I was just curious as to the most amount of short-acting insulin people have taken for a meal? And if you split your bolus, what’s the most amount of short-acting insulin you’ve taken at one time?
I’ve had T1D for a year now. I’ve taken 12 units for a meal a few times so far (my carb ratio is 9 carbs/unit, w/ adjustments depending, of course), but even 10 units is uncommon, and I’ve only taken 6 units at one time. For some reason taking more than that still scares me, even if that would be the amount needed for whatever amount of carbs are in the meal! haha. Anyway, just curious as to others’ experiences…
I changed my way of eating back in 2012. Before that I took larger meal doses since I was eating a lot more carbohydrates. I can’t remember the exact amount of my largest meal bolus but was probably in the 20-30 unit range. That higher dose likely incorporated some high glucose correction insulin.
I believe that taking fewer units of insulin, assuming in-range glucose, is better than taking more units of insulin. Why do I say that? It’s because, over time I started to slowly increase my total daily insulin dose, gain weight, and become insulin resistant.
It’s alarming when the usual dose of insulin does not contain the same glucose lowering effect. At times it felt like I could have been injecting water for the effect it had.
These days, my meal boluses are six units or fewer.
You’re sensible to respect the powerful effect of insulin but you need to lose the fear. Respect, yes, fear, no. Real fear will undermine good decisions.
Using a CGM and keeping a ready source of quick acting glucose always handy can almost eliminate any fear of insulin action.
Most of my meals fall in the 3-7 unit range. 9-12 means it’s a pasta, pizza, or takeout kinda night.
The nicest I think I’ve ever taken is for grazing type holidays, like Christmas and Thanksgiving, where there’s just a constant stream of food. Before Control-IQ, I would take 15 units on a 4 hour extended bolus. The pump won’t let me do that anymore.
The thing is, there’s a massive spectrum of insulin requirements. There are people complaining in various Tandem groups I’ve participated in that they’re using u500 insulin (five times more potent than the common u100 variety), and can only get 2 days worth out of a 3ml cartridge. That’s equivalent to 1,500 units in 2 days or so. I have no idea how much of that is bolus, but if they follow the 50/50 split theory (which I sure don’t, but I’ve gotta wager a guess somewhere), that’s like 375u in bolus a day. I know that’s likely Type 2, but the lines seem to be blurring.
I feel like I have insulin resistance, but that puts my 50-70 unit TDD into perspective.
I range from 4 to 10 units (I:C ratio of 1:7) per meal but I would need quite a bit more for a holiday meal although I can’t remember how much since it’s been over a year since I’ve had a family get together.
I normally eat one low carb meal a day and pre-bolus 8-9 units for that meal and then take another 3-4 units 2-3 time a day, all MDI as required. For a holiday meal, however, I pre-bolus 18-20 units which covers appetizers and main meal and then during meal bolus another 18-20 units to cover seconds and dessert and then 1 1/2 hours after meal take another 12 units and a couple of hours after that another 8 units. My digital pen does not allow me to take more than 60 units per day, so then need to take smaller additional amounts after midnight and at 4 AM. Holiday meals with the grand kids are tough, but well worth it.
My average is 6 units, but if I eat fat with it it could take double or triple that and sort of hang out in the 180s for hours.
I’ve been on vacation the past week and exercising less and my insulin requirements are much higher.
I can’t wait to get back home to my normal routine.
I really hate taking more than 10 units for fear of crashing, but I’ve had to do that twice this week.
Uuugh.
For meals I take 3-5 units (I still have some insulin production) I also limit my carbs.
I am sometimes a little nervous to take 5 units so one thing I do is for some meals I take 3-4 before I start eating. Then when I’m done eating I might take 1-2 more depending how much I actually ate.
I like this because it’s not predetermed before I start how much I have to eat. Also there is 15-20 minute between insulin shots. So if I do over do the insulin its not all hitting me at the exact same time.
I usually take 3-5 units per meal. I rarely have more than 45 carbs per meal. I have Tandem t slim with control IQ. My BG before I eat is typically 90-140 so sometimes there is a correction added to my meal insulin.
I’ve recently been having issues with insulin resistance so have taken 20 plus with my pump and the same with a shot if I don’t see my bg leveling off. My doc wants to try the i500 but that scares the crap outta me.
The most I’ve taken in a single shot is 33 (that’s all I could fit into a 30u syringe) for a large pasta meal. Typical for me is 15u-25u for a carby dinner, and that doesn’t bother me at all. My body gets to decide how much insulin I need for any given meal; my job is to take it. I understand that some folks choose a lower-carb diet because that makes dosing easier. My preference is to eat the good carbs and learn how to dose for it to get a good A1C, time in range, and standard deviation. Fortunately, we get to choose what approach works best for us.
I applaud Terry4 's comment about glucose as an antidote to fear. I always have glucose with me, so an insulin overdose is really easy to fix. And the CGM helps me by alerting if I’m not paying attention, and by showing me whether my BG is falling quickly.
Great info - thanks! I agree - I prefer to dictate to insulin based on the carbs I want to eat, not vice versa. If/when I ever need a large amount of insulin due to the carbs I want to eat, I’m certainly going to take it. I mean, sometimes you just want a fat stack of pancakes and maple syrup, etc. (even if it’s not the norm!)…
You might want to consider taking metformin and using your pump instead of injecting more insulin.
I mean of course you need your doctor to be on board with that.
High levels of insulin are known to cause arterial and heart damage. High sugar is worse, so of course you need to take what you need.
There is more than one way to manage it.
If the pancake example you cite is a once/year kind of thing, that makes sense. But if this is more the rule as to how you manage glucose, you may find that this is slippery slope.
I understand this position well because that’s how I managed my diabetes for many years. Over these years, I valued in-range glucose above all else and took whatever insulin that required. My A1c at the time started out in the 6.5% range but slowly marched up to > 8.0%.
Unfortunately my total daily dose of insulin was steadily stepping up from 40 units/day to 80 units/day. I also packed on about 30 pounds of weight over about five years.
My insulin sensitivity vanished. When I started to take 5-10 unit corrections and not see any glucose lowering, I became alarmed.
Hyperinsulinemia (too much insulin) is now being mentioned more frequently in the medical literature as associated with a long list of ailments including heart disease, obesity, and kidney disease to name a few.
Like everything else in life, there is no free lunch! There is definitely a limit to eating whatever you want and covering it with the requisite insulin. I learned that the hard way.
