Ok, I have the same pump, so that method makes sense to me. But I was working with a CDE recently who tried to tell me that my current basal rate = 100%, so anything additional is 150% temp, or 180% temp, or so on and so forth, but I would only view it as a 50% temp, or an 80% temp. That was really confusing! I’m going to try the combo bolus idea you’ve suggested and report back soon! Thanks again for all of your insight…I appreciate it. One more question, if you don’t mind. I know you’re a LCHFer, so I’m curious how you calculate your dose for the protein/fat? I see that it’s much higher than what you’re taking for carbs, because you’re obviously not eating many, but what ratio do you use to calculate that? I know it’s individual, but just having some ideas would be helpful to me as I move forward with this new-to-me concept. I see that AR uses a 50%/10% calculation. Is that pretty standard? Sorry for all the newbie questions!
First, on the temp basal rates. On the Animas Ping, it uses a +% (plus) and -% (minus) system. If your current basal rate is 1.0 units/hour and you start a +10% temp basal for one hour then the next hour’s basal delivery would be 1.1 units. If you choose a -10% temp basal for one hour then the basal delivery would be 0.9 units for that hour. There may very well be a pump that uses 100% to mean the current basal rate. But the Ping considers 100% to mean 100% more than the current basal rate. It would be nice if these kind of features would be standard across the industry. At least it wouldn’t confuse CDEs! 
Like AR, I count 50% of protein grams and 10% of fat grams as equivalent carbs. Then I deliver an extended bolus to cover the protein/fat equivalent carbs. I limit that delivery to a maximum of 1.2 units per hour. For example, last night’s meal had 43.4 grams of protein and 42.0 grams of fat. For protein, 43.4 x 50% = 21.7 equivalent carbs. For the fat, 42.0 x 10% = 4.2 equivalent carbs. I added the two equivalent carb numbers together, 21.7 + 4.2 = 25.9. I then divided that by my 1:7 insulin to carb ratio, 25.9/7 = 3.7 units of insulin. I shoot to limit the protein/fat bolus to 1.2 units per hour.
Since the three hour maximum total would be 3.6 (1.2 x3), just 0.1 units from my calculated extended bolus, I decided to deliver 3.7 units over three hours. I could have extended that 3.7 units over 3.5 hours as well. My evening lines lately have tended to drift high so I thought adding the extra 0.1 units over three hours would be a small push in the right direction.
I don’t make myself crazy doing this arithmetic before every meal. I use a spreadsheet for meals at home and save my more common meals. It’s a bit of a burden but not as time confusing as it at first looks like.
I learned this method reading about it on TuD. I’ve used it for three years and it works well for me
Just to be clear, I don’t use the combo bolus that the Ping system employs. I deliver a separate immediate bolus for carbs and then a separate extended bolus for protein and fat. The Ping combo bolus asks for the total insulin you want to deliver and then asks you for the percentage split you want to use to divide the immediate insulin from the extended insulin. I don’t like that extra layer of math. For me it’s a needless extra complication, definitely not a convenience.
Medtronic (at least the 522 which I am still using) has regular basal as “100%” and the changes are “80%” (on Animas: -20%, I believe) or “120%” (on Animas: +20%)
@chemfreekitten - That makes sense in light of the CDE confusion. The key for the Animas temp basal semantics is the “plus” and the “minus” percentage.
We know what the pump means since we live with it all the time! It’s only when we start to communicate with other PWDs that this pops up and may cause confusion. And for those that don’t like math, they’ve long ago stopped reading this thread!
true! It’s a bit like translation, a bit like frustration… 
Right! And that’s what I assumed you were doing…I just called it a combo because that’s the general idea, and the fact that the Ping has such rigid and not-user-friendly parameters for doing calculations is one of my greatest frustrations with this pump. But anyway…onward and upward! Thanks for the clarification!
Yes, I believe the pump my CDE uses is a Medtronic, so thus her frame of reference for the temp basal numbers. A little bit confusing!
One more question: do you do this for any fat/protein in a meal, or only after a certain threshold, i.e., 20 gm of fat, or 30 gm of protein, etc. Thanks!
Shelby - I dose insulin for all carbs, fat, and protein, not just an amount in excess of a threshold. I understand that the the body prefers to use carbs first to turn to glucose and if there’s not enough, will turn some protein in to glucose in the liver via gluconeogenesis. I’m less clear on nutritional fat metabolism but I’ve read some recommendations that using 10% of fat grams for insulin dosing will work. It seems to work OK for me.
