trying to find carb ratio but seem to hit a wall with higher doses any advice?

[fortristan]

We have recently had to change Tristans ratios (age 8 dx7-31-07). We went from using .25-1.5 for every 18-30 carbs this summer to now as its looking 1:10-1:13 depending on which meal it is. However, the ratios will be good till we hit a dose for a higher carb amount. The doses will seem just right till we hit the amount 4.5 units H for a higher carb meal. Then its to much. We fed him 72g for dinner his ratio 1:13 said to give him 6.25 units H well we knew that was to much so we gave 4.5 units H it was still to much but if we higher his carb ratio he's not getting enough for his meals. So we seem to hit a grey zone once we reach 4 units of H reguardless of the amount of carbs. I know doses go by weight, can this be a factor? Is this common? I just recently started feeding him more carbs he outgrew, the very,very,VERY low carb diet he was on and we make it healthy. Should I cut back? I would love to hear any input you all might have.

[twodoor2]

We have recently had to change Tristans ratios (age 8 dx7-31-07). We went from using .25-1.5 for every 18-30 carbs this summer to now as its looking 1:10-1:13 depending on which meal it is. However, the ratios will be good till we hit a dose for a higher carb amount. The doses will seem just right till we hit the amount 4.5 units H for a higher carb meal. Then its to much. We fed him 72g for dinner his ratio 1:13 said to give him 6.25 units H well we knew that was to much so we gave 4.5 units H it was still to much but if we higher his carb ratio he's not getting enough for his meals. So we seem to hit a grey zone once we reach 4 units of H reguardless of the amount of carbs. I know doses go by weight, can this be a factor? Is this common? I just recently started feeding him more carbs he outgrew, the very,very,VERY low carb diet he was on and we make it healthy. Should I cut back? I would love to hear any input you all might have.

Slightly confused. Are you saying if you give him more than 4.5 units, he drops too low, but for the same meal, if you give him 4.5 units or less, he's back in target at the next meal? Also, are you pumping, multiple daily injections, what basal are you on?

Studies have shown that the more insulin you give, the longer it remains in the system, hence explaining why he drops lower.

[fortristan]

yes, if we give less he is back in target., but it's only when we get to the 4.5 mark otherwise his ratios are right. We give lantus at night and we are on mdi

[momtojess]

I can explain the why part to you, but Jessi is the same way.. If her carb ratio suggest she gets 7 units for her dinner, it will drop her.. We would just give her 5.75 or something and she will be fine.

Anytime a bolus calls for more then 5 units, we have to change the ratio or else she will go low. We dont really use a new formula, or ratio, it just something we have figured out over the last 5 yrs.

SO no advice, but just wanted to say you arent alone, Jessi does this too

[saxmaniac]

We have the reverse problem... if Alex has more than around 50 carbs at a sitting, we need to give more insulin than the normal I:C.

Have you looked into the GI, fat, or protein content of the food? Is there a high later, or just a low that sticks?

[twodoor2]

yes, if we give less he is back in target., but it's only when we get to the 4.5 mark otherwise his ratios are right. We give lantus at night and we are on mdi

If you know you always have to give less insulin if the carbs are greater than X amount of grams, then you can try to calculate the new carb ratio.

Let's use this example. If the carb grams are say, 30 grams, and that equates to, in our hypothetical example, 3 units unis of insulin to cover it (1:10 carb ratio), then use the 1:10 carb ratio. If you find that if he eats 80 grams, and you figured out that you have to give him 4.5 units for him to be stable at the next meal, just divide the 80/4.5 = 17.75 (round up to 18, or down to 17). Therefore for any amount up to X amount of grams use 1:10, and for any amount greater than X amount of grams, use 1:17.

Therefore, I know it's a pain, but if that's how his body is working, that's how I would do it. Therefore, any time he eats more than X amount of grams, you always know it's going to be above the safety threshold for one carb factor, but will be fine for another carb factor.

Now other people may chime in on this, but I have noticed that if I give her too many carbs, that also, too much insulin lingers longer in her body, and gives unpredictable lows. I guess it is possible to have more than one carb factor based on the amount of carbs eaten at one particular time of day.

If other people have a better solution, please advise.

[Boo]

We have the reverse problem... if Alex has more than around 50 carbs at a sitting, we need to give more insulin than the normal I:C.

Have you looked into the GI, fat, or protein content of the food? Is there a high later, or just a low that sticks?


This describes us too...but we would definitely need to do an extended bolus, or he will go low before the high kicks in (not a rebound high though...just delayed food absorption when we start getting into larger quantities with more fat & protein).