As people with diabetes, we have often heard about diabetes’ treatment characteristics that we somehow internalize as specific hard and fast rules. Our doctor’s, nurses, and CDEs also often believe these things.
We’re taught about insulin to carb ratios, basal rates, and insulin sensitivity factors. Seemingly implied in these exact formulas is all we need to do is discover what our personal formulas are and then we’ll be able to deliver the perfect insulin dose after we’ve carefully calculated the exact carbohydrate content. Unfortunately, diabetes does not work that way.
All these formulas, including insulin onset, peak, and duration are simply nominal numbers that will indeed vary from person to person and even in the same person from day to day and meal to meal. I like to think of these formulas simply as a way to get within the vicinity of my blood sugar targets and then use dynamic dosing techniques to home in on my target glucose level.
What are some of these dynamic techniques? If you have a pump, you could set a temporary zero basal rate if your blood sugar trend is moving downward toward your lower level. As a complement to that, you could inject 0.5 units of insulin to nudge a rising blood sugar back toward the center of your zone.
Strategically timed exercise, like a 20-30 minute walk immediately after eating if you’ve been fighting after meal highs is another way to nudge a wayward trend back toward the desired range.
I’ve discovered in recent years that while I am overall insulin sensitive (I take < 0.5 units of insulin per kilogram of body weight.), my relative insulin sensitivity is changing all the time. I am definitely more insulin resistant in the morning than I am in the late afternoon. Exercise and fasting both boost my insulin sensitivity while an over-generous meal and omitting exercise increases insulin resistance.
If I find my insulin resistance is becoming too much, I will often omit a meal and do a 16-24 hour fast. That will dependably turn insulin resistance toward insulin sensitivity. I find being aware of my relative insulin sensitivity helps me to take action to benefit my BG control.
You are right to be concerned about injection site absorption as that can definitely be a factor with long term diabetes. I had a two-day old perfectly absorbing insulin infusion site go bad last night as I went to sleep. My BG soared to over 300 mg/dL (16.7). What happened, I later found, is that blood fouled the site and essentially stopped or severely impaired insulin absorption.
I haven’t had a site go bad like that in months and months. I couldn’t have anticipated that circumstance and I just wrote it off due to the fact that I have diabetes. Sometimes diabetes wins, but certainly not as often as my will prevails.
Most of what I write about here will work best if the person uses a continuous glucose monitor. I think every person who lives with glucose metabolism disfunction will do better if they use a CGM. I know there are legitimate reasons people don’t use CGM but in general I think way more people could benefit from one. Deliberate navigation through blood glucose levels without using a CGM, to me, is like driving a car with a bag over your head!
You’ve received several good tips above. I hope your blood glucose situation improves for you.