As I am learning to plot accurate basal, bolus, and correction insulin amounts for my pump, I’m realizing that I am significantly insulin resistant. The educator wanted to begin with a 1:15 ratio for carb ratio and 1:55 ratio for corrections…and I could tell immediately based how much I’ve been injecting that those ratios wouldn’t work for me. I would be more like 1:6 and 1:25, respectfully.
So, now I am on research track to discover how I can shift this resistance. Chromium and vanadium are the two supplements I’ve found most consistently recommended. Exercise, of course–which I didn’t do for a couple of years after fracturing vertebrae in 2012 but am doing for the past year or so.
I’d love to hear any tips or suggestions or experience with this. Thanks for your help
you may find the I:C ratio and the correction factor are different at different times of the day. This is where your pump really can fine tune things. I have and I:C of 1:9 in the AM and 1:15 the rest of the day. This is all programmed into my basal profiles.
Insulin resistance can affect individuals differently. I’m type 1 and did develop insulin resistance a few years back. It was characterized by weight gain and increasing levels of daily insulin combined with poorer glucose control. In my case, taking more insulin created more insulin resistance. When I cut back on my daily carbohydrate total, that led to lower insulin doses, and that led to increased sensitivity.
I’m a big fan of patient directed insulin therapy. To the extent that you feel confident in making changes while monitoring closely, writing stuff down, and keeping safety glucose always nearby, I think you could make some of the changes you write about. At least you could take some small steps in that direction. Including a doctor in the decision loop, along with all the inherent communication delay, is a clumsy, at best, feedback loop.
My number one tactic for optimal insulin sensitivity is cutting back on the carbs. For me, fewer carbs means less insulin which can lead to increased insulin sensitivity. Good luck with your new adventure!
Totally agree, @Terry4 I eat between 45 and 60 grams of carb per day and have been since May, 2015… so I will add this to the list of things I am doing to turn this train around
I started upping my bolus at meals today rather than falling way behind and making corrections over and over. For example, the pump recommended 2.25 for 22 grams of carbohydrate at lunch, and I took 4.75… topped out at 144 at about 2PM and came down to 127 by 4:30 before starting to go up again. I think we are going to have to increase the basal a bit, but I will wait until Monday when I meet with the Diabetes educator. I am very confident adjusting the boluses. The basals, while I understand the logic of the equation, I think I will wear training wheels on for just a bit longer.
I suspect that your educator is being very conservative with those ratios. In the UK, it seems to be pretty routine to start out new pumpers at an I:C of 1:10 and an ISF of 2 (which works out at around 40 in US dollars). I have seen some published data and the starting ratios used in the UK correspond pretty closely to the median numbers used by T1 pumpers. At 1:6 and 1:25 you would probably still be classified as within the insulin sensitive range. Some T2s are down at I:C ratios of 1:3 or less!
My favorite tactic is to do a temp basal reduction starting two hours before my planned exercise session start. I set the temp basal duration for the same time length that I plan to exercise. That means you don’t have to eat anything. Every tactic used needs close monitoring and appropriate counteraction, if needed. If your cereal bar is working well, then great!
I have similar ratios… Regarding weight loss and exercise (I lost 35 pounds over the past year and have slowly increased exercising, now I exercise 4-7 times a week), I bring bad news: my ratios are still 1:6g CHO and 1:20… lol
I work out at 7pm so I’ve been able to improve my resistance to insulin after 7pm, and change my ratio to 1:10 and 1:45. So maybe starting with a light walk and gradually increasing the intensity or duration will help you at night. =)
Hi, @Terry4 ! I wish I could do that, but I don’t have a pump yet. I do MDIs.
Yeah, it sort of works… sometimes it’s too many carbs, but never too little. Even if I have the same amount of carbs, depending on how energized I feel that day and how hard I work out, my bg might be great afterwards, or a little high… there’s hope: after all our talks, I am getting a G5 this week!!! Already shipped, I can’t wait… So I will see how I feel with something attached to me 24x7 (after 10 years of “freedom” and bad numbers lol), and then I will look into the pump!!!
Congrats! I think the CGM is a real game changer providing you’re willing to learn from the numbers and take some effective concrete action based on them. For example, I started going for a 20-30 minute walk when my meal insulin is peaking in order to “chop off the mountain-top” of the post-meal blood glucose rise. The best thing is you are learning customized to you. Good luck!
For me, intermittent fasting is a big help. I started doing it while was still MDI by reducing the amount of insulin I took in the AM and skipping breakfast. Lunch is a medium apple with a quarter cup greek yogurt and nuts (approx. 22 grams carb) and dinner is either a big salad with vegetables in it to bring carbs to 25 grams of carb or a bone broth stew or casserole with vegetables making up the carbs to 25grams.
I do my best to stay clear of grains, and that helps keeps carbs lower.
And, of course, when I travel it’s a different ball of wax. Then my choices change, and I end up eating more like 60-70 grams of carb. No matter what, though, I steer clear of sugar in all its forms… use stevia or xylitol.
When I was MDI, I just took less insulin in the meal before I exercised.
Until about a year and a half ago, I used to run or go to the gym most days. I have had to curtail this recently because of a chronic cough problem. My experience is that regular exercise has a significant effect on basals but doesn’t make a difference to I:C ratio or ISF. After about 3 days without exercising, I need to run my basals about 10% higher, but not change my bolus parameters.
Because of the reduced exercise, I put on a bit of weight and to try to get rid of this, I have been on the 5:2 diet for the past 7 months or so. In that time I have lost around 7kg (16 lbs - just under 10% of my bodyweigh) so the results have been effective if not dramatic. The REALLY INTERESTING thing is that my TDD is down by 20%. This is much more than could be accounted for by eating less two days per week. My basals are around 15% lower even on “5” days (less than when I was running most days) and my I:C ratios have gone from 1:8 to 1:9.
The theory behind intermittent starvation diets is that your metabolism switches over to fat burning - this fits with the reduced basal rates. Although I have now shed the weight I put on, I feel I should continue with the 5:2 because of the effect on my insulin requirements. My one warning to anyone trying it is that the reduction in basals makes it easy to have more hypos. A cgm certainly helps.
Good call! Sounds like you have a good understanding of the tactics needed. In your case, I might consider doing a temporary basal increase so you can see the effect. If it works over a few days, then consider making it permanent.
One thing I have heard from other pumpers, and it is certainly true for me, is that your TDD insulin will go down over time. When I started pumping, I was routinely around 40 - 50U/day. These days, I am routinely running around 20 - 30U/day. I like to think this is because of having tighter control by having a basal rate that can vary with your body’s needs. Because you are less likely to chase highs, which requires more insulin, your TDD should come down.
I like to do little things to up my metabolism and therefore increase my insulin sensitivity. A short, brisk walk after meals (but really anytime) seems to have significant effects for me. Especially after a LCHF dinner, I find a walk afterwards is the difference between a pretty flat CGM line and multiple corrections 2, 3, 4+ hours later. With the onset of cold(er) weather - I am in Florida, after all - I have just started doing 50+ squats while waiting for my tea to brew. The squats have a multi-fold effect: I get warmer, my metabolism gets a boost, and my tea gets brewed for the proper amount of time (please note, I am drinking my tea with my pinky extended - la te da!)
I’ve been slowing adjusting basal up…I now have three programs: midnight to 7AM, 7AM to 3:30PM, and 3:30PM to midnight. Step by step. My data says I am averaging 35.67 units of insulin daily now (the educator started me on 33,) and that is still 10 units less than what I was averaging on MDI.
I would love to see insulin usage go down! Here’s pinky tea drinkers