Needing more insulin with meals than endo advised


#1

Hi there, I was diagnosed a few weeks ago, and have been injecting at mealtime for less than 2 weeks. I was of course misdiagnosed as type 2 for 14 months before getting my LADA diagnosis. I was told by my endo to carb count and inject 1 u for every 20 g, but I am finding that I need significantly more than that to control my post meal levels. I have a Freestyle Libre CGM so am likely really going overkill with testing. Has anyone noticed that they need more than the 1:15 or 1:20? I think I have insentivity issues that aren’t being taken into account with that ratio, and I am not on metformin anymore. Help! Any and all advice is welcome.


#2

Good for you for carefully observing what your personal metabolic needs are. I’m sure the doctor just wanted you to start on a safe insulin to carb ratio. S/he defines “safe” as an amount of insulin that will not drive your post meal blood glucose values less than about 80 mg/dL (4.4 mmol/L). The doctor likely cares much less about hyperglycemia (high BGs) than hypoglycemia (low BGs).

So, think of that 1:20 ratio as simply a place to start. Carefully doing your own personal experiment and keeping a log of your results will help you to zone in on a good I:C for you. A digital kitchen scale combined with a resource called Calorie King will help you learn about the nutritional content of the food and servings sizes you like to eat.

Be aware that you are not working towards finding the perfect solution for you. No magic numbers exist when dealing with diabetes. Diabetes is a dynamic disease, not static as all the formulas might suggest. Many of us use a different I:C number at different times of day. My I:C number is more aggressive in the morning because my body is more resistant to insulin in the morning.

Learning how to detect a need for dosing changes and then carefully executing the change and observing what happens is a critical skill to acquire. Your insulin needs will change and it’s your job to adjust to those changes in a timely fashion and dose appropriately.

Learn as much as you can about this process. One good book to read is Scheiner’s Think Like a Pancreas.


#3

We all have different needs, and they vary SIGNIFICANTLY. Personally, I think 1:15-20 sounds low for an adult. I was told 1:15 as a preteen, before we knew anything about insulin to carb ratios. That was just the way it was dosed to children my age then.

I’m at 1:13 usually. I do 1:11 after 9pm because I’m not going to exercise any of those carbs off. And I do 1:9 if my glucose is already high, because it makes you more resistant to it.

You just have to figure out what works for you. There is no right or wrong answer. There is most definitely nothing abnormal about needing more than a 1:15 ratio, though!


#4

I second the suggestion to read, “Think Like a Pancreas”! It will help you in so many ways. His style of writing is easy to read and to follow.

Other great books are “Using Insulin” by John Walsh and my all-time favorite, “Dr. Bernstein’s Diabetes Solution.”


#5

Wow, thank you so much, Terry! That really resonated. Also, I am noticing that if I eat meals that skew more towards protein and fat, my blood sugar is amazing. I mean, almost flatline at ~100-120. However, I was discouraged to do so by the nutritionist that I just saw. However, eating like the way she suggested, along with the ratio he suggested of I:C, has made my BS look like garbage. I do way better when I inject more insulin and eat less carbohydrate. The only thing that made me bottom out was hiking or walking uphills after that.


#6

There’s an eating philosophy with diabetes management called “eat to your meter.” Your body will decide what certain types of foods and macro-nutrient proportions your body likes. When you eat to your meter, you will naturally drop the foods and/or portion sizes that produce high and volatile blood glucose levels. Believe your meter. It does not lie.

Unfortunately, we diabetics often disagree with the professional nutritionists or dietitians. Carbohydrates are the fundamental driver of post meal blood glucose. Some of us are more sensitive to carbs than others. That’s the beauty of letting your meter be the judge!


#7

Many people on TUD choose to limit their carb intake, and a decent number report positive results! Take a look through the threads and you’ll find people who advocate for this method, but there are some threads with people who found that limiting it to very low levels (<30-40 grams/day) gave them mixed results because they found that their carb sensitivity was less consistent.

