Ratios & Inactivity

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pawprint91

pawprint91

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So I usually go on a ratio of 1:10, which usually works pretty okay for me - so long as I am semi active after eating. (Clearing the kitchen, walking the dog or even having a shower for example). However, on the occasions that I'm inactive after eating (albeit few), I find that using this ratio will mean my BG levels rocket up, even with a decent pre-bolus time, and stay there until I either correct and/or move about. Does this mean that if I know I will be inactive following a meal, my ratio should be different?
 
pawprint91 said:
Does this mean that if I know I will be inactive following a meal, my ratio should be different?
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Yes. You don't necessarily have to do that formally, you could just add on 50% if you know you're going to be inactive (or more or less, if that works out for you). But yes, you'll want to adjust your doses according to activity, and you'll need to experiment a bit to work out what the amount of adjustment is needed and the most practical way to do that for you.
 
pawprint91 said:
So I usually go on a ratio of 1:10, which usually works pretty okay for me - so long as I am semi active after eating. (Clearing the kitchen, walking the dog or even having a shower for example). However, on the occasions that I'm inactive after eating (albeit few), I find that using this ratio will mean my BG levels rocket up, even with a decent pre-bolus time, and stay there until I either correct and/or move about. Does this mean that if I know I will be inactive following a meal, my ratio should be different?
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Yes, it’s just the opposite of exercise. If you normally eat a 50g lunch and take 5 units, if you’re out on a hike you’d reduce those 5 units. Don’t bother with a ratio as such, just knock off the amount that works for you from the bolus.

For non-activity, do the same. Your 50g carb lunch might need 6 or 7 units or whatever if you’re spending the afternoon sitting in a cinema, etc.

The ratio is the starting point but circumstances and the next few hours will affect the amount of bolus insulin you should take.
 
Yes, you can either do it as a different ratio or a % adjustment eg 25% more insulin if not going to be active (but whatever number works for you)
 
Thank you! 🙂
 
:rofl: I'm giggling because though what already has been said is absolutely true - it is by no means an exact science, unless your life is so regular you're able to judge all of the 42-ish possible factors affecting BG in advance before you eat and dose accordingly, it'll be more guesswork and instinct than anything! So, be prepared for results being random. But - the theory is correct!
 
You can increase the insulin by adjusting the bolus if that is possible on your pump or make a percentage adjustment to your carbs for a meal. On some pumps you can have different basal rates for levels of activity. I had number 3 as my normal one, then 20% up as basal profile 4 and 50% up for basal rate 5. I then have profiles 1 and 2 set in a similar way with reductions. I selected the appropriate one depending on what I was planning to do.

if it was a short period of activity/inactivity and followed the meal I could use a change in the bolus instead Or as well.

As @trophywench says this is not an exact science so we just do the best that we can.
 
In recent years I’ve found my system is particularly twitchy about activity and iob.

Correction doses will mostly just seem to sit there, completely inactive, until some sort of activity takes place (even if it is only walking up and down stairs for 5 minutes on a timer).

UNLESS it’s a fractional correction that HAL (my pump) sometimes stupidly gives seeing the rapid rise in BG from a preventative prehypo treatment. Those act immediately and at double strength. Because, of course, I don’t want them to! :rofl:
 
everydayupsanddowns said:
In recent years I’ve found my system is particularly twitchy about activity and iob.

Correction doses will mostly just seem to sit there, completely inactive, until some sort of activity takes place (even if it is only walking up and down stairs for 5 minutes on a timer).
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This is what seems to happen to me - it just sits there, but then will all hit at once!
 
pawprint91 said:
This is what seems to happen to me - it just sits there, but then will all hit at once!
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Yes it’s one reason why I’d be a little cautious adding extra insulin.

I tend to do the reverse - I may knock off a unit or two, or have some ‘unbolused’ extra carbs if I know I have activity coming up soon after a meal (eg I’m walking to the train station straight after breakfast).
 
everydayupsanddowns said:
Yes it’s one reason why I’d be a little cautious adding extra insulin.

