Insulin-to-carbs

Type 1 and LADA
1

Hello All you type 1s out there!!

Well, I was just wondering on how to figure out one's insulin to carb ratio??

I was recently diagnosed with type one, just over a month ago. So far I've

learned that the doc I saw in the hospital didnt know what he was talking

about when he gave me some sliding scale.

And I was just wondering, whats the best way to figure out an I:C ratio?

I'm just learning about counting carbs, and giving my self shots for

carbs and such..

See, the doc had me taking insulin based only on my blood sugars, and the sliding scale

he had me on, apparently was way too high, and not compensating for carbs I was eating.

Well, through a few friends I've met on here recently, I've been doing an I:C of 1 unit of insulin

to every 15g carb consumed. Its been helping a lot, lately my sugars have been pretty normal,

around 65-95.

So how do I find my own I:C ratio? then what about insulin? how do you find out how much insulin is supposed to take my sugars down? I find myself getting as low as like under 50 before lunch usually, sometimes before dinner I'll even go below like 45ish is that the insulin? or would that be the Lantus??

Thanks folks

--John

2

First you have to basal test and make sure your basals are correct. Then, as an adult, I would probably start out with a 1 to 10 ICR (total guestimation); as a young child we started with a 1 to 15 ICR and test two, three and four hours after eating. I am assuming you are using Humalog/Novolog, which typically has a four to 4.5 hour duration (for us it was five to 5.5 hours). At the two hour mark, you should be able to see if you are too high or too low and can adjust ICR from there. The other factor is that endo may prefer you have a blood sugar of 150 or so at the two hour mark, necessitating a rescue snack sometimes if you keep dropping too low hour 3 and hours 4 to 4.5. In other words, ICR is basically the best you can get most of the time; it is not foolproof. Some foods need more insulin; some less. If we used true ICR, she would be too high at the two hour mark, even though she would drop back to baseline by 4.5 hours. Using the faster insulin, Apidra, this is still true for us, as with Apidra her DIA is four hours (though dropping less in the last hour than Novolog and no tail). Breakfast or the first meal of the day needs a lower ICR than lunch and dinner. ICRs change as well, with activity. P.S. Since you are newly diagnosed, and find ICR of 1 to 15 is working well, I would stick with it and just test hours two, three, four and even five to watch spikes and see if you drop toward the end of the DIA.

3

Alrighty, that sounds somewhat good, I am using Novolog at the moment, so far taking 1 unit per 15 grams has been working all right. As for the basal, how would I go about testing that? the doc had me taking 30 units every morning. but about 3-4 days ago I switched it to 20 units at morning, then 10 units at night.
the last few days I’ve been pretty low…I’ve been hitting under 50, even under 45 around mid-day, like pre lunch and all
how do you tell if my basal needs adjusting or not??

4

Most doctors start people out with a 1:15 ratio for rapid acting insulin & then adjust from there.

It’s best to start with a meal with fewer carbs & known carbs counts. Larger doses of insulin act more unpredictably than small doses. So, begin with a 15 carb meal. Do this for several days in a row with meals at different times of day. It’s common for people to have different ratios for different meals. Breakfast is typically the smallest ratio. Lunch since it’s at the most active part of the day can be a larger ratio.

Keep the dose the same for three days in a row to get the full picture. Adjust up or down by 1-1.5 units. Making drastic changes won’t yield the info you need. Keep records, of course.

Timing of insulin is as important as dose. General guideline is to take 15 minutes before eating, but you’ll need to see what works for you. Testing a lot helps to figure this out.

Your lows could definitely be due to Lantus. Many discussions here about Lantus you can search. It’s not as level as claimed & people have experienced lows with Lantus peaks. I had awful afternoon lows on Lantus & it changing the dose didn’t help. Levemir is much more level for me. It also doesn’t sting. Lantus is acidic. I also found that Levemir doesn’t expire as quickly. A vial of Levemir is good for 6-8 weeks. Lantus is kaput at 28 days. People tend to take Levemir in two doses.

Testing basal is done by skipping meals & testing to see how level BG remains. Like testing rapid acting, it’s best to use different meals as the test case to get a good idea.

5

How do I switch to Levemir? just ask my doc for a different perscription??

6

i hate to thread hi jack but i just wanted to say thanks for the tips… because there useful for anyone including a 14 year diabetic who didnt start caring about his health till now!

7

yep… btw i used lantus and am on levemir now also i feel its alot better and more stable… good luck to you!

8

Yep, just a new Rx. My Lantus & Levemir doses were the same, but sooo much more level on Levemir. If he gives you a hard time about changing, tell him you’re allergic to Lantus & getting itchy & red where you inject. My doc gave me a song & dance about how Lantus didn’t peak. All they know is the literature put out by the pharm companies.

I:C ratios change frequently over time. Nothing is written in stone with diabetes, unfortunately.

You’re doing wonderfully figuring this all out on your own!

