Carb count plus sliding scale

Confirmed lol my only vise is coffee three cups, but my predawn doesn’t happen everyday so non days I.5 or 2u works. Now I am aware to ask myself am I in a predawn if so an extra .5-1 will curb it going over 200 with a lite bite. Wow it’s really all an awakening experiencial process an this forum really helps so thanks for sharing. M

Mary @Disco2, if your body is working normally - other than your pancreas not producing insulin, you should expect a significant increase in blood sugar / body glucose level in the morning. It is a very normal and necessary action incorporated in the human body. Your internal body clock, your circadian rhythm, tells you when to awaken and releases cortisol and adrenaline to stimulate necessary body functions.

One of the primary purposes of cortisol is to increase blood sugar and body glucose levels to feed your brain, your muscles, and the rest of your body to get you ready for a day’s activity.

Adrenaline, also called epinephrine, is a hormone release naturally as you begin moving about with the function of stimulating blood flow to muscles, primarily the heart muscle and also stimulates the liver to release glucose.

My summary, and I am NOT a medical practitioner, is that the body is designed to work against, to make life more difficult for those of us trying to live with diabetes - as if we didn’t have it hard enough already. My solution, is to have my insulin infusion system significantly increase the basal flow of insulin and also use a higher insulin to carbohydrate ratio than at other times of day. My breakfast insulin ratio is 1 unit for 9.5 grams of carbohydrate, and my supper ratio is 1 unit for 18 grams of carbohydrate.

Dennis thanks. Wow it totally makes sense to tailor my carb insulin ratio I mean I’m already doing it by experience an guessing when I know I’m in a predawn rise, which oddly enough doesn’t happen every day only randomly. But I can try it by numbers gradually to have a better system rather than risk overshooting. I appreciate your explanation. Best, M

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Did your endocrinologist or diabetes educator ever adjust your sliding scale? Both have changed mine more than once, which usually works well when I’m careful counting carbs at home; not always as close when eating out. My numbers are different, but my morning ratio is also higher than lunch and dinner. Since I don’t have near the experience as Dennis, I feel better with professionals making adjustments than doing it myself. As he said, blood sugar and blood glucose levels are naturally higher in the morning. They can rise again after exercise when the muscles need more glucose. If I’m high from an incorrect dose, I use a correction factor at the next meal. After all, four injections a day are enough, considering I’m small and don’t have a lot of body fat to vary the injection sites.

Hey Sally I’ve not been working the carb counting long enough for change but Next visit I can discuss tailoring the ratio an scale. I’ve been more careful to not under or overdose (stick to the carb count) and NOT sweat it if I peak at 232 or thereabouts. I’m getting more chilled about making the meal decision then letting it go but taking note. This is progress for me, so since our communications I’ve not corrected and im sticking to the meal injection and long acting 4 a day total because I’m also sick of poking myself. I guess I need to be more grateful that if you looked at my labs not knowing I’m T1D you’d say this person is perfectly healthy…thanks for sharing it’s really help me loosen the rains. Best,
M

Most of the diabetic sites I follow also have websites that with the same info. A few that I find worthwhile are diatribe.org, healthline.com. and diabetesstrong.com. There are others that have good nutrition, recipes, and technology videos. Dogs are a good excuse for exercise. Our black lab died of old age shortly after my husband retired, making it easier for us to travel.

I’m using a cartridge pen with half units for my Humalog. Toujeo is my long acting insulin. Do you take your long acting in the morning or night? My endo moved mine to the morning about 6 months ago, since it peaks in about 2 hours. That way it peaks about the same time the Humalog does after breakfast. Now,even if my BG goes above 200, it doesn’t go as high or stay up as long. Also no more early morning low alerts, as long as my evening meal or snack includes the correct protein. My SmartPen+App System is supposed to arrive tomorrow. It will also have 1/2 units for dosing. After logging in BG and carbs, it calculates the dose.

Another question - do you have a diabetes educator that will help you with dosing, general questions, or BG numbers? Mine can check my Dexcom Clarity reports and advise any changes. We communicate on the same medical portal that my endo uses, which is helpful. I’m thankful that she will train me on the smart pen on Wednesday. Since its new in this area, another diabetes educator will observe, as will a friend of mine who understands my hesitation when counting carbs before dosing.

I also agree with another comment about an A1c of less than 7. I’m not sure if its because I was diagnosed as t2 for 2 1/2 years before being diagnosed at t1 at 73, or applies to others adjusting to insulin, but my doctors seem to be ok with an A1c in the mid 7s. That is unless I ever need knee surgery! I think what is more important is the time in range. You will see this on your cgm Clarity reports.

Consistency isn’t always easy; every day is a new adventure.

Hi Sally sorry about your lab no longer on this side. I couldn’t live without my dogs.

