# A winge and a request for some help



## SB2015 (Dec 4, 2016)

Some help needed
I have been awake since 2:00 am getting my levels down.  The same happened last night.
On both occassions I ate late and was eating out after singing events.  I guessed the carbs and they were a lot higher than normal, but deliver insulin for them and two hours later back on target  for bedtime(5-7) and apparently needing no correction. Two hours later up to 15 and rising!!! (17 last night).  I did a basal rate test last week and the rates for over night are correct. are correct.
I changed insulin bottle last night in case and the insulin had worked throughout the day.
*If I had the carbs wrong how come I was back on target before bed.  Any ideas?*
I could certainly do with some sleep this evening!

A winge
In the last month I have found this all overwhelming again and quite out of control. Nights like the last two have not helped.  I know that these have come when eating late but that if I avoid that I miss out on concerts etc and would then feel that I am letting diabetes stop me doing stuff.
SB feeling very tired and fed up.


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## AlisonM (Dec 4, 2016)

The short answer is "I dunno". And, I don't know what to suggest either, I think this may be one for the medical, unless another early bird comes along who has a clue. I hope you get an answer soon.


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## SB2015 (Dec 4, 2016)

The Libre is now showing me on the rise again over the past hour, confirmed by my BG.  No idea what is going on.


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## grovesy (Dec 4, 2016)

I am sorry I don't know either.
Hope you get it figured out.


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## Pumper_Sue (Dec 4, 2016)

What sort of food were you eating? High protein and fat would cause the problems you are experiencing.
So perhaps look at the type of bolus you are delivering.


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## HOBIE (Dec 4, 2016)

Every time I have a meal I use delayed bolus from 30mins to 2hrs & split %. Nothings perfect but so adaptable & depends what you are eating. Good luck SB


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## Annette (Dec 5, 2016)

Agree with Pumper Sue here, could it be that you are processing the food slower than normal (can happen if you eat more/more carbs than usual, certainly for me) perhaps because of the time you are eating (unusual for you to eat that late, perhaps?), perhaps because of what you are eating (high fat etc).
Perhaps, if you're going to eat late, try eating a lower carb meal if you can (I always try to restrict my late meals out to no carbs - salads, fish without potato accompaniments, etc), that way you can enjoy your concerts etc, but not miss out on eating.


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## SB2015 (Dec 5, 2016)

Thanks all.  I think you have hit the nail on the head, and it must have been quantity of carbs and different foods.  

On Saturday it was a home cooked Sri Lankan meal and difficult to know carbs and to resist what was on offer.  I found a note I had written to myself about if more than 60 g CHo extend, but I had forgotten as I so rarely go anywhere near that amount.  

It was just unfortunate that I had had a series of bad nights after enjoyable evenings and lost the plot a bit.
Slept through last nights and Libre showed me to be at about 5-6 all night.  It is amazing how much more sense it all makes when you are not tired.

Thanks again


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## everydayupsanddowns (Dec 5, 2016)

SB2015 said:


> Thanks all.  I think you have hit the nail on the head, and it must have been quantity of carbs and different foods.
> 
> On Saturday it was a home cooked Sri Lankan meal and difficult to know carbs and to resist what was on offer.  I found a note I had written to myself about if more than 60 g CHo extend, but I had forgotten as I so rarely go anywhere near that amount.
> 
> ...



The other thing that someone mentioned to me once here is the way that bolus ratios do not always work well for larger meals. I think it was John 'Pumping Insulin' Walsh who had a rule of thumb that pretty much 'your weight in kilos' was likely to be the grams of carbs that your usual ratio would work OK for (he's American so said half your weight in pounds, but it's near enough!).

I have found this to be a pretty good indicator and can seem to need as much as a third extra in insulin when meals get larger. Partly this could be due to absorption irregularities with larger doses (a proportion can just disappear) and partly because carb counting is often less accurate/more difficult for those meals and can be out by a percentage of a much larger whole (20% error on a 10g CHO biscuit unikely to rock the boat, 20% error on a 100g CHO meal much more likely to need a different dose!)

In the grand scheme of things though - these are pretty infrequent events. Don't beat yourself up too much over any out of range numbers. The food sounds like it was well worth it!


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## SB2015 (Dec 5, 2016)

Thanks Mike

That all makes sense.  I think because I don't eat that much very often it is easy to forget how to deal with it.  The rule of thumb you mentioned is very helpful, and I know that I will need to play around with the ratio for the increase a bit, but it gives me a starting point. 

I suspect the next few weeks will offer me some other opportunities to use this,  and I can use the excuse that I am checking my ratios when that piece of Christmas cake is there with the coffee at the end of meal.  
Mmmmmm and a bit of cheddar cheese on top should help to slow the release of the carbs as well!


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## grovesy (Dec 5, 2016)

Wensleydale cheese with Christmas Cake!


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## SB2015 (Dec 5, 2016)

Just try it.  I picked this up from my father in law who was from Yorkshire.
I don't mind what cheese it is, although I'm not sure about Stilton!!


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## HOBIE (Dec 5, 2016)

I too very rarely have more than 50grams of carbs in one go.


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## grovesy (Dec 5, 2016)

SB2015 said:


> Just try it.  I picked this up from my father in law who was from Yorkshire.
> I don't mind what cheese it is, although I'm not sure about Stilton!!


