Am I the only one here who didn’t get any help during the D education in calculating all that important stuff?
I got answer that since I am probably honeymooning I shoud wait.
I am of course trying to figure out 1:c and ISf by myself but te lack of help from my dteam irritates me. How did you get your numbers?
I read often here : my endo helped me, my endo set my ratio etc.
Did they calculate them before sending you home?
What rules (500, 1800, 1700 etc) did they use? Were you send home with larger doses, how did you correct you numbers?
I get weird numbers by applying 1700 rule for example. 1IE should low mine with like 4 mmol. It’s not the case at all.
I never recived any encouragement when it came to calculating my own correction factor,carb ratio, or basal dose. In fact for the first 15 years I never knew anyone else that was insulin dependant. I was 34 years old, no help, no dTeam, no summer camp...;-)
This is a good place to learn about corection factor...note: most charts are just wrong...
No, many of us didn't get any education because many doctors don't have a clue! Many of us learned from a combination of posting on here and reading books like Using Insulin . I don't find those formulas very helpful at all, as we are all different. To me, the best way to calculate doses is trial and error. Start with a "standard" number like an I:C of 1:15 and then work up or down by a couple points until you find you are stable most of the time. Same with basal. Same with ISF: Start conservative and work back until you find the number which one unit of insulin drops you in about 3 hours. Trial and error, trial and error then rinse and repeat!
well, i'm sorry you're not getting the medical support you need. maybe find another endo and dteam? Or, demand it, tell them you want to set up an appointment, 1 hour long with either your CDE - nurse or 1/2 hour with your endo, as you need guidance. go in with questions, logs, etc..
my endo spent an hour with me this morning, downloaded my meter and we went from there and i had a list of questions. that's what he does, at least, for me because I just call and say I want to schedule a 1/2 hour appointment. that's what you pay them for, it's their job, they work for you...make them do their work. good luck! :)
I think the vast majority are entirely self taught and we compare notes a lot. For me, these ratios are essentially impossible to pin down precisely during the honeymoon period… I started out with ultra precise carb counting and corrections based on the isf I tried to determine. Over time I’ve just gone to more of an “eyeball it” approach… Eat generally consistent types of meals every day… And I take a lot of notes whenever I get an unexpected result and try to figure out what happened and learn from experience. This has worked well for me… I brought my A1c down from 11+ to under 5 in only about 7 months with no noteworthy lows. I am concerned though that I might be learning bad habits and that if honeymoon period fades Or if i ever go on a pump i may have wished I had reinforced all the technical methods I had started with. As I’m sure others have said… You need to read “pumping insulin” and / or “using insulin” and “think like a pancreas”. Sorry for the bad grammar-- iphone
I haven't done any math myself. My endo got very close when I got my pump and I've looked at it more like steering a ship against current, wind, seaweed, etc., all the things you have to sort of guess at. I'm never sure if my ISF (?? is that the acronym?) is correct. I started reading the free copy of the Francine Kaufmann book I got here and it has a lot of the formulas in it and I might give it a whirl, sort of go back to square one and see what I come up with, but I have a bunch of stuff going on and can just muddle along too...it's much easier to do that...
I am supposed to see my doctor only 1 time a year. Last time it was during the course for both type 1 and type 2. One month after my DX. Where the doctor said to me looking at my rater high averages - you should live a little. Lowcarbing was out of the question as well.
I have rather conserative nurse, she is like old-school teacher, not a coach and support. I am planning to switch but it is hard to find ones you are comfortabe with. Being type 1 I “belong” to the national hospital, I can not just go to any doctor I want. They usually work with types 2. I am in Sweden.
It's specifically oriented towards pumps/ CGMs but it has a lot of the rule of 1200 stuff in it too. I suspect I'm pretty close to where I need to be but it may be interesting to revisit things sometime. Here's a link:
Trial and error for me. But mostly I got my advice from the book "Think Like A Pancreas." Taught me way more than ANY Diabetes educator ever could. :0)
Does anyone know how to count ratio for carbs/insulin and test it. I am looking for something like: take 15 gram of carbs, inject 1 unit of novorapid or other way around…
May be someone came up with a great way to do it? I am frustrated because I can not figure mine. It’s like game without rules.
