Carb count plus sliding scale

Hi everyone,

i’m in the beginning of my 3rd year CORRECTLY diagnosed as a LADA, (insulin dependent) first year was a nightmare tossing me metformin assuming that I was T2 - eventually found a Endo who sorted me out with the right diagnoses before i died at 115 lbs. Anyway, i’m just now learning the carb counting system i’ve been instructed 1 unit novolog per 15 gm carbs ratio in addition using the sliding scale, I can do the math, I can read food labels. This was my first morning trusting this new system vrs my previous method - “sliding scale-sorta wing it”!

I’ve been having random pre-dawn surges - reason why my A1C went from a beautiful 6.1 to a 6.5 in 3 months. This morning I calculated food intake correctly, but didn’t realize till it “dawned” on me (no pun intended) after going higher than I should have - that I couldn’t and didn’t account for a predawn surge that was in motion already before injecting. I woke up at 5:11am and was 113 gl, an hour later i was 131 still rising i’m sure, but how to know or account for this - along with the tools given, I don’t know. I’m positive I was in a pre-dawn surge and had I not rolled out of bed at 6:11 am, it would have been up to 150 gl by 7 am easily (from experience).

I forgot to ask about this factor yesterday when I was at my Endo appointment getting educated on (carb counting) the next step forward to being a pump user -

Does anyone have advise on how to account for predawn in motion? I ended up taking another 1.5 units to catch the rising at 227 gl in spite of 1 mile walk, 10 minutes solofit, plus 18 minutes on gazelle! INSANE! This is not an every morning event only random. I’m a Dexcom G6 user btw.

thanks in advance for any feedback. mary

There is a thing called dawn phenomenon.

The dawn phenomenon, sometimes called the dawn effect, is an early-morning increase in blood sugar which occurs to some extent in all humans, more relevant to people with diabetes. Your body uses adrenaline to kick start body out of sleep. Adrenaline makes you insulin resistant. You will need to find how much insulin you need to combat it. I for example wake up and before feet hit the floor take a shot. Even if I’m hypo to combat dawn phenomenon.

You will also find breakfast will causes the biggest and hardest spike to control, if carb based. Some of the insulin resistance and the fact your body cycles glycogen with carbs after fasting. This will cause unexpected spike as well. Even if dosed correctly.

I personally avoid breakfast. Until I’ve been awake 2-3 hours to keep my sugar normal

You will spike as well from heart raising exercise. So you in last instance over did the attempts and overthrew each.

You need to know how much 1u of bolus insulin drops you and how high you rise. If you are 1u to 25mg/dL drop and you rise 100mg/dL in the morning you know you need 4u to combat feet on floor condition (predawn phenomenon)

Wow thanks, I should stick with my Miso soup in the morning which barely has carbs but gives me some nutritional boost. And first thing I do waking up is inject. Thanks for this valuable perspective.

HI Mary, here is what I know about Dawn P. If you haven’t eaten in some hours, the body thinks you are starving and causes the Liver to release sugar into your bloodstream, the best way to stop this is to eat a little before bed, Ie: a few crackers with P-butter, been through it myself. Re: carbs and sliding scale, I use 1 unit insulin + 10 gm. carb and 1 unit lowers your BS by 50 points. This plan works for me and I have been doing it for years, type 1 for 66+ years. You realize these parameters are not carved in stone and your parameters may need a little tweeking. Hope this helps. My a1c is 7-7.5 No one is freaking over my numbers, and you do realize new rules are “No meds with an a1c below 7” Hopefully the scale is going back to where it was safe and not the below 6 Hope this helps. Have a great day. Bye Jan

Jan thanks so much for the advice and i’ll try that…normally i try not to eat anything before sleep but will give this a shot. Its the most frustrating piece not being able to count on an outcome today that happened the day before…T1 has a life of its own i’m learning.

so, i’m curious do you take 1 unit before you eat the bed snack? I guess if you are already higher than you want at sleep? I might depending but this is not considering a snack - only if i’m higher than I want to be before sleep in that case would not eat anything.

Usually i’m between 120 - 180 before sleep. i think the 1 u 10 carb falls more in line with me than the recommended 1:15 - i’m having to take more units than calculated anyway (wait does that make sense)…

and i’m hoping to get on a pump soon, so personal question for you, do you find it more accessible to manage treatment decisions with a pump? i’m thinking in the context of the carb formula most times not working out and having to inject a bit more to curb a high - if in a pump I plug in carb numbers and it doesn’t work out as it should i’d imagine its no big deal because you aren’t having to manually inject yourself with an insulin pen like I do now like 5-7 times per day? thanks for the info…M

I’ve been counting carbs and on a sliding scale for 2 1/2 years, and still am often high or low. It takes time for the endo and diabetes educator to adjust it your level. Since I always ran high hours after breakfast, with the help of a dietitian, I was advised to eat eggs instead of oatmeal. Later my am dosing scale was change to 1/5.

Timing of the basal insulin was also a factor. For almost 2 years, I took 8 units at night. Then last summer my endo switched that to mornings, since that peaks about 2 hours later. Since I usually wait about an hour after taking a thyroid med, my bg also rises in that time period, sometimes more than others.

