OK, although my comment was also directed at Michel’s question rather than the original topic. I used the equation that I noticed years ago to tie together the different carb counting ratios Michel mentioned.
I didn’t have a CGM before, but now that I do, here is what I am talking about from today’s lunch, showing that the above equation works for me:
I’ve been tuning my basal insulin lately (since I finally got a prescription for Tresiba) and it is working well and is pretty stable - not perfect (as you can see in my overnight rise from 6am to 9am). So I’m still working on it, but my daytime is quite stable. Given a stable basal lets use these results to test the equation I gave above:
Carb/Insulin ratio (g/units) = Corr ratio (mgdl/units) / Bg/Carb ratio (mgdl/g)
Lunch injection of 5U humalog I took at about 1pm. This was after doing yoga, but it is mostly stretching and didn’t affect my BG. Short pre-bolus, because I’ve found a bread (100% whole wheat) that matches the humalog extremely well with a minimal pre-bolus (everything goes to ■■■■ if I prebolus too early). Two hours later it is clear that my carb was slightly insufficient, so I ate a 50g kiwi fruit - 7g carb. So total carb for the 5 units insulin was 30+7=37g. BG bottomed at 70 when I ate the kiwi, then rose to 98 and stable. So this 7g of kiwi carb raised my BG by 28 points.
Now the math:
Carb/Insulin ratio = 37/5 = 7.4 g/unit
Bg/Carb ratio = 28/7 = 4 mgdl/g
So predicted Corr Ratio is Carb/Insulin * Bg/Carb = 7.4 * 4 = 29.6 mgdl/unit
So what is my actual correction ratio? Well I’ve been testing Humalog against a sample of Fiasp I got at my last dr appt, so I’ve been testing and comparing my correction ratio a lot lately any time I go high. I used to use a correction ratio value of 25 and that still seems to work pretty well at night, but I measured my morning ratio (for both Humalog and Fiasp) as being 33. So anywhere from 25 to 33 is in the ballpark, and the predicted number from the equation above is right in the middle of that ballpark. QED.
I don’t see any indication that liver is having any impact. If anything will have an impact, I believe it will be our Kidneys. If BG goes high enough and long enough to start peeing out glucose, then some of the blood glucose will be lost, and that would almost certainly have some impact on the equivalence of these ratios. Impossible to say how much, however, without doing the testing.
It’s possible that I am unusual and these ratios just happen to be correlated for me and no one else, and there are lots of cases where YDMV. But the math makes sense to me, and if my ratios were far outside of ones that make the above equation work, I would do more testing because it is possible that some people may be using ratio’s that aren’t really optimal, and a re-evaluation would be in order.
I got my A1C back today and I’m disappointed that it’s not lower. It doesn’t match my Dexcom report by a difference of about 0.3%. I know there are variations in the test, but still. I was expecting a larger delta from last year’s result. At least it went down 0.56%. That’s the right direction. But I have a lot of work to do.
Today’s been an exercise in forcing myself to pre-bolus longer and realize that my bg is not going to fall off of a cliff by giving the insulin a chance to get working. Then I’m eating to the graph and spacing it out as necessary. I think that’s going to be the difference between lowering my A1C or not. Once I eat, I get sugar in my system pretty darn quickly…but since becoming a mom it has stressed me out to truly pre-bolus effectively. I’ll need to work through that and prioritize my timing over the family’s when necessary.
This is something that seems to vary a lot, but I find prebolus time varies a lot depending on what I’m going to be eating. Meal with refined carb needs a substantially greater prebolus time (20 min) compared to 100% whole grain (0-5 minutes). As to refining the timing, I believe that is the focus of the Sugar Surfing book which I ordered but hasn’t arrived yet. But should be worth a read if you don’t already have it. If you do decide to buy it, you should order it from sugarsurfing.com instead of Amazon since Bezos (and his wife) have enough money as it is.
It’s a lifestyle issue for me. I prebolused the heck outta life years ago. My current lifestyle is the typical overscheduled, under-rested, hectic “what fire do I put out next?”, “what else can get marked off of the to-do list before 11pm?”, “who has a special themed dress up day tomorrow that I got 36 hours notice for?”, “did I remember to wash my outfit for my meetings tomorrow?”…kind of life.
I’ll have to ruthlessly prioritize and restructure this year. A lot of people are going to hear “no” and “not now” this year.
It’s a good thing they put the year on school pictures. So far my younger one has worn the same outfit that my older one did at that age for each and every school picture and program. The listed year helps us tell which kid it was bc they look pretty darn similar. #winning
I’m in a high hormone induced insulin resistance time frame…just not sure exactly where I’m at resistance-wise due to switching insulins five days ago.
