Insulin Sensitivity Calculation

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sololite

sololite

Well-Known Member
Relationship to Diabetes
Type 3c
Apologies for all my random posts on my diabetes but while I get great support from my diabetes team, I'm rapidly coming to the conclusion that I have to work it all myself if i am to get my BS under control - with help from DUK!

I was listening to a podcast last night from some type 1 guys in California who were advocating a plant based diet to improve insulin sensitivity.

I've always been told I am insulin insensitive and certainly seem able to tolerate rough and ready calculations on how much Novorapid to use. I was interested to hear on the podcast about calculating your insulin sensitivity. It was all a bit fast and loose (a/b=c style) so wanted to know if there is a definitive way to calculate insulin sensitivity and so see how it might improve over time as I tinker with my diet and insulin/carb ratios?

Regards,

Chris
 
The way i did it was took food, insulin (which was, as it turned out, too little) then added up the carbs taken plus the hypo doses i took, and divided by the insulin. But i find my ratio varies depending on if its breakfast or not, and if its working day or not.
I also found a high fat, low carb diet made me more insulin resistant
 
My understanding is that insulin sensitivity calculation is how many mmol/l does 1 unit of insulin reduce your BG by?
This is used as a correction factor. Many people take a correction when eating a meal - it is part of their dose calculation along with carb counting.

This is different to the insulin to carb ratio which I think @Tdm is referring to.
Insulin sensitivity calculation can be used in the absence of food if, for example, your levels are too high going to bed.

However, HCP often use the term "insulin sensitivity" as a general indication of your total insulin dose per day.
Insulin sensitivity is the opposite of insulin resistance.

@sololite if you want to track your "improvement" in insulin sensitivity, I think you just need to track your total daily dose (TDD). Expect your basal dose to change if your insulin sensitivity changes.

Bear in mind that the correct insulin dose is the correct dose for you, It does not matter if you take a basal of 10 units a day or 100 units a day if your levels are not too high or too low.
 
Sometimes people’s basal will be mopping up some of the carbs, so I tend to do an ‘official’ calculation taking my total insulin and my total carbs, but I also do an unofficial calculation where I look at my ratios.
 
Tdm said:
The way i did it was took food, insulin (which was, as it turned out, too little) then added up the carbs taken plus the hypo doses i took, and divided by the insulin. But i find my ratio varies depending on if its breakfast or not, and if its working day or not.
I also found a high fat, low carb diet made me more insulin resistant
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Thanks TDM. I've been eating a lot of cheese etc over last 6 months in effort to put on weight so could be a factor in my insulin sensitivity.
 
@helli I - maybe wrongly - see those as two separate but related things: insulin sensitivity (as vs. insulin resistance) and ISF (ie correction info).
 
sololite said:
Thanks TDM. I've been eating a lot of cheese etc over last 6 months in effort to put on weight so could be a factor in my insulin sensitivity.
Click to expand...

I find cheese ok as long as it’s a moderate amount and part of a diet with sufficient carbs. It doesn’t improve sensitivity but it doesn’t make it hugely worse (for me).
 
helli said:
My understanding is that insulin sensitivity calculation is how many mmol/l does 1 unit of insulin reduce your BG by?
This is used as a correction factor. Many people take a correction when eating a meal - it is part of their dose calculation along with carb counting.

This is different to the insulin to carb ratio which I think @Tdm is referring to.
Insulin sensitivity calculation can be used in the absence of food if, for example, your levels are too high going to bed.

However, HCP often use the term "insulin sensitivity" as a general indication of your total insulin dose per day.
Insulin sensitivity is the opposite of insulin resistance.

@sololite if you want to track your "improvement" in insulin sensitivity, I think you just need to track your total daily dose (TDD). Expect your basal dose to change if your insulin sensitivity changes.

Bear in mind that the correct insulin dose is the correct dose for you, It does not matter if you take a basal of 10 units a day or 100 units a day if your levels are not too high or too low.
Click to expand...
Thanks Helli. I'm on a bit of journey right now following my op and this is very helpful. Regards, Chris
 
Inka said:
@helli I - maybe wrongly - see those as two separate but related things: insulin sensitivity (as vs. insulin resistance) and ISF (ie correction info).
Click to expand...
I agree and was trying to explain that the comment "I've always been told I am insulin insensitive" is different to the calculation that we take with food.
My explanation was obviously not clear enough. 🙂
 
helli said:
I agree and was trying to explain that the comment "I've always been told I am insulin insensitive" is different to the calculation that we take with food.
My explanation was obviously not clear enough. 🙂
Click to expand...