Like a previous comment, My diabetes educator suggested a small snack at bedtime. Supposedly, that way the liver doesn’t have to release any glucose in the morning. I’ve found my bg, (on my g6) about an hour before bedtime, and weather its steady or falling, determines how much I need. Sometimes cheese and a few crackers, sometimes PB. Protein and fats hold better overnight. By trial and error you can see what world for you. I’ve found that a few nuts work too, but I have to be careful of amounts.

I was surprised when you said that you do 5-7 injections/day. Other than my basal, I only do mealtime. Never at an evening snack, since it should be less than 10 carbs. The few times I’ve had an extra dose was an evening party with extra snacky food. As most people say, everyone is different.

Thanks for sharing I’ll definitely incorporate this knowledge. As for all the injections I am some days correcting a double arrow rising (also us G6 an it’s a life saver) some days are just a moving target for me and I like to try and catch a rising high before I land at 250 bg level which has happened more than I like so throw in each meal and long acting at night plus a correction here and there and I’m a total pun cushion by sleep time…m

Did your endo suggest you correct highs with and extra injection? I’ve had some highs like that, especially after 2 steroid shots for possible sciatica related to knee pain. Also when I miscalulated carbs before dosing. When I asked my endo about an extra injection in the evening, she said not to take a chance of going low overnight.

After my endo had me switch my basal (Toujeo) from night to first thing in the morning, I’ve had very few low alerts on my cgm overnight and my after breakfast bg doesn’t go as high for as long. She was ready to switch me from Humalog to Fiasp, which is supposed to act quicker, until my diabetes educator suggested I try the InPen Smart Pen +App System. I hope my old brain can handle more technology!

Good morning Sally,
Correct- my endo also said don’t take a chance rather correct at next meal…lol I’m a determined type. I’m careful not to overdose at correction by doing half units - to cut off a higher rising then I wait - if after 30 minutes it rises again another half unit and that has kept me from waking up at 180-200. I wouldn’t do that prior to getting my G6 I’d let it go and correct at next meal. I’ve only messed up a few times but G6 alert caught me - I woke up to take tabs an scoop of PB.

Last night I ate a snack before sleep and woke up at 121 which Is better than 151 for me - I’m working on the carb counting too so hopefully this tool will help me lessen the times I overdose or under dose.

Finally after 4 years I’m not having depression and meltdowns over numbers I just say f…!!! Out loud- correct if I have to - evaluate what could have gone wrong and then I keep moving not letting it wreck my day. I’m so relieved to have the G6 it’s a life saver…have a meaningful day and thanks for sharing it means a lot to me. Non diabetic people just don’t know or understand they think it gets better or eating vegan can reverse it. That talk was dangerous for me to listen to in the beginning and now it’s just aggravating but I try to patiently educate them.

All the best,

M

I go on that roller coaster heading low and then over-treating. Trying not to go too high after breakfast, I probably dosed more insulin for what I ate and then headed down more than I liked after three hours. Since I wasn’t ready for lunch yet, I had a snack, well, maybe more than I should have. Uh-oh, time for some physical activity when my BG was up to about 195. That did the trick, and back to 135 when I ate lunch. My afternoon was fine, but I miscalculated again at dinner time and tried to be careful treating. From 75 back up to 145. Hopeful that’s it for tonight. I’ll see what its like in an hour or so.

Other than when I had those two steroid injections, I haven’t worried about numbers in the mid-200s overnight. Sometimes a holiday or restaurant meat will give me a high BG later, but I seldom run over 150 at bedtime. Four shots a day is enough for me; other than those unusual situations, I’m usually not tempted to do any extras in between. Its better to get active, whether its inside or outside or just walk around inside the house.

I was quite happy to transition to the g6 the start of this year. The g5 alerted me to overnight lows a few times when I was still taking my basal insulin at bedtime. Little did I realize at the time that Toujeo reaches its peak after 2-3 hours, until the endo switched that to mornings to reduce my mid-morning highs. Even when I got up in the middle of the night to check my actual BG, most of the time no treatment was actually necessary. I wouldn’t do without a cgm; every time it alerts me I think of my sister who passed away in her sleep from low BG. Like me, she was by herself, and no one found her for two days. In hindsight, her independence ,diet, and physical activity trying to stay warm when the area lost power during a storm, probably were factors. I’ll do anything to avoid an extreme overnight low.

I hope to transition from MDI to the InPen Smart Pen+App System. Its just a little frustrating waiting for shipments from the west coast to PA.

