I have always taken the approach of being very open and communicative with my boys about daddy’s diabetes. Ever since they could talk I would explain to them what I was doing and would discuss and explain it to them. They know that if daddy says his sugar is low, that it means he needs to eat a candy bar or some gummi worms… So, as they age, it’s as if I have two little guardians with me. I have a special drawer where I keep the snacks; I had a low over the weekend and they each ran and fetched me a snickers. It was even funnier when I turned and had to reprimand my youngest, Aiden, for taking a snack before dinner…his reply…“But Daddy, I think my blood sugar is low.”…never underestimate the smarts of a toddler!
Are you using Novolog as well?
I only bolus before I eat if I'm taking a correction at the same time. I used to have a lot of trouble because I'd over-bolus so now I do more post-meal bolusing.
I don't bolus (generally) until I'm sitting down with food on my plate. Its not a perfect system for sure, but it works for me and means I don't ever have to deal with the side effects of a late (or forgotten, done that!) meal. Its not the recommended way by any means, but diabetes isn't recommended either....
For breakfast and lunch I bolus before I start preparing which works out fine for me and I don't forget or allow myself to get distracted from preparation and eating. Dinners I tend to cook a meal for 2-4 servings then just reheat it during the week. When I'm doing lengthy preparation I obviously bolus when it's getting closer to time to eat.
Hi I'm new here and not sure if this is covered somewhere already - if so pls point me in right direction:)
I am type 1 LADA currently on basal only and needing to try bolus insulin. I am low carbing and doctor has given me rapid acting insulin suggesting I use a half unit for 30-40 g of carbs. I am wondering if there are other options(such as short acting insulin for eg) where I could bolus without having to eat so much carbs? The rapid acting is fine on occasion but I'd really rather not use regularly when generally eat very low carbs. Thanks!
You appear to be highly sensitive to insulin. If your insulin to carb ratio is really 1:60-80, then that makes dosing that small amount difficult, especially since you eat a low carb diet. Your profile does not list whether you use a pump or not. With a pump you could deliver (bolus) very small amounts of insulin, like 0.1 units.
As an experiment, you could deliver 1/2 unit and then eat 30 grams of carbs and record your BGs at mealtime, 1, 2, 3, and 4 hours post meal. I know 30 grams of carbs is probably higher than you prefer for a meal but this is just a test to see if your insulin sensitivity is actually that high.
If you find that you're really that sensitive to bolus insulin, maybe you should talk to your doctor about diluting it. I know that some parents of young children dilute their insulin to enable accurate dosing.
If your experiment reveals that your BGs are driven too low, maybe it's not time to add bolus insulin just yet. What prompted the doc to recommend starting bolus insulin? Were you having post meal highs? Your doctor may not understand the metabolic effects of a low-carb diet.
i'm not sure what you mean, is your I:CR .5:30 - 40? If you don't want to use bolus insulin then you can just not eat that many carbs/meal, maybe do 20 carbs/meal w/no insulin. When I was first diagnosed and honeymooning my I:CR was 1:45 - 50, so, after a while, I just ate very few carbs per meal (still do). Also, what's your definition of 'low carbing', as everyone's is different? Just eat what you're comfortable with. Again, when I was first diagnosed (well, i did need to gain some weight), my Endo told me to eat at least 45 grams carbs per meal and 2 snacks. I didn't know what I was doing at first so I did that, was actually overeating and felt nearly sick from eating so much just because my endo told me to. After a while I just ate low carb until I needed more and more bolus.
Thanks for quick replies! Terry I like your suggestion of an experiment. Do you know how the doctor(an endo) would have calculated this initial insulin to carb ratio? The nurse/educator thought it very conservative.
I think I may be quite sensitive to insulin but it is also my low carb diet that is limiting my highs. I can get a 3mmol (so about 60 in US msmts) rise after 2-3 hrs from a VERY low carb meal (<15g). The doctor (an endo) said 1 unit of rapid acting insulin could easily correct that much of a rise. It also would allow me more flexibility in my diet so I would like to try it too:)
Re low carbing - I read the Dr Bernstein book right after diagnosed & started off on his 6-12-12 g of carbs meal plan (which alone brought my a1c at diagnosis from 13% to 8.5% in 6 wks by the way!). I have since backed off a bit but generally follow his guidelines on counting carbs and have an a1c of 6.4% but am seeing some highs post meals that are staying high for 3-4 hrs depending what I eat and want to experiment with bolus insulin but am not sure what is best for me. I am 'outside the box' re conventional treatment and I think my endo/diabetes educator find me a bit of an anomaly here :)
Karen - I'm a fellow anomaly! I've learned to basically seek my own advice here and other online sources. I currently eat about 50 grams of carbs/day. I'm pleased with the results.
When I started this "lower-carb" regimen, it was to get better control of my BGs. An immediate surprise was that I lost 23 pounds of weight with little effort. My A1c dropped about one full percentage point. My last one was 6.1% and the one before that was 5.9%, my first sub-6 ever. I cut my total daily dose of insulin in half.
I'm a bit of a number fanatic as I download all my devices and analyze the data frequently. The holy grail for me is not the A1c but BG variability. Once the roller coaster is reduced, it's possible to lower the average BG without an undue hypo risk. My current goals are BG standard deviation (a measure of variability) of 30 or less, BG average of < 110, 80% or better in target (70-140), with 5% or less < 70.
Once I figured out the limited usefulness (with regard to BG management) of doctors and other diabetes "professionals," I started to make real gains. Conducting personal experiments like I described earlier for you is a very useful method.
I'm guessing that your doctor gave you a very conservative stating point. There is a textbook formula that states the average person total daily insulin needs of about 0.5 units of insulin per kilogram of body weight. About half of that is basal and half bolus. Your situation is exceptional, however, since it appears that your body still produces some of its own insulin.
Most doctors are hyper-phobic about hypos. Your own personal experiments can determine your actual insulin to carb ratio. It's important to keep a written record as it's hard to just fly by the seat of the pants, unless you've a much better memory than I do! Be aware that your injected insulin needs can and will change over time.