my insulin to carb ratio is 1:5, which just doesn't seem right to me. (It was 1:10 before). I wish i could get a second opinion, but I dont know who else to go to if my endo doesn't have an explanation.
s high in the mornings, for example, and is ok for the rest of the day, you can increase the insulin to carb ratio for that time frame, which will prevent the highs. This is called post prandial highs, and there is a ton written about how to deal with it. There are other things with the pump like understanding the insulin duration, which is used to determine the insulin on board when you are bolusing or trying to correct from a high.
Im a type 1 Diabetic and am on the pump. I use the carb-counting method to determine the bolus of each meal/snack.
I try to limit myself and eat healthy carbs (fruits ) vs. the cookies and sweetened cereal but always find myself eating way too much cookies and/or sweets. Especially when I get the munchies.
Also understand what your insulin duration setting is. Insulin duration is the time that insulin is effective in your body. Normal duration for fast acting insulins is 4 hours, after that the effectiveness is almost nothing. If you have it set to longer than that, it's possible that your pump thinks you have more insulin on board than you really do, so it doesn't dose you enough. Then if your correction factors are wrong, you get dosed the wrong amounts of insulin, and you go low.
If you can fairly correctly estimate your dosage of insulin, based on what you eat, you should have less swings. Further a low carb diet (less carbs means less insulin means less chance of mistakes) may also help. Fat has no impact on blood sugar. Protein has less impact than carbs. The timing of dosing relative to when you eat can also make a big difference. This is called Prebolusing.
There are a number of sites that can help you to calculate your insulin sensitivity, carb/insulin ratio and how much insulin is needed to bring your BG back under control when you go high, and I would be happy to dig them up for you if you wish.
I think the best thing any diabetic can do is learn, learn, learn - and take charge of their own body. This is a VERY individualised condition, so knowing what works for YOU is of utmost importance. Best of luck!
Hello, Sherry. I'm so glad that you are taking the opportunity to learn as much as you can about how to manage diabetes, that's not something that everyone in your position would do.
The first step to learn more is to contact her nurse practioner to get hooked up with a dietician, and in particular one that specializes in diabetes. It is important to understand nutrition and how it relates to controlling blood sugars.
Carb counting is a fairly simple way of quantifying the effects that different foods with have on blood sugar levels. Because all carbohydrates (except for fiber) will convert to blood glucose, adding up the carbs in a meal or snack allows us to determine its effect on blood sugar. Those who take rapid-acting insulin at mealtimes can match the dose to the amount of carbohydrate using an "insulin-to-carb" ratio.
Another thought is that he may need to temporarily go on a low-carb diet to help lower the blood sugar levels if for some reason the insulin alone is not doing the job. Most type 1 folks respond easily to insulin, so insulin resistance seems to be the first thing I would ask his doctor about. There are people who have a combination of true type 1 autoimmune issues plus insulin resistant type 2 issues.
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