Is there a magic number for insulin dosage intake?

In 2012 before I started a carb limited diet, I was probably eating over 200 grams of carbs each day. At first I cut my carbs to less than 100 grams per day but when I saw my glucose levels improve and my weight start to drop, I cut my carb consumption to 50 grams/day.

I never attempted to restore my carb consumption back to my former eating habits. The benefits of eating a low carb diet motivated me to keep on with this way of eating.

Within six months or so, I cut my daily carb limit down to 30 grams/day, the Bernstein method. In 2018 I received a coronary artery disease diagnosis and I stopped eating all grains including wheat, rice, and corn. When I did that I lost another 12 pounds of weight.

The shorter answer to your question is that yes, when I resume eating more carbs, my daily insulin total rises and the weight starts to come back.

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Wow, that’s a massive reduction. I don’t know whether I can go down to 50 let alone 30! Carbs are everywhere and they are addictive! I can’t go without my piece of bread every morning or a bowl of pasta now and again :sob: Even my cup of milk has carbs.

Do you bolus for proteins? Without carbs, proteins will increase BG. How do you factor for it in your bolus?

The T slim X2 has a pump history that details how much basal and bolus you use either day by day or averages. My 30 average is 42 units a day split 50/50 bolus/basal.

@tedos Carb exchanges are anywhere from 15 to 20 years out of date depending on where you are. You may need to do some basic reading to bone up on more modern techniques. Some of the highly regarded books are
Think Like A Pancreas by Gary Scheiner
Sugar Surfing by Stephen Ponder
Pumping Insulin by John Walsh and Ruth Roberts

I would read one or all of those books to fine tune my diabetes control.
There is also Diabetes Solution by Dr. Richard Bernstein but he is very hard line on how you are supposed to treat your diabetes so while he definitely makes a lot of sense and many, many people have great success with his protocol it is hard to stick to if you can’t imagine giving up all starches and sweet fruits and milk.

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What is the current way to do this? I’ve looked up some sites online and it seems to still suggest carb counting is still current. I’m not sure there is anyway around this, the pump asks you to input how many grams you are taking so carb counting must be in place isn’t it?

Or is it the fact that we no longer work in exchanges but in grams. For example, 1 slice of bread is 1 exchange but today we count that as 15 grams. Is that what you mean by carb exchange is out of date? If so, nothing has really changed, it’s just a different measurement system or have I missed the plot completely? :sweat_smile:

Carb counting is current, carb exchanges are not.

Yes, 15 g of carbohydrate is usually equal to 1 carb exchange… But nutritional labels on food didn’t exist when carb exchanges ruled, though when they were introduced varies by country.

I was diagnosed in 1988, 2 years before nutritional labels were required in the US. Prior to that, we had no idea how many grams of carbohydrate were in what we ate. We may have had a diet book with some generalized info, but it could be far off from what was actually in the food. We also had slower insulin, thus we learned to eat to our insulin regiment, rather than dosing for what’s on your plate. With carbohydrate exchanges, you had a set meal plan… Something like 3 carbs for breakfast, 2 carbs for am snack, 3 carbs for lunch, 1 carb for afternoon snack, 4 carbs for dinner, and 2 carbs with protein for a pm snack. You took the same amount of insulin at the same time everyday, plus you had a “sliding scale” of extra shorter-acting insulin you added for correcting highs. Then you had to learn things like 1 carbohydrate exchange = 1 slice of sandwich bread but only ½ of a bagel or English muffin, or 8 oz. of milk, or 1 small apple or orange, or 10 french fries, or ¼ cup of cereal…

This notion of exactly how many grams equals a carb exchange didn’t really enter the picture until people were trying to recognize these new nutritional fact labels with the already familiar exchange system. (Yes, there were some more fastidious endos who more thoroughly trained patients prior to that, but it was not common place.) As we obtained more specific food knowledge, we drifted more to the I:carbohydrate ratio for dosing, and away from eating a required amount of carb to satisfy the insulin you took.

Just because you happen to know that 15 grams of carbs equals 1 carb exchange, doesn’t mean you’re following an exchange system… Unless you are actively trying to eat the same amount of carb every day at the same time. If so, then yes, you’re following an outdated system.

When Humalog first hit the market, I was told to take 1 unit for every 15g of carbohydrate, despite being a small child. I think that was just a generalized rule for everyone to stick with the exchange system we already knew. To this day, I still haven’t strayed far from that original 1:15 ratio, though. I’m currently using 1:13, and from what I’ve read, the vast majority of diabetics have an I:c ratio fairly close to 1:15, so in that regard the old carb exchange system might still be relevant.