9

I was on Lantus shortly before going on the pump. Both my CDE and my endo told me there can be a peak in the afternoon. I did go low, but just adjusted with a snack at that time. I usually wanted a snack then so it wasn’t a problem. But for me, it was night and day compared to Humulin N. Plus I wan’t on Lantus but a couple of months before going on the pump.

10

I know I have said this before, but at the risk of sounding like a broken record, there is a great book called “Think Like a Pancreas.” It has been such a good resource for me. It is written by someone who is a diabetic himself and became a certified diabetic educator (I do believe). He gives excellent explanations of the different types and methods of injection insulins. He also explains how to test basal insulins.

11

See, whats really confusing for me is this whole testing, I ate breakfast two hours ago, I was 169 (cause i “experimented” and did some binge eating last night, to see how much it’d jack up my sugar) and I ate like 75 carbs for breakfast, so I took my 20 units of lantus, like usual…then for my Novolog I took 5 units for the carbs, then 1 unit to bring me down (i was told to try taking 1 unit for like 50 BG over 150) for a total of 6 units of Novolog.
Then I ate my breakfast.
Now I’m here 2 hours later, to test my post meal…I’m 193…
isn’t it supposed to go down? should I take another shot? ride it out, let it go down on its own??

all…so…confusing, and depressing…

12

Yes, it is confusing, but it will come together in time, and it sounds like you are doing great at learning all the new stuff there is to learn.

75 carbs for breakfast, for me would be impossible. The only way I can explain it is that for me, my I:C ratio which normally works well most of the time gets “broken” if I go above 50 carbs. Plus the morning is the time we are most sensitive to carbs. Many of us have different ratios for the morning (sorry to make it more complicated). Like mine is 1:7, 1:9 and 1:18 for the three meals. I definitely wouldn’t eat that many carbs if I was 169 before the meal!

As for corrections, you need to find out for sure what your correction factor is (how much one unit of insulin lowers you). Mine is 1:30. Then if you want to do a correction after the meal you need to compute in your “Insulin on Board.” I figure on the basis of 3 hours, some people do 4. So if I took 3 units, let’s say and then two hours later was high I would calculate I still had 1 unit IOB and add that to whatever I took to correct.

I have used Using Insulin by John Walsh and learned a lot; after that it is just trial and error.
Btw if your bs is so low before meals that definitely means your basal is too high. I would try lowering it one unit then waiting a few days and logging the results before lowering it more. I take Lantus and it seems fine for me but I do split my dose. When I took it all at night like the doctor said I was high by bedtime as it didn’t last 24 hours.

13

lol, see…every new reply is something different
now there are different I:C ratios by "time of day"
per meal, blah…my mind is going crazy!!
but! thank you for the input, because believe me, I’m definately
paying attention and trying to learn it all.
so how do I figure out how my basal is working properly? I’m pretty positive
its just a little bit too high. and you say we’re more sensitive in the mornings?
so mornings should be lower in carbs than my other meals?
I’ve been averaging about 60-75 carbs per meal, including breakfast.

In fact, I’ll give a run-down of my number for say the past like 5 days and my doses
here goes :smiley:
oh, and these are all pre-meal numbers, in order of:
breakfast, lunch, dinner, bed

8/24/2010 - ‘7:30am 87; 30uLantus, 4uNovolog’ ‘1:30pm 55; 3uNovolog’ 7:00pm 84; 3uNovolog’ ‘11:30pm 80; 10uLantus’ <—this is the day i switched my basal around

8/25/2010 - ‘7:00am 87; 20uLantus, 3uNovolog’ ‘1:30pm 41; 4uNovolog’ ‘7:30pm 114; 4uNovolog’ ‘11:30pm 92; 10uLantus’

8/26/2010 - ‘7:15am 71; 20uLantus, 4uNovolog’ ‘2:00pm 55; 3uNovolog’ ’ 7:20pm 69; 5uNovolog’ '11:20pm 90; 10uLantus

8/27/2010 - ‘7:30 82; 20uLantus, 4uNovolog’ ‘2:30pm 55; 3uNovolog’ ‘8:00pm 41; 4uNovolog’ '11:45 122; 10uLantus

8/28/2010 - ‘6:30am 162; 20uLantus, 4uNovolog’ ‘12:30pm 46; 3uNovolog’ ‘7:30 189; 4uNovolog’ '11:30 265; 10uLantus, 2uNovolog
(the reason my sugars were so high, i did some ‘experimenting’ and did a lil binge eating, to see how much the food would jack up my sugars)

8/29/2010 - ‘7:00am 169; 20uLantus, 6uNovolog’

and thats a breakdowm of the last 5 days
whatcha think yall?? bleh, I hate asking so much, and I hate now knowing things
my bad to sound way too noob to yall veterans :frowning:

14

I wouldn’t take another shot yet & see if it starts coming down.

Experimenting by binge eating isn’t a good plan, but you’ve realized that:) One experiment to chalk up to experience.