So far, it does appear that due to hormones my blood sugar wants to drift and hover at 150-160. It did that on Humalog, too. However, out of an abundance of caution (for The Drop coming up plus acclimating to Novolog), I’m not running any temporary extra basal. Normally I’d be running a temp basal of +10 to +20% right now. I’m not running any temp extra, and I’m noticing that Novolog does a much better job of overcoming the hormone resistance via bolus. As long as I take enough insulin to handle my food and my hormones, my blood sugar is willing to go down into the 90’s and hang out there for a while. Now if I leave everything alone (no boluses, no food) for long enough, like overnight, it will drift back up to the current resistance plain…of 150-160…and stay there. But I am amazed that extra bolus insulin is enough to coax my bg down below the resistance plain. I never had success with Humalog on that front if my basal was off by more than 5%. With Humalog, if I didn’t adjust my basal for hormones, I’d have to throw bolus after bolus at it, and it wouldn’t budge until it really broke loose. And by that point there was no easy way to figure out ahead of time how much it was going to drop bc I’d already taken so much insulin that it was anyone’s guess.
12AM: took a somewhat aggressive correction bolus of Novolog
3AM: start of Drift back up to hormone resistance hover point around 150
On Humalog, the correction bolus never would have gotten me that much action in the face of hormones. But it’s interesting (and helpful) that my hormones still make my bg behave with hover and drift on Novolog. I’ll start comparing temp basals in a little bit after getting more of my bearings.
I believe I’ve seen The Drop. Running my regular weekend basal routine, I went from my bg wanting to stick around 150 to wanting to stick around low 80’s, upper 70’s. That change happened in about a two hour span, I think. It’s stuck that way for the last seven hours so far. I didn’t bolus for dinner until after I ate, and cut off 60% of my normal bolus, and still never exceeded 135.
I’ll try -5% tonight to see what happens, although I suspect I’ll need to scale back at least to -10%.
Just an update: My Novolog injections look the same as my Humalog injections did (red dime to quarter sized area for 24 hours after injection). It’s possible that they looked like this six years ago on MDI and I just never worried about it if I was getting results. I can’t swear either way at this point. Pump sites with Novolog seem the same…maybe better?..but mostly the same.
Novolog’s tail is stronger than I’m used to with Humalog, for me. Maybe others don’t react this way.
I believe that I’ve been having issues with early lows right after eating dinner due to IOB from a snack bolus from 3 hours prior. I had this issue very occasionally on Humalog.
It’s not a big deal, but I do want to be aware of it so that I can use it to my advantage and plan around it. I’m taking later and lower dinner doses…but I don’t think that’s bc I’m super insulin sensitive at night…I just think it is bc of leftover insulin from getting through the day at work.
I’m apparently not diabetic in the evenings on work days…especially during hormone week 2…on Novolog.
I was much more insulin sensitive today than yesterday…I’m on Day 2 of the same pod as yesterday. Yesterday, I got a 70 point morning “feet on the floor” spike. Today I got no “feet on the floor” spike even with identical morning demands.
Here’s my work day bolus routine and how it’s worked today:
7:30AM 2.5 units, hour pre-bolus for 16g carbs and coffee
11AM 7 units, 45 minute pre-bolus for 40g carbs…and then eat remaining 15g of carbs once the first spike comes down (around 1PM - except yesterday it never came down enough to eat Part 2)
1:30PM 3 units, 30 minute pre-bolus for 24g carb snack + 2 cups of decaf
4:30PM feed the tail…yesterday the tail didn’t come until 5:30PM so it covered most of dinner, today it hit at 4:30PM and I fed it with 20g of carb
5:30PM only took 2.5 units, no prebolus, all extended over 30 minutes for about 40g carb dinner
7:30PM 40 point shower drop…surprised relatively little IOB did that to me…it didn’t do that yesterday
8:00PM only took 2.6 units for 40g carb snack…then dipped into 80’s by 9PM and treated with 20g carb…will see if/how much I bounce. I’m testing a snack I haven’t eaten in the evenings on Novolog yet.
On Humalog, I had to take larger boluses even in the evenings…usually 1:10 plus 1 or 2 depending on how resistant the day had been. With Novolog, it’s doing more and gains steam as the day goes on. On its best days, Humalog would do that a little bit but I really don’t think it held a candle to Novolog on this aspect. It’s amazing to me how much I have to pre-bolus in the morning and at lunch…but I better not do that with dinner, likely due to IOB.