I met my diabetes educator nutritionist at my last appointment so the Endo, NP and Educator are all apart of my team. They are very accessible via portal as well. Next visit I’ll inquire about switching my Toujeo long acting to morning. Originally I chose evening for being able to remember easily and I was first starting out on insulin using a finger prick monitor so now that The team is able to see my pattern on clarity they can advice me for any adjustments. Next visit I’m moving towards the T:slim x2 pump G6 closed loop system. I’m excited and that they give me a class on it first before handing me the prescription so I can make a final decision to feel if it’s right for me. I’ve saved a bucket of the last 4 months used needles to impact my perception of how many times I’ve pierced my skin and help me push off this current place- I’m not shy of using technology I’m hesitant to introduce another time frame of frustration. However, I believe in a brief period of use can make my life easier. That’s great you guys get to travel…I am 58 recently got married to a 70 year old retired Air Force guy! I’m coasting now and it’s nice to not deal with a job and diabetic stress…hope the west is having good weather today. Finally coming out of a cold snap here. Have a meaningful day…M

Hi Mary, Our black lab’s legs were giving out, not unusual for labs. Since it was about the time my husband retired, we had more time to visit family and friends. When my husband was sick with kidney disease, he wanted another dog. At that point, he couldn’t walk or train a puppy and I was too busy to do that.

After training on the InPen Smart insulin +App System yesterday, I had some interesting calculations. Based on a variety of settings, the app shows the last insulin given and blood glucose and amount of insulin on board. It will then calculate a dose for the present bg and carbs eaten. BecauseI’ve had some trouble adjusting to the pen itself and not dosing enough, I had to give myself a correction dose several hours later. It tells you how much in half unit increments. Its another step before dosing, but it should be more accurate. Once I master the dosing unit on the pen, it will be great!

Good luck with the closed loop system pump. I have friends who enjoy being on a pump, but for various reasons its not for me.

Hi Sally
I’ll have to check out this app system? I use a half unit dial cartridge pen but don’t know anything about the app. I understand the dog dilemma, I’m the traveler and my husband is just as content staying with the dogs. Have a good weekend! M

The InPen Smart Insulin Pen + App System is a new type of insulin 1/2 unit pen that blue -tooths with a smart phone to determine the dose, including a correction factor, after putting BG and carb numbers into a calculator. It also tracks your insulin on board, so you know how much insulin you have at any time. All the info can be saved and reported, just like Clarity reports. I still use the one unit Toujeo pen, but not the Humalog 1/2 unit pen. I still do 4 injections a day.

It’s easier to see if a correction is needed after 2 or 3 hours according to the IOB (insulin on board) and the bg and arrows on the Dexcom. After my first use after training on Wednesday, I didn’t push the plunger down far enough and under-dosed. Later the calculator showed the correction dose # to bring it in back in range. I’m not sure what I did wrong this morning, but it did not register my correct dose. I put half my breakfast in the fridge, since I knew I didn’t have enough insulin. A lot easier than worrying about going high later. I’ll either have a low carb snack if needed or eat an early lunch.

Enjoy your week-end. Sally Ann

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wow yes i read up on it. seems like a lite version of the pump on a loop but worked manually without being hooked up to a tube - hmmm - please keep me up to date on how you like it. when i go for my pump education class i’ll be able to finalize how i feel about being hooked up to that system, if i’m not sure i’ll like it, definitely this sounds like an option in between what i’m already doing. have a good sunday. m

Mary,

I’ve had a few crazy weeks adjusting to the InPen, good and not so good on that roller coaster as I am not always good at estimating carbs when eating out. Then in the middle of the third week I had an allergic reaction to a new BP med which messed up my BG for a couple days. A few days ago my diabetes educator increased my basal, which seems to have helped. Hopefully, the next report that she forwards to my endo will show some improvement.

One of the advantages is the way it calculates a dose and even gives a suggested correction dose. If needed, I wait until my IOB (insulin on board) is down to or almost at 0.0. Usually that seems to help; occasionally I’ve dropped too low too fast, so once IM decreased the recommended dose by .5 at bedtime. The full dose might have been fine, but I didn’t want to chance it overnight. When I asked my D Ed about increasing a dose for high fat foods like avocados or peanut butter, she said to wait and bolus more after eating if necessary.

I’ve found some of the articles on JDRF, Healthline, and Diabetes Strong very helpful. Last night I watch a few UTube videos from Between Two Lines (referring to the upper and lower lines of in-range numbers). Very informative on a variety of topics.

Hi Sally,

sorry to reply late. i’ve been on the go from TN to NC now helping a friend for two weeks.

Sorry to hear about your challenges. I know its difficult to have some expectations for how its supposed to go then the big let down happens. i’ve had to blow off the letdowns to take a break - i’m realizing the carb counting and sliding scale is just a tool to try to make it work for me - but it doesn’t always work, rarely works with a carb even when its says how many carbs i’m eating. So, I’m surrendering to the disappointments and just doing the best that I can. this is an ongoing disease with a mind of its own right? you know all too well.

just when we get one thing figured out then we get a curve ball - have to regroup and refocus. its exhausting. i feel ya. sometimes I take a mental break with removing myself from intense focus on my glucose pattern and just make a decision each meal then keep moving without analyzing it. i’m positive my next A1C will be 7 or more - i just can’t get a grip on NOT going over 200 with each meal, i don’t sweat it if i feel its stopping at 220 but going higher i correct without a care and move on. i’m realizing its just the way it is. hang in there and try to enjoy yourself outdoors…well, thats my church!

take it easy…Mary