Insulin Basics Part-2 BOLUS
FIRST! You must have your BASAL dose such that you are stable and level in whatever range you are to be. IF your BASAL is not stable, it will throw off your attempts to figure out a good carb ratio.
BASAL is simply a BASE amount of insulin your body (everyone varies) needs with no food or physical activity to keep blood glucose normal (your normal).
BOLUS is simply extra insulin need to process the food, mainly CARBS (carbohydrates). Carbs affect BS levels to a greater degree and faster and more directly than fats or protein.
FOOD … yep we gotta eat. And when we do PHYSICAL activity, exercise, work, or play, we need extra carbs to provide our body FUEL for that. Many if not most diabetics NEED extra fuel when (just before) doing physical activity so we don’t get shaky or unexpectedly go over and out.
To check your BOLUS, you MUST have a good stable IN-RANGE BS before a measured meal, a meal with KNOWN accurate amount of carbs. I use a 4 hr standard measure. When my BOLUS carb ratio is good, my BS 4 hrs after a meal will be about the same (no food/no exercise) as before I ate and BOLUSED based on my carb ratio.
IF you BS INCREASED (too high) before the next meal, increase BOLUS insulin.
= example, say I had a 30 grams of carb meal and took 2 units of Bolus (a 1:15 insulin/carb ratio) and my BS level climbed (increased) I will next time try 3 units for that SAME 30 grams/carb meal or a 1:10 insulin/carb ratio
IF your BS DECREASED (too high) before the next meal, then decrease insulin….
= example, say I had a 30 grams of carb meal and took 3 units of Bolus (a 1:10 insulin/carb ratio) and my BS level dropped (decreased) I will next time try 2 units for that SAME 30 grams/carb meal or a 1:15 insulin/carb ratio
What do you do if your meal carbs are not a multiple of your insulin/carb ratio? You should have a range to try and keep you BS level in, If my BS level is near the upper end of my range I will ROUND UP my insulin dose, so instead of 4.5 units of insulin I will take 5. IF my starting BS level is in the lower end of my range I will round down my insulin dose and take 4 units. A funny thing is either way I will have made a minor correction and be closer to the middle of my target range.
ROOM for ERROR; The more accurate the better, but being human, we make mistakes. It is better to error on the side of SAFETY, in other words better to let BS level go a LITTLE high than too low and go HYPO. I set my own range of 80 to 120 or almost 2 whole units of insulin. Many of you might want a wider range, maybe 75 to 150 or whatever your doctor advises.
IMPORTANT, I you are nut absolutely SURE you understand this, DO NOT ATTEMPT! Its is always best to work with your diabetes health care team on ANY changes to your insulin routine.