Well in my  part of Yorkshire it had to be Wensleydale Cheese.


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## Martin Canty (Dec 5, 2016)

grovesy said:


> Well in part of Yorkshire it had to be Wensleydale Cheese


Hmmmm, yes Wensleydale & Christmas Cake.... Salivating at the dim & distant memories....


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## khskel (Dec 5, 2016)

Martin Canty said:


> Hmmmm, yes Wensleydale & Christmas Cake.... Salivating at the dim & distant memories....


Wensleydale with cranberry or stem ginger


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## SB2015 (Dec 5, 2016)

everydayupsanddowns said:


> The other thing that someone mentioned to me once here is the way that bolus ratios do not always work well for larger meals. I think it was John 'Pumping Insulin' Walsh who had a rule of thumb that pretty much 'your weight in kilos' was likely to be the grams of carbs that your usual ratio would work OK for (he's American so said half your weight in pounds, but it's near enough!).
> 
> I have found this to be a pretty good indicator and can seem to need as much as a third extra in insulin when meals get larger. Partly this could be due to absorption irregularities with larger doses (a proportion can just disappear) and partly because carb counting is often less accurate/more difficult for those meals and can be out by a percentage of a much larger whole (20% error on a 10g CHO biscuit unikely to rock the boat, 20% error on a 100g CHO meal much more likely to need a different dose!)



When you increase the dose for a bigger meal, do you apply the increase to the whole dose or just for the insulin for the carbs in excess of your weight in Kg?  I could do that as two separate deliveries if necessary.


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## everydayupsanddowns (Dec 5, 2016)

SB2015 said:


> When you increase the dose for a bigger meal, do you apply the increase to the whole dose or just for the insulin for the carbs in excess of your weight in Kg?  I could do that as two separate deliveries if necessary.



I have more of a vague system than that I'm afraid - though I did do some more precise experiments in the early days. For those I calculated carbs and then the dose (inc any correction) using pump wizard, then added a percentage to the total dose using phone calculator. Started with 115% and saw how that went then added 5% extra until I seemed to hit a sweet spot. 

These days, I tend to simply dose my 'usual' amount for those meals and gauge carbs more by eye and experience than any real precise measurement. Sorry!


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## grovesy (Dec 6, 2016)

khskel said:


> Wensleydale with cranberry or stem ginger


I like Wensleydale with cranberry but have not tried it with Christmas cake.


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## SB2015 (Dec 6, 2016)

everydayupsanddowns said:


> These days, I tend to simply dose my 'usual' amount for those meals and gauge carbs more by eye and experience than any real precise measurement. Sorry!


That is kind of encouraging, as I think I have got myself bogged down in trying to 'get things right', so good to know a more relaxed approach is possible.  However just had another meal out and having eyeballed the various courses, when I got to the pud I simply shared with OH and also increased Bolus for it as I was past my weight in KG by then and then reduced it a bit as we were walking home from restaurant.  Home with a BG of 5.4!!!!  Now I wait to see what happens over night, but overall things are much more settled.  Thanks for your help.


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## KookyCat (Dec 7, 2016)

SB2015 said:


> When you increase the dose for a bigger meal, do you apply the increase to the whole dose or just for the insulin for the carbs in excess of your weight in Kg?  I could do that as two separate deliveries if necessary.



I have a different ratio if I go mega carb as I affectionately call it.  In the evening I normally do 1:20 for example,  and I'm quite predictable with carbs having between 40 and 60.  If I go above 70g which is rare but does happen at this time of the year I go to 1:18 and that does the trick for me.  At lunch time I normally do a 1:15 ratio so if I'm going mega carb above 60 at that stage in the day I do 1:13.  If I was a bit low before the meal which is also common for me I'd split the difference and do 1:19 or 1:14.  I also split doses for a big meal because I'm insulin sensitive so such large doses would be a disaster otherwise.  I inject for starter and main just before I eat the main course (I usually eat salad as a starter though) and then inject for the pud after I've eaten it (straight after) because my pudding choices tend to be high fat and with the volume of food involved in three courses my metabolism seems to go a bit off kilter.  I digest food quickly (another condition nothing to do with diabetes) normally but when faced with lots of food it seems to do a sort of quickstep routine, with a quick, quick slow routine, hence the after pudding injection.  Also my eyes can be bigger than my belly when it comes to pudding so I often quit half way through.  

Hope you start to feel a bit better about things, I hate those "haven't a clue" periods, they're the pits.  You just think you've got it licked and you at least understand what's going on and then it floors you with a new flavour of weirdness.  Made me feel a bit better though, I thought I was the only one who had to do something different for big meals, not much compensation for you I realise but you've helped me feel more positive this week, so thank you


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## SB2015 (Dec 7, 2016)

Thanks Kookycat and Mike
After an excellent meal out and a walk home, here is the overnight result.
You have both given me strategies to use.  It always helps to have a plan (and a yummy pud).

Useful advice, more sleep, some understanding of what might have caused problems during November (being away more then I was at home during that time!!) and knowing that times like this get to most of us at times, has all helped me to feel a lot better.


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## everydayupsanddowns (Dec 8, 2016)

Fantastic @SB2015! A Libre line to be proud of after a big meal out


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