New to Humalog

When I was diagnosed in May of this year, my a1c was 8.6. Today, it was 5.4. To say that I’m proud is an understatement!

For these past 7 months, I’ve managed with Metformin, Glipizide, and a low carb diet. Because pregnancy hormones cause rapid changes in bg for many people, my numbers have been steadily rising (though I have kept the same tight control over my diet). My endo suggested adding in Humalog at a 1:10 dosage. I’m super new to this - perhaps this is backwards, but I am actually so very excited that I have access to this tool. Especially with morning sickness - the fact that my food options will open up is just very exciting and a huge relief to me.

So - any tips for a total newbie? Would you keep going with a mostly low carb diet? I don’t usually go low bg-wise, but because I am new, I’m worried about over-dosing. Any favorite apps to calculate carbs, or do you ever wing it? My endo suggested that generally winging it would be ok, but that makes me nervous!

Calorie King is a great tool. It presents nutritional info in a standardized food label format. You can use it on your computer and they have an app for smart phones, too.

While the addition of mealtime insulin will make your control a bit easier, I would encourage you to not overdo it with the carbs. With me, once I’m eating too many, my control disappears. I would also encourage you to log your meals, insulin doses, and blood glucose numbers. It will keep you well-informed about how your body metabolizes food.

I congratulate you on your stellar success in bringing down your A1c! You’ve done you and your baby a big favor.

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Thanks for the advice @Terry4! I downloaded Calorie King on my phone and will plan to use that.

My endo mentioned 60 carbs per meal - which is WAY more than I’ve been eating. I plan to start off slow and see how it goes.

You will have to decide what level of carbs you will consume. Just keep in mind that the fewer carbs translates to less insulin and smaller mistakes. This is known as the Bernstein law of small numbers.

I only eat about 60 grams or fewer carbs per day. If I started eating 60 grams per meal, my control would evaporate. Your control and discipline has been so good, you’ll find what works best for you, I’m sure.

“Start off slow” is good advice for changing anything in your diabetes management, and it applies with particular force to insulin. Insulin is the next thing to magic in terms of the control it can give you, but it’s a two-edged sword; it can get you into trouble just as quickly IF (and it’s a big IF) you don’t take the time and trouble to learn how to use it correctly.

Not that I have any concern about that in your case–you are obviously approaching this the right way, doing your homework, and keeping your expectations well grounded.

But back to starting slow: I would urge you to start with low doses, perhaps even lower than you think you need, and ramp them up slowly until you know exactly how much insulin you require to properly cover a given number of carbs. That number is very individual; the numbers you will see in print, or be told by a health care professional, are just guidelines. Each person’s physiology responds in an individual way. You can always take more insulin; but you can’t “un-take” it if you go too far the other way. Your meter will tell you exactly how your body is responding–it’s the best tool you have.


Excellent advice, David. That 1:10 insulin to carb ratio is just a starting number. You actual ratio that you will discover could range from 1:5 to 1:20 (aggressive to conservative). Starting out conservative and letting your meter be your guide is a good idea. Keeping a log will help guide you.

Yup, and no shortage of smartphone apps for that if you’re so inclined.

I also endorse the take-it-slow approach with insulin. I remember when I was first DX’d (T1) and thinking the warnings about hypoglycemia were just like those “may cause drowsiness” things on OTC cold medicine. Then I had my first one. Nope, not like those cold medicine warnings at all. Not even a little. Cone vision, difficulty walking, brain turns to mush except for the Eat Now or DIE alarm going off–not fun. Especially nothing you want to mess around while pregnant.


That is pretty generous. You can probably manage with less and still feel pretty good with what you’re eating. T2 is different, but basically keeping the carbs down helps you avoid the Insulin Roller Coaster effect, which is where you can put yourself in danger of severe hypos if you go crazy trying to correct a stubborn high (there’s a term around here: “rage bolus”–not a good thing, but we’ve all done it). One thing to know is that there are two lag-times involved, one is how much time the insulin takes to reach maximum effect and the other is how quickly the carbs metabolize. Your aim is to get those two peaks to coincide, insofar as you can (it’s rarely perfect). What the textbooks say and what your particular metabolism actually does can be quite different, so that’s why keeping a log and changing things in conservative increments is the way to go until you learn your own patterns.

