Changing I:C ratio or insulin sensitivity?

Happy new year everyone!

I’ve got a question regarding my bolus doses. When in was dx’d in April my CDE started me off with an I:C ratio of 1:12 and my goal BG was initially 120. After reading a lot and spending time on these boards, I tried to shoot for BG’s around 90-95, so I would take a bit extra bolus than my ratio indicated (basically if i calculated for 3.5 units, for example, I would round up to 4 instead of down to 3). This worked really well andi didn’t get many lows. My diet was pretty strictly low-carb (at least in comparison to what I typically ate) and my first A1C test was 5.1.

Since that A1C test, my CDE challenged me to try some meals closer to my old diet so that i could be prepared for situations when low-carb might not be available and so that in could vary my diet and not fall off the low-carb wagon in a big way. I’ve had a few meals with more carbs than I ever imagined eating when I was first diagnosed, and for the most part my post-meal BG has been good.

What’s puzzling me, though, is that my I:C seems to have changed drastically. For example, I used to take 3U for two slices of bread and now I have to take 7-8 for the same exact portion of the same exact bread. This ratio seems to be consistent across all foods and I was wondering if that drastic of a ratio change over a few months is normal, especially considering that I haven’t seen a change in my Basal dose and that my BG is stable between tests.

There are a grip of factors over the last few months that I know can affect my ratio, but I’m still wondering if this much of a change is unusual. Specifically, it’s a lot colder now and I know heat/cold can affect BG, I’m not nearly as active as I was before my first A1C (works been crazy) and I’ve obviously been eating higher levels of carbs than before (but certainly not going overboard and I certainly still have several meals a week that are nearly zero-carb).

I’ve got another CDE meeting next week to follow up on my last, and id love to get some perspective on this before going in for that appointment.

Thanks in advance for any info and all the best to everyone in 2013!


I think all of the things you mentioned are a factor but I also think you are moving out of your honeymoon phase where your pancreas was helping out by making some insulin. this has happened to me pretty recently also. I found it to be frustrating and I beat myself up for needing more insulin, but really, if you need more insulin, you need more insulin. It has forced me to be more strict about low carbing and to exercise more, even adding crossfit to add higher intensity to my workouts. I think as long as you aren’t gaining weight, your numbers are good and you feel good, you are good.

Thanks Molly!

Yeah, the honeymoon factor was the other that crossed my mind right after I put up the post. I've noticed that even when I go very low-carb (chicken and broccoli, for example) I'm taking more insulin to cover the BG increase from the protein than I used to.

I need to get my butt in gear about exercising, though!

Thanks again!

I am starting to have to be really careful about the protein also. I found that I was going higher than expected after meals and it was because of the protein. I still have trouble at times figuring out the timing on injecting with more protein based meals. I eat too much protein, I know it, and I am interested to see how my blood work pans out. I am a little bummed that I am noticing greek yogurt causes me to spike a bit where it never used to. Maybe bc I am not adding in for the protein, ugh. Hang in there. My cgm helps me a lot. Get one if you don't already have one.
This site is great. It helps to think out loud with others!!

Thanks again, Molly. I find myself relying really heavily on protein to feel like I'm having a "real meal" while avoiding carb-heavy foods.

The yogurt is a tough one for me, too - even though it has less carbs than a couple pieces of toast I've never really felt like I've been able to figure out how it really affects me so I've avoided it for now.

Love this site - like you said, it's great to be able to just talk through these things!

All the best!

Yes I would definitely second Molly's opinion about the honeymoon maybe coming to an end. I was dx'd in 1975 and don't really remember how long the honeymoon actually lasted but I do know I was on a single dose of lente insulin for probably close to 8 months regardless of carb intake. For me the weather doesn't have much of an effect on my blood sugars and although I live outside of Boston, I still try to get out and walk every morning despite the cold. But I think getting active and staying active is one of the best ways to keep blood sugars regulated. I don't eat many meals that are zero carbs in general I have cut back on carbs but if I want something like ice cream or a fun size snickers bar, I have it and bolus for it or work it off on a stationary bike or on a walk with my dog.
My CDE is a bit like yours still follows the ADA 45 grams of carbs per meal routine but I have found that fewer carbs make my blood sugar less variable and require less insulin. And less insulin leads to fewer mistakes or opportunities for mistakes. The CGM has also made a big difference too.
Good luck with your meeting.

Thanks Clare!

I agree on things like ice cream or a bit of chocolate - I tend to bolus a bit extra with my meal and then eat some chocolate about an hour after the main meal so that the spike from the chocolate is more in line with the peak from my insulin - seems to work pretty well and it helps keep my sweet-tooth satisfied without my having to resort to something far less predictable.

I'm with you on the carbs - I want to eat enough to keep my body happy but stay within the threshold of keeping my BG stable and predictable.

Thanks again for the input!!!!