Insulin dosage adjustments

Type 1 and LADA
#1

The recommendation is to inject Novolog 20 minutes before meal time.
What are some of the options if:

a. you eat more than you planned because you are more hungry

or

b. somewhere between 3 and 4 hours since the last bolus injection, you decide to eat a medium sized banana, (27g carb,according to calorieking.com)

I just began using insulin and was told that 1 unit of insulin/15g carb.

Do I

a. inject more insulin to cover the extra food?
b. inject 1 1/2 units to cover the 27 g carb for the banana?

What are some of the "problems" or trouble that I can get into because while bolus insulin peaks 60-90 minutes from time of injection, it's still in the body up to about 4 hours, right?

#2

Everybody is different. You will just have to find out. If you want to snack every couple of hours you may have to consider way too many factors in your bolus calculation. Those factors include whether you have digested your previous meal, whether you have insulin still on board, what your blood sugar is and what you are eating. I found that eliminating snacking (that requires a bolus) makes it a lot simpler.

#3

BTW I have a question about Insulin On Board. If I bolused for a meal correctly, and then had a snack that is a carb, what's the difference how much IOB i have? It wasn't meant to cover this additional snack. Why shouldn't I just add inject some insuling -- what I would need for this snack -- and disregard the IOB? Thanks

#4

Negg, i think that way too. i only subtract IOB for corrections of high blood sugars.

#5

I used the pre-bolus technique with MDI before I went on pump. I would take a set amount of insulin before heading to lunch - for an amount that I will always eat as a minimum. When I get food and start to eat my insulin has been onboard for about 15 minutes. If my meal turns out to be more than my standard pre dose then I take a second shot to cover the extra carbs. This has worked well for me and now that I'm pumping I do the same with good results. Its kind of like what a pancreas would do - add in the required amount of insulin for each meal or series of meals we eat. I don't chase after highs if I have staggered insulin and food on board. I wait till the last dose has cleared before adding in more for a correction. I have not had problems with going low when I do it this way. It works nicely for those grazing kind of meals that come with the holidays - where there are several courses spread over time. If you dosed for the whole meal at once you would crash before all the courses have been served and then run high afterwards because there was still food coming when you insulin activity wound down.

And definitely agree that if food is not active then IOB gets subtracted from correction doses.
#6

I agree. I have found that the term "stacking" is used far too liberally by many (docs/nurses especially). It's only stacking when you take more insulin to bring down glucose levels when there is still insulin working to bring it down.

Unfortunately, many medical professionals still go for a one-size-fits-all approach. And that often means eating on a schedule, taking a dose at a certain time, etc. I never (absolutely never) took insulin prior to eating. It was easier with a pump, but even on mdi, I acted this way. Sometimes I lost my appetite (due to gastro issues) and couldn't eat all I planned on. Sometimes I ate more. Plus, with gastroparesis, my stomach emptying was delayed, so especially on mdi I got a better bg curve taking the insulin after the food. And don't get me started on waiting for meals in a restaurant!

#7

How does injecting after eating work? because I was told that it would take the insulin about 60 to 90 minutes to peak. By injecting after eating, would you run the risk of the insulin peaking when the blood glucose is no longer high?

I'm new to this and my biggest concern and fear is low because one time I tested 50 and had no symptoms. I only tested because I was planning to exercise.

#8

The different insulins have differences in when they peak and how long the duration.

Have you read either Think Like A Pancreas or Using Insulin? Both are availabe in hard copy as well as for ereader. They cover the differences and have a lot of good info on how to figure basal doses, bolus Insulin to Carb ratios, how to figure out how long your insulin works in your body, how to figure out your correction factor s.

All of these may be different at different times of the day so getting a good handle on how to test and calculate things is important. Once you known how to do this, as things change with time you will know how to adjust.

#9

Your sugar wont just sink without insulin, the only thing with later injection is that you will stay high a bit longer than you want to, lets say you peak at 12.30 and stay there until the insulin kicks in.
so no fear of lows i guess… but the two books hobbit suggested are definitely good material to work with.

#10

How long does this process of figuring out correction factor....etc take? Also, recently, I feel full after only eating a small amount. Is it gastroparesis, and how would that affect matters. I will definitely look into the two books.

Is it Using Insulin by John Walsh?