# Insulin/Crb ratio adjustment



## novorapidboi26 (Mar 14, 2013)

Is there a guide like the basal guide for adjusting the bolus doses.......

I have concluded my basal rates between breakfast and lunch are correct, however I am still ending up high at lunch.......

I am on 1 unit to every 10 grams across the board......

How much should I increase it by? Previously, on MDI, I would have increased it to 1.5 units to every 10 grams.......I would really like to take as little insulin as possible, which can be done with the pump...


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## everydayupsanddowns (Mar 14, 2013)

Have you got Pumping Insulin?

There are all sorts of tables and charts that you can use to give you an idea based on your TDD, basal:bolus split and how much 'out' your lunchtime reading is.

Simple version for me would be to find a day where little or no correction was required at breakfast, then see how far above mid-range I was at lunch and conclude that I should have needed that much of a correction. Split the 'should have had' correction over the breakfast carbs to give the extra that should (might) have achieved it.

Did that make sense? I sort of lost my thread halfway through


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## novorapidboi26 (Mar 14, 2013)

I think I understand, basically work out what I would have needed to be on target, then split that up over the hours between breakfast and lunch........

today is one of those days......

6.7 at breakfast, 19g yoghurt, 1.9 units, normal bolus......

10.4 at lunch.....


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## Dory (Mar 14, 2013)

Get the book!! Best thing I ever bought - explains everything that's complicated in a really understandable way.  Pumping Insulin by John Walsh.


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## novorapidboi26 (Mar 14, 2013)

Dory said:


> Get the book!! Best thing I ever bought - explains everything that's complicated in a really understandable way.  Pumping Insulin by John Walsh.



I may need to take the plunge.....thanks......


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## everydayupsanddowns (Mar 14, 2013)

Other option is just to take it up 'a notch' by eye and review over a few days.

You may, of course, be suffering a little extra 'liver action' and it may not simply be an i:c issue... more that you might need to allow for (say) an extra 10g CHO that you never eat because of the extra glucose you have sloshing about just by virtue of waking up.

I do something similar. Dose for 40g carbs even though I usually eat more like 30g.


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## pgcity (Mar 14, 2013)

novorapidboi26 said:


> I think I understand, basically work out what I would have needed to be on target, then split that up over the hours between breakfast and lunch........
> 
> today is one of those days......
> 
> ...



I add the correction for the 10.4 to the previous bolus to get a new ratio. Say 1u drops you 3, that would get you back to your starting point of 6.7 ish and make your new ratio go from 1u for 10g to 1u for 6.5. (19/2.9)

Do you know what your reading was between breakfast and lunch? The reason I ask is you may have gone lower than 6.7 but not hypo and then risen. Was the yogurt high fat and low gi? If so its combo bolus time.


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## sacol4940 (Mar 14, 2013)

Dory said:


> Get the book!! Best thing I ever bought - explains everything that's complicated in a really understandable way.  Pumping Insulin by John Walsh.



I'm waiting (im)patiently for mine to turn up


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## novorapidboi26 (Mar 14, 2013)

pgcity said:


> I add the correction for the 10.4 to the previous bolus to get a new ratio. Say 1u drops you 3, that would get you back to your starting point of 6.7 ish and make your new ratio go from 1u for 10g to 1u for 6.5. (19/2.9)
> 
> Do you know what your reading was between breakfast and lunch? The reason I ask is you may have gone lower than 6.7 but not hypo and then risen. Was the yogurt high fat and low gi? If so its combo bolus time.



How did you get the 6.5.......?

My sensitivity is actually 1 unit drops me by 2.5mmol/l.

So by my calculations I would need 1.6 units extra on top of my normal 1:10 dose.......therefore 1.9 + 1.6 = 3.5units, so , 19/3.5 = 5.4

So new ratio would be 1 unit for every 5.4 grams

Am I on the right lines here....?