I tend to do the reverse - I may knock off a unit or two, or have some ‘unbolused’ extra carbs if I know I have activity coming up soon after a meal (eg I’m walking to the train station straight after breakfast).
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I definitely do that for exercise/activity too!

It's just on those very rare occasions where I don't move at all that I was wondering what to do :rofl:
 
Amity Island said:
Mike, any idea why? Any scientific explanation for this? It doesn't have any logic to it.
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A conference presentation I saw once described us as treating diabetes, “with the wrong insulin, acting over the wrong timespan, delivered in the wrong place”.

Insulin in the body isn’t supposed to be in subcutaneous tissue. But that’s the option we have. So we deliver doses, and they they have to gradually absorb from tissue, via fine capillaries, and become available in the bloodstream. And increased bloodflow (and also warmth) can increase insulin sensitivity as I understand it.
 
everydayupsanddowns said:
A conference presentation I saw once described us as treating diabetes, “with the wrong insulin, acting over the wrong timespan, delivered in the wrong place”.

Insulin in the body isn’t supposed to be in subcutaneous tissue. But that’s the option we have. So we deliver doses, and they they have to gradually absorb from tissue, via fine capillaries, and become available in the bloodstream. And increased bloodflow (and also warmth) can increase insulin sensitivity as I understand it.
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Spot on! That all sounds right to me.
 
everydayupsanddowns said:
A conference presentation I saw once described us as treating diabetes, “with the wrong insulin, acting over the wrong timespan, delivered in the wrong place”.

Insulin in the body isn’t supposed to be in subcutaneous tissue. But that’s the option we have. So we deliver doses, and they they have to gradually absorb from tissue, via fine capillaries, and become available in the bloodstream. And increased bloodflow (and also warmth) can increase insulin sensitivity as I understand it.
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Being a type 1, it never occurred to me whilst injecting, it's going in the wrong place. I've always thought it to be going in the right place, this is clearly wrong.
 
Amity Island said:
Being a type 1, it never occurred to me whilst injecting, it's going in the wrong place. I've always thought it to be going in the right place, this is clearly wrong.
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Yes it wasn’t something I’d really clocked either. But the body’s own insulin goes directly to the bloodstream - so it starts working immediately (and can be switched off just as rapidly).

None of this 15-60 minutes to get going and 5 hours duration nonsense! :D
 
everydayupsanddowns said:
Yes it wasn’t something I’d really clocked either. But the body’s own insulin goes directly to the bloodstream - so it starts working immediately (and can be switched off just as rapidly).

None of this 15-60 minutes to get going and 5 hours duration nonsense! :D
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So....would smart insulin really sort this problem out? If its delivered in the wrong place?
 
Amity Island said:
So....would smart insulin really sort this problem out? If its delivered in the wrong place?
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I guess we’ll have to wait and see! But in theory - at least with smart insulin it will already be in the bloodstream ‘ready’, waiting to be switched on.

I suspect the proof of the pudding will be in the sensitivity of whatever the on and off mechanism ends up being. How rapidly it responds and stops responding to glucose fluctuations?
 
everydayupsanddowns said:
I guess we’ll have to wait and see! But in theory - at least with smart insulin it will already be in the bloodstream ‘ready’, waiting to be switched on.

I suspect the proof of the pudding will be in the sensitivity of whatever the on and off mechanism ends up being. How rapidly it responds and stops responding to glucose fluctuations?
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I've always had to add an extra 3 units on top to my usual corrections (1unit insulin for every 3mmol over target) when over 13mmol. A straight correction as you say, just sits there and doesn't drop back into target. If 13 or under just a straight correction is suffice.
 
Amity Island said:
I've always had to add an extra 3 units on top to my usual corrections (1unit insulin for every 3mmol over target) when over 13mmol. A straight correction as you say, just sits there and doesn't drop back into target. If 13 or under just a straight correction is suffice.
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Gosh I’m not sure that would work for me! Especially around the borderline. 😱

12.8mmol/L correction = 2u (rounded)
13.1mmol/L correction = 5.5u (rounded)

Would feel pretty risky to me. But glad you’ve found a rule of thumb that works for you 🙂
 
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