I think for that reason, my endo suggested conservatively dosing - she also suggested I not try to correct a high at all, and that during pregnancy it would be better to be a little high than too low. Though, of course I will strive for an appropriate range.

I think that 60 grams per meal is quite high. I don’t know if that means I should be calculating carbs in non-starchy veggies, etc - as the endo said that if I ate a meal as strict as I’ve been eating up to this point, that I shouldn’t dose at all.

I think it will be a bit of a science experiment around here! I do plan to log everything.

It definitely will be! And I’ll echo the “be conservative” chorus. One thing that concerns me, though, is the Glipizide that you’re taking, as that medication encourages your pancreas to make insulin. If your numbers are creeping up in spite of taking that, I wonder if you should talk to your doctor about eliminating that entirely. It may cause you to need a bit more Humalog than without it, but it might help minimize the “wild card” of insulin that your pancreas produces due to the medication’s “encouragement.” There are some that believe that those meds “wear out” the pancreas sooner, though I’m not sure that that is clear - still, I know that some of my worst BG swings happened when my pancreas seemed to “randomly” kick in some unexpected “help…” I would check with your doctor on that one.

Forgot to mention that - great point! I am going to only take Glipizide at night since I have some Dawn Phenomenon happening, and Humalog at meal times.

Hi has your Endo given you blood glucose target pre and post meals hun. That’s what happens in uk for pregnancy :smiley:

Yes - the issue was that I couldn’t stay within that range precisely before, so she switched me to insulin.

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Question: if my pre-meal number is a little high, would you suggest adding a little more to the dose? I would assume it’s kind of relative to where you start. I ate a meal of about 15 carbs for breakfast and am finding that my bg test 2 hours later is still high. I did 2 units.

For me, the answer would be yes. But I would be very careful about how much. I would begin with slightly less than I think I need, measure the results, and use that as a guideline for the future.

I need to amplify that a bit. I treat a pre-meal high just like any other non-food-caused high: I correct it using the amount of insulin calculated to reduce my BG however many points it needs to be lowered.

I use an aggressive correction target of 83 mg/dl. I’ll correct anything over mid 90s. One unit of insulin usually corrects my BG by about 50 mg/dl. So for a correction of 103 BG level, I only take 0.4 units, (103-83)/50=0.4 units.

People and doctors that like a conservative safety factor will often target a higher number, like 120 mg/dl. I understand their philosophy but I choose differently for me. I monitor my BGs closely with a CGM, a watch display, and a hypo-alert dog. I like to aim for what I consider a normal BG, 83 mg/dl.

A high at 2 hours post-meal could be from under-dosing (may need to adjust insulin to carb ratio from 1:7.5 to 1:7) but also from insufficient per-bolus time.

I seriously don’t know what I would do without this community! My endo made it sound so - simple? But it’s so much more highly personalized than the standard advice/prescription she gave. I think I just need to experiment more!

LOL. There’s nothing simple about managing this beast. That’s why you have to become your own expert rather than just trusting to the one-size-fits-all rules of thumb that HCPs will give you.

Think of it this way: no one knows your body like you do. Plus, no one else is there 24x7 to manage it.

This community was founded with one overriding principle: that no diabetic should ever have to feel alone.


The biggest lesson I learned this year is that fixed formulas are highly useful but you have to understand that they will only give you an approximate answer. You have to be willing to keep your eyes open, monitor appropriately, and adjust in time.

Insulin dosing for diabetes is not a fix it and forget it regimen. Diabetes routinely disabuses people of the notion that the perfect insulin to carb ratio or insulin sensitivity factor exists. It’s a dynamic disease.