So, I understand that as long as you limit carbs then you may need to dose insulin for protein. I try to limit my daily carbs to 30 grams but I still dose insulin for protein and fat when I’ve eaten as many as 75 or 100 grams of carbs per day. The best way to sort this out for you is to use personal trial and error.
Yikes…I guess I’ve been ignoring fats and protein when counting carbs. For dinner tonight, I had a stir fried vegetables using avocado oil consisting of: slice of tomato, a slice of red pepper with collard green; stir fried chicken; and 1/2 avocado. 2 strawberries with whipped cream. pre meal BG 87. 2 hr post meal BG 125. Had a cup of herbal tea (organic wild berry tea leaf hibiscus rosehips) 3 hours post meal BG 153. What caused this delayed rise Is this possibly caused by the fat and protein content or the mystery berry tea lef tea?
Would I be incorrect in assuming that teas, even the ones that say berry tea leaves do not contain much carbs because they’re tea leaves, not the berry. So many variables…Just trying to enjoy a cup of caffeine free tea before bedtime…sigh…
Any ideas?
@lh378 - Your dinner meal contains few carbs. Since your 2-hour post-meal BG was in range and your 3-hour number was elevated, that suggests that your body is turning some of the protein (from the chicken) into glucose. Do you use a pump? If you do then you could experiment with an extended bolus to cover some of the protein.
As far as the herbal tea goes, I doubt if there are any carbs in that unless it comes in a jar and is mixed with juice. I wouldn’t add any insulin for tea.
Thanks @Terry4. I was thinking the same thing about the tea. It was not a jar; a teabag. No, I do not use a pump. I use a NovoPenEcho with refillabe cartridge capable of half unit doses of insulin. The CDE nor the dietician did not mention counting carbs from protein. Do fats lead to slow BG rise in a similar fashion as the protein?
Tonight, dinner consisted of stir fried boneless skinless chicken thighs with snow peas, and then 10 strawberries with sour cream/whipped cream. For this I bolused 1 unit figuring about 15g for the strawberries. I have no idea how to estimate the carbs for the sour cream/whipped cream. About 2 1/2 hours later, BG is a slow rise to 132.
Diabetes is just so weird and crazy. If I eat only 1 item, for example a container of yogurt, 16g, I inject 1 unit insulin, BG rises and then declines often close to pre meal. And I’ve even eaten 1 banana by itself, injected 2 units of insulin to cover 30 g and the pre snack and post snack was as expected. If the banana were added to a dinner meal…then it gets complicated.
Please don’t get me wrong…many, (especially an endo would say fantastic) would consider post meal BG of 132 to be not bad. Would anyone correct BG of 132 to try to get it closer to 80 or 90?
I’d test again in 15 minutes. If 132 is the peak, I’d be happy!!
If you’d like to experiment with dosing for protein using your pen, you could deliver a second dose at 1-2 hours after eating and watch your BGs. I agree with AR, a 132 is not bad but for me, I would correct it, aiming for 83, especially if there is little insulin on board.
It depends what your goals are. I aim to stay in the 65-120 range for a high percentage of the time. I used to have wider 65-140 target and I think that’s a good goal, too. You have to set your own personal goals taking your life into consideration.
When I whip cream I like to put 2 teaspoons of sugar in a serving. That’s 8 grams of carbs. Peas, beans, and legumes all have moderate, but not low, numbers of carbs.
Thank you both for your input! I’d like help with determining what my correction factor is, and if my thinking process is reasonable:
7:30 pm 1/2 unit for dinner.
8pm 1/2 unit for dinner
10:30 pm BG 147
After correction : BG 116 (half unit)
The BG confirmed by fingerstick was 147 at 10:30 pm so I experimented with correcting: a half unit novolog (there was possibly 20 % of 1 unit insulin from dinner remaining because I injected 1/2 unit @ 7:30 pm and 1/2 unit at 8pm for dinner). 11:30 pm confirmed BG 116 and then went to sleep with my usual 5.5 units of Lantus. Woke up this morning with fasting BG of 99. Is my correction factor 1/2 unit for 25 ? If I wanted to drop my BG by 25 points, I’d use 1/2 unit? Presently, I have only been comfortable correcting if near or above 200 (it’s not often) with 1/2 or 1 unit, which may be too little insulin. My concern for correcting for the post dinners BG generally, is going low during sleep. What is considered to be “dangerous hypoglycemia”? Previous CDE told me to “15g and check in 15 min when BG is below 80.” CDE target for post meal is BG 180. Anytime BG is near 80…they seem to sound alarms. So I don’t have much knowledge guidance or experience in correcting and trying to keep BG in the lower range like Terry4’s 65-120. I would be grateful for guidance because I am still new and experimenting and feel…well confused because of the “BG 80 alarm” message.