I suspect you just talk about exchanges now as an easy way to recognize a defined amount of carbohydrate I still find that information useful more then 30 years later, since I make everything from scratch and most of what I eat doesn’t have a nutritional label.

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In the old days, this worked because there were few choices of breads. Now, checking grams of carb is more precise and accurate, using food labels. In early days of exchanges, we didn’t have food labels like we have today.

Pumps also made the math easier, to count grams instead of exchanges and be more precise.

However, it wasn’t until I found online groups that suggested also taking into account protein grams into calculations. Sometimes referred to as TAG - total available glucose.

I include protein in most meals, since it slows the bg spike of carbs only.

Here is old post about “taggers”.
https://forum.tudiabetes.org/t/taking-insulin-for-protein-and-fat

I get this. After reading on this forum about people who adopted a low carb way of eating, it took me two years and one complication diagnosis to commit to giving it a fair trial.

I loved my carbs, too. I was fond of those large bakery bagels – their chewy texture was addicting. For years I ate a bagel with peanut butter and a banana for lunch at work. I also loved Italian dishes with heaps of pasta. Suggesting that anyone change what they eat each day is akin to suggesting that they change political parties or their religion. It’s highly personal and bound up in culture and social fabric.

As is often the case in things like these, changes loom large when they’re in front of you but then slowly diminish in size when you enact them and they start to produce benefits. And these are tangible benefits like more time in range, fewer hypos, reduced glucose variability, clearer thinking – in short, metabolic sanity.

While I don’t follow the Bernstein protocol per se, I’m a big fan of his law of small numbers: fewer carbs = smaller insulin doses = smaller mistakes.

Dosing insulin, whether you use exchanges or direct carb counting, is tricky business – a point readers here know all too well. It’s not precise or fully predictable. Diabetes is a dynamic disease. You can eat the same meal at the same time every day with post-meal BGs rising too high one day and dangerous hypoglycemia the next.

Food labels are not dependable. They may or may not show the correct carb count for what’s inside. I know you can take steps like weighing your food portions to determine the carbs and the insulin dose. But what if your insulin to carb ratio changes on that particular day? Or if you want to calculate an insulin correction dose to bring down a hyper, what if your insulin sensitivity factor markedly changes for a day or two?

I played that high stakes insulin dosing game for 28 years – for me, I determined it was a failure. I can’t tell you the number of incidents where my blood sugar was high and then came screaming down in a frightful descent. I was a pro at sticking these landings – until I wasn’t and literally crashed and risked my very life.

This way of eating is not for everyone. But I’m here to tell you that it significantly improved my life for the better. I don’t really miss my old way of eating. I understand the addictive quality that you raise. Once you break that bond, I found it easy to sustain my path going forward. It’s harder when you first start, but when you start to feel better, lose weight and use much less insulin, your motivation is fueled by many tangible benefits.

I wished I had taken that step sooner. As I said, this path is not for everyone and there are other ways of eating that people with diabetes use to manage blood sugar. Good luck with your decision.

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Yes, I do bolus for protein and fat. Before Loop, I actually delivered two separate boluses for each meal. The first immediate bolus was to cover carbs. The second pump-extended bolus covered protein and fat. For the extended protein/fat bolus, I counted 50% of the protein grams and 10% of the fat grams as “carb equivalents” but I extended that bolus over 2-5 hours. I can provide further details if interested.

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@tedos I’m one of the people who needs to bolus more than 50% of the protein grams to deal with rising post meal blood sugar. The ratio varies depending on how many grams of protein you eat.

I usually do an extended bolus to cover BG spike 3 hours after meals, and it often is in excess of what I’d normally use for the same amount of carbs (i.e. Greater than 1:1 ratio)

This link may help you as you experiment. There’s no right or wrong amount, everyone is different and it can vary from day to day.

https://www.diabetesdaily.com/learn-about-diabetes/treatment/insulin-101/how-to-use-insulin/how-to-calculate-bolus-insulin-dosing-for-protein/

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Thanks for explaining everyone.

I know where the confusion is now. I seem to have been taught a hybrid model. So rather than a set meal plan, I was taught to bolus for what I eat but instead of grams, I was taught to read the labels and divide by 15 to convert to exchange. New school yet old school if you know what I mean :grin:.

I was taught (and this was 20 years ago) that this was a guideline. It also depends on what type of bread and how big is a slice… and to throw a spanner into the mix later on, GI index became a thing so even if you account for 15 g for a slice of bread, you are likely to get different outcomes depending whether its a sourdough or panini.

