Share your insulin dose strategies - Page 3

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Share your insulin dose strategies - Page 3


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Old 07-26-2016, 01:44   #21
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@Bunjee Sounds like you usually take 1U of insulin for every 4g of carbs? Is that how you figure out your doses or do you do something different?

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Old 07-26-2016, 05:12   #22
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7pm
- BG: 107
- Carbs: 46g
- Bolus: 8U

9pm
- BG: 123

After bolusing I ate just the protein part of my dinner, and waited 20 minutes before eating the carby portion. That worked well on two fronts. Delaying the carbs a bit ensured that some of the insulin was working and ready to handle the carbs. Eating the non-carby parts first helped give me the patience to wait!

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Old 07-26-2016, 06:31   #23
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Quote:
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@Bunjee Have you thought about splitting your levemir dose? It definitely does not last a full 24 hours, and I get much better coverage by splitting it up. I actually overlap them a bit for extra "oomf" in the morning but it's pretty common to do them 12 hours apart.

Also there's a new basal insulin, Tresiba, that looks really promising.
I have tried splitting my dose and the result was a high FBG as well as very high after post breakfast reading. I see the endo for the first time in a couple of weeks and decided to just keep doing the single dose until then. I forgot today (darn it), but moving it to 4:30 seemed like it would cover when I needed it better - evening and morning. Middle of the day I have stacking from the Novolog helping me along.

Daytona, thank you for noticing that about the 4 gr/unit. That will help a lot!

When I started using insulin, I was using 7-5-7+2 for the rapid (that's 7 for breakfast, 5 for lunch, 7 for dinner and 2 for snack). I have fairly consistent carbs for those meals. Since dropping the metformin, I've had to increase the bolus to 9-5-8 +3. From there, I've been figuring out the extra carbs to figure out how to adjust to meet my goals.

I had the same sandwich and dinner as yesterday. Increased bolus for lunch and had a HIGHER before lunch BG - same post meal numbers (146). Dinner - yesterday BD was 91, AD 116. Today BD was 109 AD 90. I know I'm a biological unit, but it's tough to figure this stuff out when you have such unexpected results for the same foods.

Thanks for mentioning Tresiba. I'll have to see if my insurance covers it before I see the endo. Note: info for this med says this: Never use a syringe to remove Tresiba® from the FlexTouch® pen. <--- any idea why? Makes no sense to be wasting a lot of insulin.

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Old 07-26-2016, 06:39   #24
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The insulin dose strategy strategy I have used is "keep it small" for both carb intake and insulin intake. Example is matching each unit of insulin to total carbs in order to maintain as steady and consistent level of glucose within a range of 65-125. I eliminate many types of foods and stay under 15g carbs for any serving. In past experiences many years ago I found the more insulin I took, the more carbs I required and harder it was to stay within a tight range. I want to minimize how many times I correct either because my glucose is too low or too high. My brain is like a circuit breaker with many switches and I shutdown those switches that contribute the most carbs. Examples would be :

Switch 3: turns off flour, bread, and starch
Switch 8: turns off bananas, apples, grapes
Switch 12: turns off dressings and sauces
Switch 19: turns off alcohol
The Main Circuit Breaker: no more than 15g carbs per serving

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Old 07-26-2016, 23:44   #25
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Daytona, thank you for noticing that about the 4 gr/unit. That will help a lot!
You may need to keep fine tuning that ratio, I was just doing the math from your posts and it seems that is what you use most of the time.

I find that having a ratio is MUCH easier to deal with than a fixed number of carbs or insulin per meal. I figure out what I want to eat, estimate the carbs and divide by my number. For example, if I'm eating 21g of carbs, and my i:c ratio is 1:7 (1U of insulin for 7g of carbs), then I take 21/7=3U of insulin.

If you are willing to do math, it's much better for you to do it this way than eating some preset amount of carbs to match a magical insulin dose!

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Thanks for mentioning Tresiba. I'll have to see if my insurance covers it before I see the endo. Note: info for this med says this: Never use a syringe to remove Tresiba® from the FlexTouch® pen. <--- any idea why? Makes no sense to be wasting a lot of insulin.
They are just saying that Tresiba only comes in a prefilled disposable pen, and that you shouldn't try to stick a syringe into it like you would with a vial. Basically use pen needles instead of syringes. So there's no waste or anything.

They also tell you to "prime" your pen by dialing 1-2U and just pushing it out. I'm not an expert but what I do instead is tip the pen so the needle is facing down, and tap the pen to make the air bubbles go up, until I see a drop of insulin on the tip of the needle. Much less waste.