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## everydayupsanddowns (Mar 14, 2013)

Quite a bit change that... I might be tempted to go halfway first off and see how that worked out (1:7.5ish)

But I guess you could go the whole hog and just watch it.

Is your correction ration the same all day?


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## novorapidboi26 (Mar 14, 2013)

everydayupsanddowns said:


> Quite a bit change that... I might be tempted to go halfway first off and see how that worked out (1:7.5ish)
> 
> But I guess you could go the whole hog and just watch it.
> 
> Is your correction ration the same all day?



So far yes, I haven't got around to investigating it further yet, as this is only just me venturing in to the insulin/carb ratios.........I have still some periods of the day where my basal needs tweaked....

Will set up a new ratio of 1:8 between 7:00 and 13:30, see how that goes......


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## pgcity (Mar 14, 2013)

novorapidboi26 said:


> How did you get the 6.5.......?
> 
> My sensitivity is actually 1 unit drops me by 2.5mmol/l.
> 
> ...



Yup  but it may have just been a one off......


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## bennyg70 (Mar 15, 2013)

I know im on MDI, but the principals the same...

I kept spreadsheets over a numberof weeks for break lunch and dinner.

A known amount of carbs (As sure as possible) and different amounts on different days. then I started at 1 to 10 and tried it for a couple of days testing 2 hours and 4 hours after. 

If I were a little out by lunch too high, Id drop to 1 to 9 and repeat. Too low 1 to 11 and repeat. The advantage with your pump is you can fine tune it. Where as on MDI as you know minimum half units and theres a little room for error or confusion ..


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## novorapidboi26 (Mar 15, 2013)

bennyg70 said:


> I know im on MDI, but the principals the same...
> 
> I kept spreadsheets over a numberof weeks for break lunch and dinner.
> 
> ...



I could never attempt anything other than 1:10, 1.5:10 etc on MDI, so it is definitely a new concept..........I was secretly hoping I could manage on the 1:10 OK..........

Just need to remember that to give more insulin on the pump, I need to put in less carbs in the wizard....


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## everydayupsanddowns (Mar 15, 2013)

novorapidboi26 said:


> I could never attempt anything other than 1:10, 1.5:10 etc on MDI, so it is definitely a new concept..........I was secretly hoping I could manage on the 1:10 OK..........



This was one of the major benefits of the Expert for me, I could set the ratio to 1:7.7 (or whatever) and the gizmo would work out the bolus and then round up or down to the available units (having added on or shaved off whatever sliver was required for correction).

Keeping it in 5's or 10's was def my approach when trying to do it at the table in my head though!


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## trophywench (Mar 15, 2013)

NRB, have you got any 'Illness' or 'Exercise' settings programed into your pump?

If I want to have a fiddle but not change the whole hog on a bolus ratio at any time of day, I will often tell it 'Illness 1' at the point when I ask it to calculate my bolus, so that adds X% or 'Exercise 1' when I want it to reduce my bolus.  Kind of like using a TBR?

If it works, THEN I'd change my bolus ratio.


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## novorapidboi26 (Mar 15, 2013)

trophywench said:


> NRB, have you got any 'Illness' or 'Exercise' settings programed into your pump?
> 
> If I want to have a fiddle but not change the whole hog on a bolus ratio at any time of day, I will often tell it 'Illness 1' at the point when I ask it to calculate my bolus, so that adds X% or 'Exercise 1' when I want it to reduce my bolus.  Kind of like using a TBR?
> 
> If it works, THEN I'd change my bolus ratio.



Currently, NO.......

My pump has the option to create basal patterns, for things like illness and exercise, the weekend etc....

Not got round to it yet..I have been going for a few months so far and all I have managed to do is test my basal over the 24 hours and now I am on to the bolus, but apart from this lunchtime high, my BG are doing what they are supposed to........

Not been in ill in a while, fingers crossed..............CUE MAN FLU!!1


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