Yes, ratios can be different for different meals. Most people are most insulin resistant/carb sensitive in the morning. Eating 75 carbs for breakfast, which is a lot, wasn’t covered by 5 units. I eat the fewest carbs for breakfast & stick to protein.

Promise that you’ll figure it out. We all did & felt just as confused & frustrated. Ask anything you want to know.

15

If it is at 2 hours, wait one more hour and check and then correct. Also, if it is high before your meal, take your insulin 15, 20, 25, or 30 minutes before you eat. It will start working before you eat and get things going.

Zoe’s post is excellent. My carb sensitivity is different with breakfast, especially the more I have. It’s quite confusing and some of this you will only come to know over time. That’s why I said on the other post that journaling what you eat, when you eat and your meds, will benefit you. It’s tedious, but the benefit to doing it will help you when you look back through it. I try to keep it around the same carbs and the same time. It helped me alot in the beginning. It minimizes the variables that can affect your blood glucose. I also have what I like to call “Goto Meals.” Meals that I know how much of what I am eating and have eaten the exact same thing before and gotten good results and know pretty much how much insulin I need. Here is on of my breakfasts: yoplait lowfat yogurt, 1 piece of Peppridge Farms cinnamon bread, 2 turkey sausage links (or 1 egg) and coffee with fat free half and half. I have that probably 4 mornings each week. I know how much to take, when to take my insulin and generally how my bloodsugars will look after.

I know that if my blood sugar was 193 before my meal (especially breakfast), I would need a little more insluin to bring it down and I would eat less carbs. This is what my insulin to carb ratio is (I:C)

mornings - 1u:9g
afternoons until 7:30pm - 1:12
7:30 until midnight - 1:15

Sometimes we can do the same thing EXACTLY the same way the next day and get two different results. I know it is confusing, frustrating, depressing. I just try to hit the reset button in my mind at the end of the day (with my emotions) and start all over the next day. It can bring you down. BTW, I have an electronic version of the book Think Like a Pancreas. I could try to find the chapter on basal insulins and email it to you. I really feel for your situation. It’s hard under the care of good physicians. I cannot imagine how difficult it must be to navigate though this pretty much on your own. Just let me know.

16

So i should probably stick to low/no carbs in the breakfast time, and stick to a medium amount for lunch/dinner

lol, yeah…binge eating brought me to almost (and probably did) over 300
heh, that aint gunna happen again. thats for sure. now I sorta want to figure
out how much 1 unit of insulin will take me down.

Thanks again Gerri for all the advice too, helps out way more than ya think :smiley:
no doc or endo here for me, so all my info is coming from yall.
I think I am just gunna have to spend the like 17$-18$ on one of them books :smiley:

17

Oh my, you have no idea how much that would be Awesome!!
I’d love to check it out, you need an email address?

Oh, I checked my sugar just a little bit ago, it was 193 2 hours after eating, and it went down to 173 an hour later, gunna check again in like 20 minutes…

I’ve been talking to some people here on the website and they said the same thing, they tend to have the same meals many times a week.
I’ve started somewhat doing that, I’ve been making sure to have a salad for all lunches, and with dinner, and been trying to keep my carbs balanced.
Since yall say we’re generally more sensitive to insulin/carbs in the mornings, I guess you can say I’ve sorta been the opposite of what I should be doing?
I’ve been doing like 60-75 carbs for breakfast, very low/no carb lunches and about 60-75 carbs for dinner.
and i dont really have much in the way of snacks, sometimes ill have a bedtime snack, but thats about it. I really am not a fan of trying to snack all the time…

18

That’s what I do. I’d be flying at 75 carbs. Eating mostly protein in the morning also will make you less hungry at lunch. Carbs digest fast & just leave us wanting more. The more carbs you eat, the more you’ll crave.

Sorry for the frustration–been there. If it’s any consolation on not having a doc or endo, we all stumbled along on our own figuring this out.

Learning your correction (insulin sensitivity factor ISF) isn’t hard. Next time BG is high, take 1 unit & test (after your 2 hour reading & dose). Remember that it peaks at around 2 hours, so don’t expect an immediate result. One unit brings me down 60 pts, but I’m small. I’ve found that my correction dose has stayed the same for 2 years.

Worth buying those books, yes.

19

Even if you eat no carbs for breakfast, you still need to take a meal bolus. About 58% of protein converts to glucose just at a much slower rate than carbs. Really is easier to try to stay with lower carb meals as your determing your ratio. It seems that if 1 unit of insulin cover 15 grams of carbs that 5 units should cover 75, but it doesn’t work out that neatly. Larger doses take longer to absorb.

20

I was looking at the book on my device and the only way I can do it is by screens shots. I can find the section on basal insulin dosing and send you that. It should get you going for the next few days. I would call your local library and see if they have a copy on hand. I sent you a friend request and you can then send me a private message with your email (if you are comfortable with that).