Welcome to TuDiabetes! You have found a place with a wealth of information about diabetes. I hope you find it as useful as I have over the years.
Let me start by saying that diabetes is a moving target. As much as we depend on math formulas to help us dose insulin, things change from day to day and even meal to meal. Expecting predictability is not reasonable. You may use a certain dose size for a certain meal and get good results for weeks but then you don’t. You need to roll with this new reality and adjust. The sooner you adjust, the better you will feel.
Recognizing and responding appropriately to this inherent variability will lead to conducting your own personal diabetes experiments. This is a fundamental skill that will reward you mightily if you use it to learn about your unique metabolism.
This to me looks like symptoms of a basal insulin out of whack than it is a fast-acting insulin meal dosing issue. Rapid acting insulin has a limited duration, usually less than 5 or 6 hours. Dropping rapidly 6 or 7 hours later indicates to me that your basal insulin needs to be adjusted. Problems with meal insulin will occur during the time from when you dose and up to 5 or 6 hours later.
The first step in setting up any insulin program is to get your basal insulin coverage dialed in. You need to do this before you can successfully adjust your meal-time doses. You don’t mention taking a long-acting basal insulin. Do you also take Lantus or Levemir, or Tresiba once or twice per day? Here’s a good reference to Gary Scheiner, type 1 diabetic, author, and diabetes educator, that teaches how to adjust your basal insulin.
If your meal insulin leaves you high 3-5 hours after your meal then you insulin to carb ratio (I:C) needs to be made more aggressive - you need more insulin. If you currently use an I:C of say 1:10 and it leads to going higher 3-5 hours post-meal, then you could experiment with 1:9 or even 1:8. Write things down as you experiment so that later analysis is easier.
Many of us who use a low carb way of eating often learn that we need to dose for fat and protein as well as carbs. If the body does not have enough carbs to convert to glucose, it will look to protein and fat to provide energy. I count 50% of my protein grams and 10% of my fat gram as “carb equivalents.” I add these carb equivalents to the actual carb grams that I eat and then calculate my meal insulin dose based on actual carbs + carb equivalents.
This might appear overly complicated now, but I can assure you that using it for a while will help to make it second nature.
Out of all the variables you must contend with to treat your diabetes, the one that is the most under your control is your diabetes knowledge. Invest in that knowledge base and it will reward you ten-fold. I recommend reading Gary Scheiner’s Think Like a Pancreas and John Walsh’s Using Insulin to start.
This will get easier! Be tenacious and when you start to get better results, you will feel empowered. Stay in touch; we are here to help you. Good luck!