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Old 07-27-2016, 00:38   #26
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Wouldn't it be harder to stay within a tightly controlled glucose range ( say 70 to 125) if someone ate say 50g of carbs with I:C ratio of 1:7 which would be 50/7=7u of insulin? Or extend even further like 70g carbs requiring 10 units insulin. I could see a spike in glucose (such as 180+) before it drops when insulin kicks in and it settles in range of 80 to 120. Do you usually keep carb intake for serving small like 15g to 25g at once? Would it also depend on the type of carbs as there are 3 main types: Starch, Sugars, Fiber)

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You may need to keep fine tuning that ratio, I was just doing the math from your posts and it seems that is what you use most of the time.

I find that having a ratio is MUCH easier to deal with than a fixed number of carbs or insulin per meal. I figure out what I want to eat, estimate the carbs and divide by my number. For example, if I'm eating 21g of carbs, and my i:c ratio is 1:7 (1U of insulin for 7g of carbs), then I take 21/7=3U of insulin.

If you are willing to do math, it's much better for you to do it this way than eating some preset amount of carbs to match a magical insulin dose!



They are just saying that Tresiba only comes in a prefilled disposable pen, and that you shouldn't try to stick a syringe into it like you would with a vial. Basically use pen needles instead of syringes. So there's no waste or anything.

They also tell you to "prime" your pen by dialing 1-2U and just pushing it out. I'm not an expert but what I do instead is tip the pen so the needle is facing down, and tap the pen to make the air bubbles go up, until I see a drop of insulin on the tip of the needle. Much less waste.


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Old 07-27-2016, 02:30   #27
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Wouldn't it be harder to stay within a tightly controlled glucose range ( say 70 to 125) if someone ate say 50g of carbs with I:C ratio of 1:7 which would be 50/7=7u of insulin? Or extend even further like 70g carbs requiring 10 units insulin. I could see a spike in glucose (such as 180+) before it drops when insulin kicks in and it settles in range of 80 to 120. Do you usually keep carb intake for serving small like 15g to 25g at once? Would it also depend on the type of carbs as there are 3 main types: Starch, Sugars, Fiber)
Yes, I do believe the law of small numbers is the best road. You won't find any argument from me that its easier to control your BG by eating the least amount of carbs. That said, I would like to keep this thread focused on insulin strategies and not veer too far into low-carb strategies.

I am still very new to insulin but here's what I have been doing so far:

- If the meal is all protein/fat, I will take my bolus after I finish eating, as the BG spike is delayed. Still figuring that out though, as I have seen some big spikes when the protein portion is large.

- If I can split up the carbs from the protein/fat, like a steak + a side dish, I will take my insulin and start with the steak, and after 20-30 minutes, tackle the side.

I have read that some people will split the meal dose (especially helpful for long meals at a restaurant) taking 1/2 at the beginning, and then the rest later on. That way they have good coverage the entire time. I haven't tried that though.

Do you use an i:c ratio? It would help to know how you are calculating your insulin doses as I'm just starting out.

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Old 07-27-2016, 02:53   #28
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My i:c ratio is 1 unit Humalog to 7g carbs and my CF Correction Factor is 1 unit insulin corrects about 20-25 pts glucose over a 2-3 hr period. you also have a corrective bolus is figured which is usually 1 or 2 units.

I take 3 units Humalog at 8:30am, 4 units at 12:30pm, 3 units at 4:00pm and 3 units at 7:30pm = total 13 units. I also take 25 units lantus at 7:00am which lasts 22-24 hrs. Sometimes I alter my dose by 1 unit so its can be 3 or 4 units.

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Yes, I do believe the law of small numbers is the best road. You won't find any argument from me that its easier to control your BG by eating the least amount of carbs. That said, I would like to keep this thread focused on insulin strategies and not veer too far into low-carb strategies.

I am still very new to insulin but here's what I have been doing so far:

- If the meal is all protein/fat, I will take my bolus after I finish eating, as the BG spike is delayed. Still figuring that out though, as I have seen some big spikes when the protein portion is large.

- If I can split up the carbs from the protein/fat, like a steak + a side dish, I will take my insulin and start with the steak, and after 20-30 minutes, tackle the side.

I have read that some people will split the meal dose (especially helpful for long meals at a restaurant) taking 1/2 at the beginning, and then the rest later on. That way they have good coverage the entire time. I haven't tried that though.

Do you use an i:c ratio? It would help to know how you are calculating your insulin doses as I'm just starting out.

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Old 07-27-2016, 03:43   #29
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I'm a bit fuzzy on the difference between your correction factor and correction bolus? Is it just that the correction factor is used to calculate a correction bolus?

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Old 07-27-2016, 05:08   #30
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I don't use correction factor to calculate correction bolus. Sometimes ill take 1 unit of Humalog as a correction bolus if want my glucose to go 20 pts lower. An example for me would be if I see a glucose of 125 I would prefer to see it at 100.

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I'm a bit fuzzy on the difference between your correction factor and correction bolus? Is it just that the correction factor is used to calculate a correction bolus?

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