I have been figuring this out with hit-and-miss success. I started out doing one basal and the three pre-meal boluses (boli?). Then figured out that I needed to split my basal, so I did that which was helpful. I have had a few lows which are zero fun, so I’m deciding to avoid those if possible. I have been using a correction ratio of about 1:30 with sporadic success, and I don’t know WHAT I am doing for bolus. I generally have a very low carb meal (maybe 20 tops), so I take 2-3 units depending… but I am frequently finding that my 3-hr BG is still high (140 - 160 or more). So then I bolus again to correct even though I’m not going to eat. Some days I am taking 2-3 extra shots to catch up. I am a 1.5, so I probably have some insulin resistance, but I do have antibodies so they are considering me type 1. Any words of wisdom, or am I getting carried away with my self-management? The shots DO get old! I see my endo again this week and may bring up the P word. What thoughts?
I was the same way. Once i started doing MDIs, i started testing like crazy and realized all the times i was high that i probably didn’t know about before. I solved it all with the pump. I’m also 1.5 w/resistance. You can correct for that 140-160 with a bolus if it was caused by the previous meal, or adjust your basals if you see a pattern at that time. Either way, multipe boli (I like that word) are so much easier with the pump. Your ENDO should not object to the pump if you are testing and really trying to gain control. Keep us posted.
The P word is a good one to use with the endo.
I’m delighted you’re working on your self management. I’m not sure what your target is - 110? Decide that. Then start with your basal insulin. Give it always at the same times. Gather the information of exactly when and what percent of the total goes in in the am, what in the pm; tell that to the endo.
When you wake up, are you at your target? When you haven’t eaten carbs, are you at your target? Does it stay there when you haven’t eaten carbs. Get that established.
Then start establishing your breakfast bolus/ratio. The number units per grams carb. Keep the number grams the same a few days in a row. Same # grams, same kind of carbs. You have the test result from before breakfast. Two hours later it should be back within 20 of that pre meal test. Say breakfast is 15 grams and you take 3 units, you say it’s at a 1 unit per 5 grams ratio. If it’s 160 at 2 hours, you need to add 2 more units (if you have a 1:30 correction factor), so that puts it at 1 unit per 3 grams ratio. Think ratio. Different types of carbs may require different ratios.
Day 2 give your pre meal insulin at 1:3 if that was what was needed. Remember, same meal. Test again at 2 hours. Does it need fine tuning further?
Take a small non starchy snack after you test at 2 hours, maybe 7.5 grams between meals.
Between breakfast and lunch after a couple days you should be running smoothly if your basal insulin dose is correct. Then you can do the same for other meals. You need to have an excellent written record to work it out.
No you are not getting carried away with your self management! Playing catch up isn’t fun. I have different ratios for different meals due to resistance, too, but you can establish the ratio for the time of day. Dealing with smaller numbers is easier and builds confidence! Go do it! Forgive my wordiness.
Hi Rebecca!
First of all, I love “boli”-- I think that I will always use that when referring to bolus in the plural from now on!
I was the same way when on MDI. I think that I took 6-10 injections a day. Switching to the pump did make things easier in that way, also because the pump “remembers” how much insulin is still active in you! (I was horrible about stacking insulin with MDI and ended up with LOTS of lows).
One tip for getting your after meal blood sugars more normal is to give your bolus earlier. Even the fast acting insulins take 15-30 minutes to become active. I found that my blood sugars only start to drop 25 minutes after I take my bolus. So I take my bolus now 15-25 minutes before eating. This helped a lot!! I can now be under 140 after 2 hours, without going low later.
Here’s the tip that I got about testing this (from Dr. Bernstein):
One time when your blood sugar is 120-140mg/dl before a meal, take your bolus, but do not eat right away. Measure your blood sugar every 5 minutes and eat when your blood sugar has dropped 10 mg/dl.
BE CAREFUL doing this because it puts you at risk for BAD lows. So don’t do this when you are alone. But it is good info to know about how long until your bolus makes you start to drop. It is not the same for everyone!
Love boli, too!
Wanted to add my reassurance that you’re not getting carried away. Keep testing & adjusting!
hink we’re all hitting & missing. The ever changing fun of diabetes. I need different ratios for breakfast & lunch compared to dinner, often twice as much for the same number of carbs.
Timing of injections is critical for me. I go low at 2 hour post meals & then high 3-5 hours later (often need correction for these). S L O W digestion & possible gastroparesis. I take insulin after dinner to compensate, but injections before breakfast & lunch. Go figure that one out!
You probably aren’t taking a large enough bolus dose if your 3 hour readings are high. You can try upping it slowly with 1/2 unit increases.
Insulin needs change frequently, so don’t be worried if you need to increase/decrease at times. If only there was a set formula–sigh.
my pump broke, and I’m waiting for insurance to approve my new one since I changed pump companies.
I do 2 basal, 6 bolus, and as many corrections as needed.
I can’t wait to get back to pumping.