1:15 - one unit of insulin for every 15 carbs is a good starting place, Tabacblond. Then you test 2 hours after each meal and see if you are in target. Give it a few days. If you find you are continuously too high, then try going to say 1:14 or 1:13. if you are too low go to 1:16 or 1:17. Keep tweaking this number,keeping careful records of your results until you get to the ratio where you are in target more often than not. That is the way to do it, there isn't any shortcut or formula. Also you might find that you have different ratios for different meals. Mine for example are 1:6, 1:10 and 1:15.
Those rules or formulas are not particularly accurate, I advise trial and error.
And no, medical professional ever helped me with this. The one and only endo I ever saw (once) said "take between 1 and 3 units before each meal". Then she went on vacation and the secretary couldn't translate I:C into Spanish when I e-mailed (I lived in Guatemala at the time). I finally got on here and people explained what I described above. I also read Using Insulin though quickly learned that the principals in the book were much more valuable than the formulas.
It is so frustrating all the articles on the internet say: go to ypur CDE, they will help you to figure out your ratios. I wonder what secrets CDE and MD poses :-). What formulas and approaches do they use
While you're trying to figure it out, I would stay away from high carb/high fat combination meals as those have different timing. In general what ever ratio you work out will take into account your protein needs if you figure it based on typical meals. It's a lot easier to get a single I:C ratio (per meal) that works than worry about both protein and carbs. That's just my opinion, and it keeps things simple. The only time I specifically change my bolus for protein is when I eat a very low carb breakfast such as an omelet with vegies and cheese. I've found that bolusing just for the 4 carbs of vegetables is not enough, so I always bolus for 6. I think people who eat Bernstein low carb are more inclined to be the ones who bolus for protein separately.
Yeah, well, some people are lucky and there are CDEs, Endos and Dieticians out there that do that. But most of them don't have either the knowledge or the time. I'd say the most common thing we hear on here is people are told to use a set dose, a sliding scale,eat the same thing every day, or if they recommend I:C they say to use 1:15 which is just a starting place not the right I:C for everyone. I don't think they possess any secrets....only the one that they don't know as much as we do about our own D management!
I think that all endos use a weight-based formula, maybe adjusted based on their experience and your reported activity level and say "here's your dose...let's see how it goes for 3-6-12 months and we'll see how you're doing..." so you think "ok, let's see how it goes..." and end up with odd numbers. So you call the "help desk" or CDE who, at least in my experience, can provide encouragement and coaching but won't change doses so, if it comes to that, they go "I'll talk to the doc and we'll see what he says..." and they call you back in a day or two with a proposed adjustment of maybe +/- 5-10% depending on how "off" the numbers are, and you're sent back to log and report some more whether it's off or not. The challenges of this sort of "remote" management is that it can be very frustrating when you're dealing with other factors. I encountered voice mail, doctor being on vacation, needing other referrals, the whole time consuming chore of interfering with your own business, even if your business is chilling out, to deal with "the call" when it comes. Some people can do this sort of stuff @ work but some people will be ratted out or griped at by coworkers or bosses for making "personal calls" (protected, of course, by the ADA, but people who are jerks about phone calls tend to be jerks about civil rights as well...). So, after a couple of weeks at the new dose(s), if the numbers work, you're set! If they don't, then the whole tortuous process starts again. A lot of people get pretty good service from doctors. I like going to a small, convenient clinic but have found their paradigm mystifying. At times I think "maybe I should go to the big endo specialty place..." but their location is way at the other end of a burb the wrong way from my office and I can't pull the trigger on that just yet.
The calculating process is based on clinical guidelines but precise control and adjustment is based on trial and error and being able to come up with a paradigm that will let you be comfortable making changes. It's also utterly ***critical*** to have the support of your doctor and insurance company to provide enough test strips to cover your needs while you do this. Insurers get their fax machines in a bunch at the notion of providing anything "extra" but there should be padding in any type of prescription for strips, particularly for anyone who is dealing with any type of diaflux and needing to attack it.