I know from my personal experience that my counter-regulatory systems (hormones + liver) kick in at 65 mg/dl and lower. The usual published lower limit that pops up frequently in studies is 70 mg/dl.
I think reflexively treating an 80 mg/dl is a mistake without knowing the background trend. Is the trend up or down? What is the slope of that trend? How much IOB at the time? What has your activity level been leading up to that measurement and what will it be in the hours after?
Gluco-normals can hang out in the 80-range for hours at a time.
I consider the “low blood glucose range” to be segmented into gradients. Hypoglycemia in the 60’s I consider “low.” In the 50’s = “very low.” And below 50 is “dangerously low.”
If I’m at a fingerstick 60 mg/dl with no insulin on board, I’d usually treat with 1/2 a glucose tab and check in 15 minutes. Indescriminately throwing 15 grams of carbs at each and every low, no matter the IOB or recent or expected activity level is a blunt tool that can often reinforce a yo-yo BG. Medicos are often hypophobic and react too severely to any hypoglycemia. I don’t pay any attention to their advice in these matters.
If I’m at 55 mg/dl, I’ll treat with 1-2 glucose tabs and below 50 mg/dl, I’ll eat 2-4 glucose tabs. I try to consider the context (IOB, recent/expected exercise) in every case.
You should be more conservative with any corrections after dinner. If you want to experiment with a larger correction that you think may compromise your safety, why not set an alarm for 2-3 hours post correction and do a fingerstick then?
The best way to size up your insulin sensitivity factor or ISF (how many points in mg/dl will 1 unit of insulin drop your BG?) is to correct a high BG when there is no active food or meal insulin in your system. This test also assumes that your current basal insulin is well-calibrated to your liver glucose output.
Record the starting BG, the amount and time of the correction and then the BG level at the 4-5 hour timeframe. Doing this test during waking hours helps with safety. You may find, however, that your ISF varies with time of day and starting level of BG. I find corrections at higher starting levels, say above 250, to be more resistant to corrections and need more insulin. If I usually use an ISF of 50 for below 250, I may use an ISF of 40 above 250. These are my personal numbers and may not be yours!
You need to run an ISF test that only lasts about 5 hours. You can’t necessarily draw the same conclusions with an overnight test but waking up at 99 mg/dl definitely suggests that your correction was successful. If you dipped into the 60s before waking up, however, that complicates things. Using a CGM is handy.
You’re asking the right questions. The way to answer these kind of things is to set up and perform the experiment yourself. Writing stuff down will help you draw the right conclusions. Good luck!
Thanks Terry4. Regarding ISF, what do you mean by no active food? I have not experienced a situation where I have been high (higher than 180) with no food recently. (Highs, over 200 have been due to croissants, pizza, panini, these occur not often) When I have food, I generally take some insulin. How does one perform the ISF test? Meal insulin potency may last about 4-5 hours and diminishes with time. Food digestion,…well it varies right?
I think I may have approached the low carb high fat diet slightly incorrectly. I may not be taking in sufficient quantities of fat, therefore feeling hungry and may be eating a bit much protein (meat).
For a lunch or dinner meal, I may eat (stir fried in avocado oil) meat portion is a little more than the size of my fist. Green Vegetables are often steamed. berries, quantities vary. I try to have half of an avocado for most lunches/dinners.
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More fat - should I be eat berries with sour cream/whipped cream, some kind of cream?
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Whether vegetables or salads - should the greens always be in oily/fatty dressing sauce?
After awhile, it would seem like I have a “habit” or a “pattern” of eating a certain quantity of “meat/protein” and meal combinations that does not leave me hungry or deprived, physically, emotionally. It seems to me that after repeatedly weighing, and checking calorieking.com and converting using 50%, I have about 10 to 20g of carbs equivalent of protein, approx 20g starch (rice, yam) (I know starch is not the best for diabetics) and 10 g green veggies/fruits.
I guess keeping “regular” and “habitual” will enable one to “estimate” “guesstimate”. Is that more or less your approaches @Terry4 and @acidrock23?
BTW if eating about 35-50g per meal, one still needs to include protein conversion to carbs?
Thank you all for your fantastic advice here and on other threads! This is really a terrific community!!