I think the diet you choose should be catered to what works best for you. What works best is going to vary a bit for each person. Prebolusing can be a very effective strategy when dosing for meals. You may benefit from dosing ~30 minutes in advance for high glycemic index foods. The timing varies from person to person, but this can be very, very helpful.

My insulin to carb ratio is close to 1:8 depending on the time of day. My doctor said I don’t show any signs of insulin resistance. Don’t be afraid to adjust/change the ratio. Experiment and figure out what works best for you. Just make sure you always have sugar handy in case you drop low. The CGM can be so incredibly helpful in preventing these though. Glad you were able to get one!


#8

@msinoway
The I:C is certainly much lighter on the insulin then we use. We are somewhere around 1:6 ~ 1:8 depending on time of day. This would be for an average size younger T1 person diagnosed some years back. As I think was mentioned earlier in the thread, it is possible that your Doc merely proposed the 1:20 as a starting point which you would then dial in to the value which you find actually works for you.

IMHO you should be able to dose for whatever you eat whether it be the fats, proteins or carbs. Knowing how to dose for these foods is very useful.

However that in no way implies you should not also be free to choose your preferred dietary approach as you prefer. If the low-carb approach is your preference then great. I would argue against a low-carb approach if the only reason for low-carb is strictly for the reason that 1:20 is not working.


#9

I’m honestly basing that observation about my diet only on meter results for not even 2 weeks worth of data. I think I might need a little more data to make a real change. I am pretty active, exercising 6 days a week, with 3 of those days being HIIT. I can’t imagine that is very sustainable with minimizing my carb intake! However, the 45-60 g per meal, with 3-4 units to take care of it, will not work for me either.


#10

RDs tend to adhere to the all four food groups (or food pyramid) diet. They don’t really want you to not eat grains long term, for fear of not getting solid nutrition and also ketoacidosis isn’t great long-term. I had an RD who recommended South Beach style diet and that really helped me. I ate legumes and veggies and complex carbs (like a sweet potato) much more than bread or rice. It’s fantastic for blood sugar levels as well as keeping your insulin needs lower and controlling weight (for me).


#11

Do what works. Your diabetes, your management! There are no essential carbs, but there is an amount of carb that will work for you.

If you are eating less carbs (perfectly valid approach), then you need to eat more protein, and particularly fats to get your required energy. I am one of those people following low carb. I eat about 25 g of carbs a day, about 115 g of protein, and 70 or so grams of fat (I eat less fat because I’ve still got plenty stored on my body which I’d like to consume). I do HIIT, weights and swimming at least 5 - 6 days a week. My energy levels are fine.


#12

Yeah, my body LOVES fat. My BG is flatline when I include a lot of nut butter, avocado, etc. I also do HIIT (OTF) 3X per week, weights, and hike. I have a good amount of energy and don’t feel deprived at all. I have been eating a lot of protein and fat and veggies in the past few weeks, and things are pretty good. I guess like they say, the proof is in the pudding, and the pudding is in my Freestyle Libre data! I am just usually a very compliant with MD instructions type of person, but have never been on the bucking bronco that is a type 1 diagnosis! The interesting thing also was the disconnect between my MD and my CDE - my endo said, “I have had patients do very well on a low carb diet, how do you feel about that?” and my CDE said “dogma dogma dogma 45-60 grams of carbs per meal must be eaten or world will stop turning”. I am so glad that I found this site so I know that I’m not nuts!


#13

This ^^^^ and when you’re getting lots of conflicting advice, this ^^^^!

As you spend more time managing this frequently unpredictable chronic condition, you will become THE expert for YOUR diabetes. Your health care team are your expert advisors, but they are going to spend about 60 minutes a year with you and your diabetes, while you will spend well over a half-million minutes with it.

For me, I spend most of my day running with a 1:17 I:C ratio, but recently, I have begun trending closer to 1:20 in the mornings. Unlike many others, for MY diabetes, I run high carb, low fat, but it’s MY diabetes and this is what works for me. As they say in the commercials, “You do you.”

Welcome to the club that no one wants to join. Embrace the new you.