Or maybe I need more coffee? :D Glad we were thinking along the same lines🙂
 
sololite said:
Apologies for all my random posts on my diabetes but while I get great support from my diabetes team, I'm rapidly coming to the conclusion that I have to work it all myself if i am to get my BS under control - with help from DUK!

I was listening to a podcast last night from some type 1 guys in California who were advocating a plant based diet to improve insulin sensitivity.

I've always been told I am insulin insensitive and certainly seem able to tolerate rough and ready calculations on how much Novorapid to use. I was interested to hear on the podcast about calculating your insulin sensitivity. It was all a bit fast and loose (a/b=c style) so wanted to know if there is a definitive way to calculate insulin sensitivity and so see how it might improve over time as I tinker with my diet and insulin/carb ratios?

Regards,

Chris
Click to expand...
I will be interested to see where this thread goes.

I don't think insulin sensitivity (or the converse of insulin resistance) can be readily quantified or in some way generalised. We are all different and within individual differences I am pretty sure that my insulin resistance varies with the time of day. During my DAFNE course last November I was introduced to the "simplified" concept of "carb portions (CPs)" whereby for all of us 10 gms of carbohydrate was 1 CP and 1 CP needed 1 unit of insulin, described as 1 quick acting unit (1 QA). But when this simplified concept didn't work for me, or some others, we were then advised to adjust the number of QAs, in my case an increase of 20 % to accommodate my breakfast response and reduce by different %s according to levels of activity. It was a bit farcical really - in the interests of having standard CPs and standard QA units fudge factors were applied at the end which reflected my original different ratios for different circumstances. But my varying insulin resistance was ultimately still being recognised.

But my insulin sensitivity is also affected by how sedentary or active I have been during the preceding hours or even days and I can reduce my bolus by over 50% for "full on" days. Likewise the ambient weather change sometimes needs accommodating.

The idea from the Californian podcast that a plant based diet can improve insulin sensitivity is potentially interesting and yet my gut instinct is that once that sensitivity change has occurred the net consequence for me as someone totally external insulin dependent is changed dosing ratios. However, I can see for those T2s who are struggling to make best use of their insulin (natural home grown or injected) the existence of a potential plant based magic potion has far more utility for them.
 
@helli I am now genuinely confused.
helli said:
My understanding is that insulin sensitivity calculation is how many mmol/l does 1 unit of insulin reduce your BG by?
This is used as a correction factor. Many people take a correction when eating a meal - it is part of their dose calculation along with carb counting.

This is different to the insulin to carb ratio which I think @Tdm is referring to.
Insulin sensitivity calculation can be used in the absence of food if, for example, your levels are too high going to bed.

However, HCP often use the term "insulin sensitivity" as a general indication of your total insulin dose per day.
Insulin sensitivity is the opposite of insulin resistance
Click to expand...
helli said:
@sololite if you want to track your "improvement" in insulin sensitivity, I think you just need to track your total daily dose (TDD).
Click to expand...
I've had the idea of TDD discussed in my first Consultant review and that felt to me coherent with the postulation in Gary Scheiner's book Think Like a Pancreas, where he points out that to our bodies insulin is just insulin and our body doesn't know the origin of insulin or whether it is quicker release bolus or slower release basal. If there is insulin present our body will use it, to some greater or lesser extent.
helli said:
Expect your basal dose to change if your insulin sensitivity changes.
Click to expand...
But why just basal dose change?
helli said:
Bear in mind that the correct insulin dose is the correct dose for you, It does not matter if you take a basal of 10 units a day or 100 units a day if your levels are not too high or too low.
Click to expand...
Again why just reference to basal. Surely it's the TDD that is the correct dose for each of us?
 