Sally so sorry to hear the story about your sister. My older sister died of pancreatic cancer two weeks suddenly after diagnosis. We inherit our imperfect immune system from my mother, her sister died of JT1D. It’s meaningful to have each day we have right, however difficult. I also respond quickly to exercise and just movement to curb bg going high. It’s when I’ve done 16 minutes on the gazelle and a couple of 5 minutes on the solofit and it’s still rising that I need to correct. I had 1% Times only going low in last three months so in that light it’s not too bad. I’m looking at the Tandem closed loop new T:slim x2 pump that syncs with the G6. Ive been taking a long time to edge towards being comfortable with the idea of more technology but I can always go back to injecting manually if I hate it. I heard a Ted Talk from the guy inventing the iLet. It’s one small device that acts as the CGM and pump that automatically gives glucagon when low and insulin when high I believe there is some data setting to plug in your food intake. They are calling it the artificial pancreas. It’s in trial phase now probably a good five years from hitting the market but I’m keeping my eye on that one. BTW, snack last night at sleep and no predawn high!!! I remember my first Endo telling me to eat a snack before sleep when I was not on a CGM, to avoid a low. Thanks for explaining the starving and output of sugar in early morning…

Hope you have a beautiful day, weather? I’m in Tennessee foggy and too cold for my desire. Best

M

OK Mary here it goes, I do not take any Insulin unless I need to, the way this works is if you have sugar in your system apparently the liver is happy, and if I can stay below 200 in the early am I don’t have to worry, usually I am about 156 liver is happy and I don’t have to panic over the numbers. It’s not a matter of how much you eat to back the liver off, it’s just a matter of eating something , a few crackers with P-butter ( a protein) seems to work well, Protein with carbs work best. I’m using an Omni Pod, just love it and I can take as little as 1/10 of a unit, it gives me the freedom to take insulin when I need to, besides it’s too difficult to load a syringe for a tiny amount, pen is easier but who wants to stick a needle for a tiny amount, If I am going to inject with pen or syringe, I want to make it worth while. Another good reason for my Omni Pod besides it’s tubeless and wireless, what more could I want other than a cure. I’ve had this for so long I don’t know what it would be like not to. Hope this helps, keep in touch. Bye Jan

Jan thanks I’m learning so much from this forum. I’m definitely moving towards the pump. Learning more each day about “how this works” (like that) and how I can work with healthy food choices safely without feeling like I have to fret about everything i put in my mouth.
Thanks for sharing! M

When you change over to a pump, you would be able to raise the amount of insulin being automatically dispensed in the morning hours, so you would not need a snack at bedtime.

And as to the carb ratio you were assigned, I find my carb ratios change depending on what I am eating and the time of year. I also need less insulin for carbs consumed in the evening, and for no reason that I can figure out. That is just me. So with a pump, you can program all that in, and don’t be surprised if your carb ratios have to change at times. It will take a good deal of experience for you to figure out what you need.

Hi Mary,

Just curious, are you on Facebook? I’ve been following and learning a lot from various diabetic columns and blogs.

Do you work out in the morning before or after you’ve dosed insulin and eaten breakfast? I read somewhere about different ways to estimate carbs and insulin before working out depending on what kind of exercise . Depending on what you are doing, its not unusual for the BG to go high when your body thinks you need more glucose. Or for it to go low and then back up after you stop and rest.

The most I do is walk either in the small town where I live or at a nearby state park with friends. When I did a senior exercise program led by someone who followed guidelines from the American Arthritis Organization, I was glad I had a cgm and extra G tabs for when I went low a few times. Then I’d remember to dose less before I ate dinner. If I knew then what I know now, maybe I would have eaten dinner after the session instead of before. As much as I enjoyed exercising like that I’m not sure I’ll go back this Spring, after having knee problems this past Fall. It’s hard to sit still and only do part of the routine on a chair. After treatment with an ortho, I don’t want to take a chance on having more problems.

Maybe after I learn how to use the InPen Smart Pen + App System, I’ll be able to do corrections 2 hours after a meal for times when the fat or protein is causing the BG to continue to rise and stays high. Another technology learning curve in my future!

Sally Ann

Hi Sally, yes I have fb but never on it, but I’d look into what you r referencing. I have two GSDogs, needless to say they need regular routine of exercise so every morning I walk them a mile then usually again in afternoon. I eat before or after depending on being higher or low. I’ve learned to help curb highs all I have to do is exercise 15 minutes so each day I’m doing several 15 minute exercises on solofit and gazelle. I read a good article on lifting weights and that seems to be a whole other diabetic realm of guidelines. So are using a syringe or a cartridge pen you can dial half units? I’m on cartridge pen for meals and regular 1u measurement dial pen for long acting.

I’ve been T1 since 1995. Pump since 2007. The reason I went to pump is it’s a computer and more reliable than me to figure out calculations. I enter glucose level and carbs and it figures it out.

I strongly would recommend moving to pump like Tandem with DG6.

Hello! I’ve had T1D for 44 yrs and have always experienced that dawn phenomenon. But I just learned from a Medtronic rep working on my 670G transition that coffee raises blood sugar! Yup! Who knew! She suggested I take 4-5 units when I have my first cup in the morning and that has leveled off my morning spikes. Like you, I awake at 5am with a BG of 110 and by 7:30am, it’s 150. (BTW I think 150 is okl!) But it climbed even higher after my first cup of java. So the coffee bolus really helps! Good luck!

Thanks I didn’t realize it figured to that degree. I’m recommended by Endo for the recent Tandem T:slim x2. I’m currently using CGM G6. M