It never actually occurred to me to switch to grams, and I was just dividing everything by 15 because it was how i was taught. To be honest, there was really not much label reading. Home cooked meals and dining out once in a while doesn’t come with nutritional labels so I just estimate how much the portion is and hope I get it right.

I think this is also where we differ, food labels have always been around for as long as I can remember - certainly 20 years ago when I was first diagnosed I remembered being taught to read the labels. I think it’s mandatory in Australia, they make it more strict over the years. So not having food labels is something I can’t relate to and threw me off a bit in the earlier posts. However, I honestly don’t remember how I did it initially because I was on MDI and not the pump, I don’t recall at all how my insulin dosage was calculated… I don’t recall any carb exchange ration but I can’t see any other way.

Thanks for this, I’ll have a look.

Nicely put, i like the way you explained this.

I’m glad it has worked out for you and led you to a healthier life. I can see the incentive in this. I think i will try to reduce my carb intake and not drastically. I’ve been trying the last few weeks with cutting down my bolus replacing it with exercise instead and overall reducing my carb intake during my meals so i need less insulin. I’m not seeing any results just yet but its still early days.

Out of the three meals every day, I take the most insulin during dinner as its my largest meal, but when I think about it, I don’t really have much carbs at dinner time. Perhaps a small bowl of rice and maybe some sauce in the protein and a fruit but not much other carbs. So the insulin must be accounting for the protein I take, but that seems awfully high for proteins. I may have to relook at this, thank you for the link.

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It’s really not out of date. It’s just a way to count carbs in 15s
Weather you count 3 exchanges or 45 carbs, it sort of works out the same. When I count carbs I end up counting in 15s anyway. Sometimes I count a 10 or a 20 though.

It’s more a terminology thing where the term exchanges has gone out of favor.

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Well, you can think of it in those terms if it helps. I just do carb-counting, ever since insulins came out that were precise enough to allow for that. To me the exchanges are tied into the R/N insulins, which were so slow and imprecise that you had to arrange your diet to the insulin rather than the other way around.

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No such thing as a magic number! It is whatever works for you! And your magic number isn’t going to be the same as mine. And what I am using now, is nothing like what I was using 10 years ago.
Of course there are guidelines that doctors and CDE’s use when first setting things up but they are just guidelines.
I am not a low carb person. I like food and use to enjoy the social aspect of dining (until COVID-19) so my numbers maybe different than some others. But I will say, my biggest learning over the past 6-7 years. More insulin for me, lead to more lows, which lead to more empty calories to fix the lows. So we just did a clean start and reset the basal at .6 for the 24 hour span excoriated work which was .3. And the amazing thing was, I was no longer bouncing back and forth. And while I could no longer snack and be ok without a bolus, I was losing weight and taking much less insulin.
And this questions is one I get every time I see a new doctor, “How much insulin do you take each day?” And my answer is always, it depends on what I am eating that day or what kind of exercise I am doing that day or how stressful work is that day. I can have as little as 12 units for the day to as much as 35 a day. It depends on the day.
A person who needs 100 units a day to keep their blood sugars in range is no different than the person who needs 20 units a day to stay in range. And unlike many, my numbers are a moving number. I’m thinking once I retire, I might stabilize some but while working a physical type job, not happening anytime soon.
Good luck and you will find your magic number. Only to see it change but that is why you are your own experiment!

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11 or 12U of Toujeo, probably 7.5U Humalog, 5’2" 125lb, MDI. My endocrinologist tells me I’m doing exceptionally well at the same time I’m telling him how frustrated I am at the unpredictability of it.

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@machiya It can drive you a little nuts sometimes. You think you have it completely down pat and then your Bg’s just start doing something else. I want to fire it, but it won’t listen. :grinning:

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I have had T1 for about 52 years. My basal is PZI bovine insulin and I use 12 units a day, split dose - 6 in the morning, 6 at supper time. My bolus is regular porcine insulin and the amount depends on what I’m eating and what my BG is, but usually between 1 and 4 units. I rarely eat breakfast. So my daily amount with both insulins is between 14 and 17 units. I’m super sensitive to the pork insulin, and (perhaps because of that high level of sensitivity) I can’t use any recombinant human or analogue insulins. I’ve been hearing more and more about insulin resistance among Type 1s and wonder what’s causing it. It’s not caused by Type 1 diabetes.

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I was on pork before human insulin was available.
I made the switch with no issues. Same schedule.
It was nph and regular back then.
I’ve had my resistance checked and mine always come back minimal.
I’m glad you can still get animal insulin’s. They don’t make it in the states anymore.

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How do you get your insulin resistance “checked”?

Blood test

Is there a special thing to look for or are you basing this on the hb1ac?