Which chart or calculations do you use to determine IOB? Walsh's or Scheiner's?

Treatment Insulin
1

In the USING INSULIN book John Walsh says that 20% of a dose will be used each hour after it is given, which leaves the active insulin length at 5 hours.

In the THINK LIKE A PANCREAS book Scheiner states the most precise method for Humalog/Nololog uses a 4 hour active insulin length, but says on page 133 that at 1 hr - 70% active, 2 hrs - 30% active, 3 hrs - 10% active. It looks like the curve is closer to the insulin graphs I see.

He also lists an aggressive calculation easy method of 67% at 1 hours, 33% at 2 hours and none at 3 hours.

or a Conservative calculation of 25% each hour used: 75% active at 1 hr, 50% at 2 hrs, 25% at 3 hrs, and none at 4 hrs.

Which of these do you use - and why. Or do you use another way to determine the calculations?

Do you have index cards you carry with tables on them, or do you use a calculator - or do you use your brain? Mine is usually fried - ha!

Thanks,

2

I go off of my own curve - 1.5 hours after I inject I peak, which I figure the insulin has hit its most effective point (I say 50%). Using this I test 2 hours after injecting/eating and say that I still have 35-40% (I guess it matches the aggressive calculation pretty closely). Taking this data and employing the highly refined SWAG calculation method I determine the exact dosage of insulin and double check the hind-database. This of course takes place in my head due to the lack of SWAG technology in the area I am in; also there are very few hind-databases other than my personally owned that I can access. I find this method to be extremely effective with my constant on the run lifestyle here in college.

TRANSLATION - I guess. A lot. I’m right about 90% of the time. 8% of the time I go a little too high (never over 200) and 2% of the time I go low. 30s and 40s low.

SWAG - Scientific Wild A(rear-end) Guess

Hind-Database - The database in which knowledge is taken; located on the hindquarters of the human body (AKA "I pulled it out of my …)

Hope this helps :smiley:

3

You as alot here at once but here goes. I use brain to calculate what is needed or if i have to my cell. The dose can be split up as need for most 2x daily with the higher dose at bed time. I use Lantus with Humalog R for controll so my calculations are different but I use 45 in the morning and 49 at bedtime R with each meal. My brother takes his Lantus 6 times daily to spread over the day more evenly he has a high metabolism and food intake is 2500 calories a day so there is not rules you have to find what actually works for you and it takes time.

4

My experience is that there is a curve, as it takes a while to get started and it has a peak action period, but exactly when I can’t determine, as I haven’t tried to be precise as the amounts I take are so small.
I have been acting according to these men’s principles, but hadn’t read a book about them, until now, as I am reading Walsh’s “Pumping Insulin” to see if a pump might be the better way for me.
The concept of insulin in advance for the carb content of what I plan to eat had always been in my mind and the separate concept of correction doses I was also doing, but hadn’t put a name to it. I have been on a variable insulin level depending on my food and activity for as long as I can remember, so 30 years. It is the only proper way to do it if you want to stay slim, as it is the way a normal body works. I hands down reject the idea of eating more just because I am walking and because some doctor told me to take a certain level of insulin.
Could we as a group put pressure on Scheiner to create an updated book that includes the different types of analogue insulin such as Lantus and Levemir because that is what is preventing me buying his book, as I expect he should already be working on an update. I think Scheiner is more accurate in the curve concept and Walsh just used the linear concept for simplicity in the explanation, but I think all users must have discovered the curve concept is closer to reality. But percentages and how fast the insulin disseminates must be variable based on each person and where in the body it was injected and also how soon after active exercise.

5

I bought the THINK LIKE A PANCREAS at Amazon.com with shipping for $10.79. It is dated 2004. However, he does have graphs and explanations on both Humalog/Novolog as well as Lantus or Levemir - see page 95 for MDI with basal insulin.

I have Walsh’s Pumping Insulin, and am waiting for my Using Insulin book to come in. I think Walsh is dryer and sometimes talks over my head. I had the hardest time trying to figure out the Ex Carb system.

I think Gary Scheiner’s book is an easy read, full of all kinds of great tables and information. After having diabetes since 1980 - I thought I knew it all - boy was I wrong. Things have changed since I first started taking injections in 1980 and peeing for the uring pills. He does not have the Apria (sp?) in the book. I think he covers real life situationa, in a humerous manner. I wish also that he would update this book.

So now I have the way Walsh presents tables and the way Gary presents the tables - but I seem to want to follow Gary’s graphs, etc instead.

Good luck.

6

I inject from experience and trial and error.

I figured out that if I needed say 20 units to cover a meal, I would either inject 10 + 10 (2 diff sites, but in rapid succession) or 4 x 5 (4 shots at 5ui each).

When I do this, my spikes are quite a bit lower due to faster absorption rates.

I also discovered that the abdomen isn’t necessarily the optimal place to inject. If you inject on the front of your thigh, then as you walk, you also get a faster absorption rate.

Needle length also affects things. Short needles seem to give slower rates, longer needles seem to give faster rates.

Oh, and hitting a muscle isn’t fun at all. (should have used an 8mm not a 12.7mm needle).

For me, it’s incredibly hard to guess the dose as no sliding scale can calculate needs based on a totally random lifestyle. What works for eating and sitting makes you low if you move around.

I was going to investigate the use of pure injectable water. Mix it 50/50 with insulin and inject. It should absorb much faster. Have to see where I can get some.

I gained 40 pounds with insulin and my dosage doubled and tripled.
I am lucky though. My fasting numbers are still within the normal range.

Once the weather cooperates and I can get back to exercising daily, My insulin needs will diminish and my weight will drop.

So, for me, the sliding scale doesn’t work, neither does Victoza. Insulin works best.
I have use an analog, regular human, and NPH at the same time. But this is rare. I reserve that for a high carb, high fat meal like greasy pizza.

So, I pretty much guess. If too low, I shoot a little more, If too high, I get to eat something sweet.

I wonder if a pump would give better control??

Note: I use pens and syringes. No pills whatsoever.

7

I almost have to inject 1 hour before eating just to match the timing of the spikes. Seems I have a very slow absorption rate no matter where I inject…