The way I calculated my insulin sensitivity was wait till about 9-10 with no food or insulin on board. Took 1 unit of insulin and waited 4hrs (or however long your insulin lasts) and then I could how much it has dropped me
 
I've never done DAFNE so could not care less about carb portions. My carb counting and dose adjustment training was 100% firmly based on BERTIE, which never subscribed to 'carb portions' so I never have either - only grams of carb. Exercise, which in my case has always included housework, gardening and walking the streets and supermarket aisles shopping, can affect the human body for up to 48 hours in the way it responds to the fuel we give it (ie food and drink) and the amount of insulin (and most likely all the other hormones it uses along the way its wonders to perform, the enzymes, the minerals, trace elements and simply EVERY THING) it requires, to continue to remain alive and healthy.

A normal human body that leads a standard life rising at 7am (ish) working 9-5 (ish) and going to bed at 10-11 (ish) has its lowest blood sugar period of each 24 hrs at 2.30 - 3.30am (ish). After that time, the blood sugar starts to increase so that when the body starts to awake we have enough energy to achieve what we need to do after rising from slumber. This is the primieval requirement to either hunt and gather or go forward and hunt (eg woolly mammoth), for food. We cannot actually stop our body doing this as far as I know. This increase has an official medical name - Dawn Phenomenon.

For those of us 100% exogenous insulin dependant, the first thing we ALL need to do is ensure that our basal insulin dose(s) is(are) as 100% cock-on to correct as we can humanly manage to adjust it (them). Having done that, only then can we move on to adjusting the doses of bolus insulin to cover the carbs we are going to eat.

Your standard human needs 1u of bolus to deal with 10g of carbohydrate, in the absence of carb that 1u should deal with 40g of protein, or in the absence of either of them, 100g of fat. Trouble is - nobody ever eats ONLY one of any of those. 100g of prime roast beef protein? Well of course it was bought raw with visible fat marbling. otherwise it would be inedible once cooked. 100g of boiled pasta carb? On its own with no sauce? forget it. One McVitie's digestive biscuit is about 10g of carb so that's what I always used as a benchmark - and Lo & Behold - 1u covered it nicely. Also 1u reduces my BG by between 2.5 and 3.0 and those 10g of carb increases my BG by the same amount.
 
Great information @trophywench I am learning all the time. I'm off Mammoth hunting tomorrow so will need extra weetabix, although not smothered in granulated sugar like I did when I was a child - what were parents thinking in the 60's?!?
 
nonethewiser said:
Out fav as kids was weetabix with thick butter spread on top, mmmmm delicious it was.
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I remember ”weetabix with butter on” but you are the first other person I have ever known to have them. Everyone else just thinks it’s another example of how weird I am.
 
Proud to be erratic said:
But why just basal dose change?

Again why just reference to basal. Surely it's the TDD that is the correct dose for each of us?
Click to expand...
Not “just” basal change.
I highlighted the basal because it is often forgotten when adjusting doses.
Unless we do a basal test, we often focus on tweaking insulin to carb ratios or just bolusing less because we eat less carbs.
I have read in a number of places that low carb diet can increase insulin resistance (lower insulin sensitivity). But we all need to remember that we are all different and need as much insulin as we need and there is no “right amount” apart from the amount we need individually to avoid hypos nd hypers.
 
elmehdaoui said:

The Insulin Resistance Diet: Managing Blood Sugar and Improving Insulin Sensitivity​

Click to expand...
Do you follow this? Or just posting from a specific blog which you may have a connection with?
It would be helpful to learn something about you such as what is your relationship to diabetes?

As some one with Type 1 diabetes, the article seems a little confusing. It seems to mix up high blood sugars with insulin resistance. With high or low insulin resistance, someone with Type 1 would expect their sugars to rise regardless whether they had high or low GI food with no insulin. For our insulin dose, the amount of insulin is most important. For insulin timing, the GI comes into affect but I do not understand how that affects insulin resistance.
 
helli said:
Do you follow this? Or just posting from a specific blog which you may have a connection with?
It would be helpful to learn something about you such as what is your relationship to diabetes?

As some one with Type 1 diabetes, the article seems a little confusing. It seems to mix up high blood sugars with insulin resistance. With high or low insulin resistance, someone with Type 1 would expect their sugars to rise regardless whether they had high or low GI food with no insulin. For our insulin dose, the amount of insulin is most important. For insulin timing, the GI comes into affect but I do not understand how that affects insulin resistance.
Click to expand...

It’s spam @helli Report and ignore 🙂
 
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