i’m a T1 on MDI (lantus/humalog) and i run into the following situation a lot:
i check my blood sugar before eating and am somewhere b/w 75-95. i put together a meal that is quite low-carb but not carb-free (like 5-10 grams of carbs…for instance, a chicken caesar with no croutons, or some roasted veggies and a filet of salmon). i’m quite insulin-sensitive and have an I/C factor of 1:15. i cannot give partial units of insulin. bolus or no bolus? fwiw when i don’t bolus i usually end up b/w 130-150 which is sliiiiiiightly too high i think but i’m not sure.
Protein will also raise BG, just at a slower rate than carbs. You might have a rise hours later that you can correct. If you bolus, seems that you would go way low. I’d eat a few more carbs to bolus & cover everything. Five more carbs would do it. You can get syringes with half units.
I used to have the same dilemma when on MDI (my I/C ratio was 1:30 during my honeymoon and 1:15 afterward). I chose to use syringes with half units and was very glad about it. There is also a Novo pen junior half units, which may be a good enough reason to use Novolog for now if you prefer pens to syringes.
Another thing that my endo said that I could do is to dilute some insulin into an empty vial with saline solution. I never did this because I found injecting half units much simpler.
What I generally did was eat more carbs until I got to the next half a unit. I would buy 5 gram chocolate bars and add them to the end of a low carb meal. You can do something more healthy, but the chocolate worked for me… as long as I didn’t eat them at other times
One thing you need to be aware of is that when a meal is very low carb, the sources of your blood sugar load which are usually insignicant can suddenly be significant. Think about it, you said you ate 5-10g of carbs, let’s say 10g. And you rose 60 mg/dl. I weight 200 lbs and only rise 2-3 mg/dl for each gram of carb, so I would normally rise only 20-30 mg/dl. Do you weigh less than 100lbs? Probably not. If I calculate your insulin sensitivity factor (correction factor) using the 500/1800 rule (from Using Insulin), it comes out to 54 mg/dl. One unit should drop you 50-60 mg/dl when you correct. Is that close?
Did you count the carbs in the veggies? Did you account for the protein? Remember, perhaps half of the protein in a low carb meal will be converted to blood sugar. Nowhere have you suggested that bolusing for the meal gave you a hypo.
My suggestion is that if you have a very low carb meal, you may need to more precisely count the carbs and account for the trace sources of carbs and protein. The TAG approach can be helpful. In this case, I suspect that you could have bolused with 1 units and been fine.
