Working out insulin to carb ratio

S

SweetNanna

Member
Relationship to Diabetes
Type 1
Hi everyone just wondering how everyone worked out their insulin to carb ratio. I'm Type 1 on fiasp bolus and Basal abasalgar. At my last hospital visit I asked the nurse what my icr was and she looked at me like I was daft and said probably 1:10. If that didn't work then I'd have to play around till it worked out for me. I've got a mysugr app and it won't be accurate for bolus calculation if I don't put in my icr and correction amount. I've worked through a few different values but my sugars are still high 3 hours after eating. I've got icr set at 2.5 and correction factor set at 3. At lunch I was at 11.2 blood glucose and ate 5 grams of carbs (low carb eater) but my sugars are currently 10.8 nearly 4 hours after eating. Need a simple way to work values out but hey it's diabetes so ain't nothing simple out there
 
Firstly, you need to be sure that your basal insulin (Abasaglar) dose is holding you as close to level as you can get it by doing some basal testing and adjustment as necessary. Then I would start at the time of day when your levels are most steady with your basal and when you are nicely in range (5 or 6), probably lunchtime, and eat a set amount of carbs that you know the value of, say 20g carbs and inject 2 units of insulin (1:10 ratio) and see where you are 4-5 hours later. If you are back to between 5-6mmols then your 1:10 ratio worked, if you are higher, say 10 mmols, then you might want to try 1:5 next time and repeat the experiment another day. If you are down to 4 or have to eat some carbs to prevent you hypoing then 1:10 is too much and you might need 1:12 or 1:15 depending upon how low you dropped. The important thing is to make sure your basal is holding you steady first because if it isn't, it will throw off the carb ratio test.
You then repeat for evening meal and breakfast.

The thing I have found with Fiasp is that it has a tendency to turn to water when levels get above 10 and even at 8 it becomes less effective for me, so correction doses need to be quite aggressive I find to be effective, so your correction factor of 3 may well not be working at 10. I know it is frowned upon, but I usually end up stacking corrections to bring me down from 10 or above because I find it is safer than injecting one much larger dose as the drop from staggered corrections is slower than a sudden drop from a single large correction.
What I was intending to say is that working out your carb ratios needs to be done when you are mid range and not above range, hence 5 or 6mmols when you start, because your correction factor could well also be wrong, so you need to eliminate as many factors as possible, including avoiding exercise when you are doing these experiments. You will afterwards learn to adjust your bolus to take into consideration any exercise you are going to do after a meal, but initially you want to know your ratio in a normal environment,

Not sure if that makes sense to you and I would add that I am not encouraging anyone to follow my lead and stack corrections with Fiasp, this is just want has become necessary for me and if you do try it you must keep a very close eye on your levels after stacking and be ready to intervene with a small preventative hypo treatment if your levels start to drop too far too quickly and make sure your low alarm is set well above 4. Mine is 4.5 and I know that 2 jelly babies will turn that around from a vertical downward arrow and 1 JB if it is a sloping arrow, but this is just me. You might be best with your alarm set higher.
 
Welcome @SweetNanna 🙂 Don’t even look at your mealtime ratios until you’ve got your basal checked. If that’s wrong, it throws everything else off. Also, bear in mind that you might need different ratios for different meals, ie breakfast, lunch, etc. I’ve never used a bolus calculator as I prefer to work mine out myself, taking into account other factors that might affect my blood sugar.

How many carbs are you eating a day? Too few can cause insulin resistance. I find it easier to eat a reasonable amount of carbs as the insulin ‘works better’ that way - ie is more predictable and makes it easier to stay in range usually. If you’re eating very few carbs, then you might need to look at TAG to calculate your boluses as this assigns ‘carb’ values to protein and fat in order that they can be included in the bolus calculation.
 
Wow I never knew that about fiasp, but yes there have been nights when I've got up and tested my pen because I actually thought no fiasp was coming out . What I've found is that if my sugars have been good they've stayed reasonably within preferred limits, but if high they've been a swine to get back on track without ending up with a hypo. Lots of good advice there to work with. Thank you so much
 
I started splitting my abasalgar doing 16 at bedtime and 6 first thing in the morning because I was having lows during the night but my sugars went high during the day. Guess that might be a no no
 
Great advice from @Inka.
Like you and @rebrascora I too take Fiasp. I understand what rebrascora says about Fiaps appearing to behave like water when BG is high, in my experience, this is mostly down to the speed at which it starts working and very little to do with changes in insulin to carb ration until my BG is at least 12mmol/l. Above this level I experience noticeable insulin resistance and need at least 1.5 times my ratio.
The challenges, and the reason why I wait until my BG is in single figures (but not necessarily as low as 5s because I have a life outside diabetes) before eating, is that my BG can seriously impact the speed at which it starts working. If my BG is in the 5s, it will work instantly whereas if it is in double figures it can take 90 minutes to have an affect. I have to be very strict with myself to avoid rage blousing when my BG is high. If I followed the stacking approach rebrasora mentioned (or should I say "when I do"' ), my BG will plummet and I will hypo a few hours later.

With this in mind, I agree to do your bolus testing when your BG is lower as it makes it easier to manage the speed and insulin resistance. And reduces the impact of insulin resistance when high. But I am not sitting around waiting to eat if my BG is in the 8s - this impacts everyone who is eating with me and eating a meal together is one of life's great events.

I also second Inka's comment about eating normally and the extra complications of a low carb diet. I tried it for a while and found I needed to bolus for protein when I do not consume enough carb and the insulin to protein ratio varied according to each different type of protein I ate.
Plus there is the risk of increasing insulin resistance through a low carb diet.

Sadly, diabetes is very individual ... much like each of us are individual ... and we need to find what works for us - our body, our lifestyle and our desires. And not let diabetes dictate too much in life.
 
Thank you yes I need to look at my carb intake definitely. I had started to read up on insulin resistance, but like everything else diabetes related it's all so darn complicated and confusing
 
Inka said:
Welcome @SweetNanna 🙂 Don’t even look at your mealtime ratios until you’ve got your basal checked. If that’s wrong, it throws everything else off. Also, bear in mind that you might need different ratios for different meals, ie breakfast, lunch, etc. I’ve never used a bolus calculator as I prefer to work mine out myself, taking into account other factors that might affect my blood sugar.

How many carbs are you eating a day? Too few can cause insulin resistance. I find it easier to eat a reasonable amount of carbs as the insulin ‘works better’ that way - ie is more predictable and makes it easier to stay in range usually. If you’re eating very few carbs, then you might need to look at TAG to calculate your boluses as this assigns ‘carb’ values to protein and fat in order that they can be included in the bolus calculation.
Click to expand...
Sorry I should have asked what TAG is
 
Vicki Tamblin said:
btw… remember, achieving optimal blood sugar control takes time and patience.
Click to expand...
I would suggest optimal blood glucose control is not possible and trying to achieve perfection is as easy as controlling a class of four year olds.
There is always something outside of your control.

I manage my diabetes which means I get it ok most of the time but there are times when I am stressed, exercise more than I planned, unwell or just wearing the wrong socks when it does just what it wants regardless of what I do. Just like a four year old will.
 
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