Hi all. I’m starting to teach myself to calculate a rapid mealtime dose of insulin so I’m ready to hit the ground running after my upcoming endo appointment (aren’t I the model student)… does this example seem correct. I’m going by I:C of 1:10g until I know mine. Correction factor 1u to drop 45mg/dL.
Pre breakfast level: 155 (goal level 100 ish)
Carbs I intend to eat : 23
So 2u to cover carbs plus 1 extra unit to correct.
And I’d take this how long before I eat ?
I’d monitor hourly, Ideally I’d get to 100 by 2 hours post meal ?
Your math looks great! I know several of our low-carb members choose to include some or all of their protein count when they calculate food boluses - you may want to read some of those past discussions and see if it applies to your situation.
As far as timing goes, that’s a case of YDMV. For me, if I’m more than 50 above my target range, I’d bolus half-an-hour before eating a normal (for me, ~30-45 slow-acting carbs) meal. Depending on what you are eating, that time may shift (for quick-acting high carbs, I’d wait a little longer; for a high-fat/protein meal, I may cut it back to 15 minutes before the meal because the protein and fat take longer to enter the bloodstream).
Usually, the peak of your meal is around 2 hours after (again, depending on what you eat). I wouldn’t expect to reach your target glucose level until at least 3 hours after the meal.
As with all things diabetes, try a few experiments and see what works best with your body.
I think the correct units is mg/dL. The blood glucose normal range in mmol/L is about 4.0-8.0 mmol/L (72-144 mg/dL).
Some people use a range to target, like 90-100 mg/dL. I like to target a discrete number. But the math may be rounded to whole units of insulin.
It would help to do a small test on yourself to see how long it takes after you start eating for your BG to rise. The way to test this is to eat a known quantity of carbs and then fingerstick every 15 minutes after eating. When the trend noticeably bends down, like 10-20 mg/dL in 15 minutes, say from 125 to 110 mg/dL, then eating at that time should help match your dose well to your meal. Then you know what to expect for a reasonable pre-bolus time.
Your pre-bolus time is likely to be different at different times of day. MIne is 60 minutes in the late morning and 30 minutes in the evening. Your needs likely to differ.
Should I leave my basal as is when I begin post meal bolus ? It’s currently 12u at 8pm of lantus. 60% of my levels are stable around 8-9mmol overnight. 40% drop by around 4mmol but this is when I have a late dinner or dessert and my before bed is 13/14. (I’ve been ignoring this).
One unit drops 45mg/dL it should’ve been (so that’s 2.5mmol). I just took an average to calculate that from websites that describe how to calculate your correction factor.
On day one of bolus when I get out of bed I’ll test this. Maybe I’ll do a correction first see what that does before eating my first meal. It may mean delaying my breakfast a few hours. I’m not sure I’m game enough to do a correction plus carb cover bolus on my very first shot not knowing any of my real responsiveness factors. Does this sound like a plan?
If you get to 2 hours post-meal @ 100 mg/dL (~ 6 mmol/L). Then you may go low at 3-4 hours after eating. Read up on duration of insulin action in the bolus insulin package insert. You’ll pick up on this with experience. [quote=“PemW, post:6, topic:58428”]
Should I leave my basal as is when I begin post meal bolus ?
[/quote]
All these diabetes settings are not set-it-and-forget-it. You may be able to leave some ratios and numbers the same from day to day or week to week but don’t get overly invested in that number. You may need to change it. Your insulin needs will change for any number of reasons we know about but also for hidden reasons that you may never discover.
Diabetes is dynamic, not static. Expect the target to move and when you move with it, you’ll will have hit your stride.
it depends also on what your BG is prior to the meal
a good place to start tuning may be, from common advice given in books and clinics, to dose 15-20 minutes prior to the meal. If your BG is close to the low end of your range, dose right before the meal. If your BG is high, wait longer after dosing before starting your meal (and include dosing for lowering your high BG as well).
EDIT: this is assuming fast acting insulins such as Humalog or Novolog.
All great recommendations above, but I would add getting a Continuous Glucose Monitor (CGM). One of the best tools we have available for managing our Diabetes. Good luck!
Trying a split dose of Lantus today, 12 hours apart, night and morning. So far so good (steady levels). I also put a new needle tip on my pen and stabbed myself in a few different spots as a “best painless spots” experiment, lol.
My GP thinks maybe the endo will suggest a mixed insulin to start with. I hope not. I was sort of hoping just a rapid to try first. I’ve heard mixed insulins can be unpredictable with hypos etc. any recommendations for best rapid insulin to push for (if I get a preference) ?
I’ll put up a few more links, they might come in handy later, so don’t get overwhelmed it will take a few months to get a handle on it all.
There are a lot of people on a mixed insulin, but best practice seems to be a basal and separate bolus. It gives a lot of meal flexibility, including missing or delaying a meal if you aren’t hungry.
have you got yourself some books yet?
‘think like a pancreas’ by Scheiner is one of the classics
12hr is a common split, see how it goes, It isn’t a hard and fast 12hr… Bernstein would suggest taking the lantus at bedtime and again when you wake up, The amount of each, as per the basal testing…so it can be a 9hr/15hr split.
I’ve got think like a pancreas and diabetes solution, reading those. I’m sort of low carb by default anyway (around 100g a day - more over Christmas ). Eg my lunch just then was 38g but it’s my carby meal of the day. I found an app for kids that calcs your insulin dose for you when you enter your factors but if doesn’t say anything about insulin on board which I think you have to factor in too. I’m reading up on that now.
For me, if I’m more than 50 above my target range, I’d bolus half-an-hour before eating a normal (for me, ~30-45 slow-acting carbs) meal. Depending on what you are eating, that time may shift (for quick-acting high carbs, I’d wait a little longer; for a high-fat/protein meal, I may cut it back to 15 minutes before the meal because the protein and fat take longer to enter the bloodstream).
). Eg my lunch just then was 38g but it’s my carby meal of the day. I found an app for kids that calcs your insulin dose for you when you enter your factors but if doesn’t say anything about insulin on board which I think you have to factor in too. I’m reading up on that now.