Friday, July 29, 2011

Feeding the Insulin

I was trying to figure out my insulin to carb ratios in order to write them down in an "in case I am unconscious" script, and it got me thinking about why I no longer know or really care about my insulin to carb ratio. My stomach stopped hurting (baruch Hashem! as we say in my community) about a month ago, and since then I've been doing something I haven't done in a loong time. It is what I call feed the insulin, and it is definitely part of why my blood sugar average is down by 20 mg/dl from June.

Here's how a typical breakfast or supper goes for me, if my blood sugar is in the 80 to 180 range before I eat:

Step 1: I take a lotta Novolog (or Regular). Somewhere in the range of 8 to 15 units.

Step 2: I wait 10 to 20 minutes.

Step 3: I eat about forty grams of carbohydrates over the course of about twenty minutes.

Step 4: I wait ten minutes and see what my Dexcom shows my blood sugar as doing or not doing.

Step 5: . If blood sugar is level, I eat more. If blood sugar is falling, I eat lots more If blood sugar is rising or high, I don't eat.

Step 6: About two hours after I took the insulin, I take a look to see if I need more insulin or more food. Usually after breakfast, it's more food, and after supper it's been more insulin.

Tada! For the record, when I do count the carbs, it appears that my breakfast ratio is about 1 unit to 8 grams of carbohydrates. I haven't counted enough suppers lately to have a good idea as to what my ratio is in that department.

Feeding the insulin has generally gotten a bad rap in diabetes history. It's often associated with fixed dose insulin regimens, particularly ones based off of NPH. The most widely touted advantage of the basal bolus regimen is that you don't feed the insulin; the insulin feeds you. But I think feeding the insulin has gotten the short shift.

If I decide how much insulin to take- I say I'm 5 units of hungry or 15 units of hungry- and then watch the monitor to find out how hungry that really is, I get much more stable blood sugars than if I decide I'm 75 carbs worth of hungry and then use yesterday's formula to find out how much insulin that is.
And if it turns out that I'm more than 5 or 15 units of hungry, well, I can inject again.

I continue to have more problems with my overnight blood sugars than my daytime ones. Too bad I don't stay up all night eating.


Reyna said...

As Bennet says "Your Diabetes May Vary". I have never heard of this way of managing it Jonah...but it seems to work for you. So sorry to hear about your nights...and YIPPEE for a more comfortable stomach!

Scott said...

Feeding insulin does provide better numbers, but its not without hassle. It can be a nuisance and lead to unwanted weight gain over the long term (although when you're young enough, that may not be an issue), although it is definitely easier and sometimes, you can never guesstimate the numbers anyway. But it does work as well as any other method of control.