Do you believe in Carb Ratios and follow them closely? Or do you believe in dosing for meals based on a general “feel” and experience?
I’ve been tripped up for the last few years on bolusing for lunch on work days (office job - sedentary despite a concerted effort to go do stairs and take walks throughout the day). Up until the last few years, it did not phase me in the least to take 11-14 units of insulin for a 60g carb lunch on a work day. It also didn’t phase me to take 4 units of insulin for a 16g carb drink for breakfast every day. But supposedly I was supposed to hover around a 1:10 ratio according to: everyone (endo, CDE, a consultant CDE, etc). 1:10 worked for me…for weekend lunches and for all dinners. Otherwise it was garbage.
So I would drink the same breakfast everyday, and eat the same work lunch everyday, b/c I had those figured out for dose and for timing. I did not think a 1:4 ratio for breakfast was particularly scaleable…i.e. I really would not want to try eating a 45g carb breakfast one day and see how 11 units with a 40 minute pre-bolus did for me. But in theory, that’s supposed to be the idea. And I wouldn’t want to try to scale up using a 1:5 or 1:6 ratio on work days for higher carb lunches for a similar reason.
Now I’m thinking more in terms of Oomph for dosing meals. How much Oomph does my insulin need in the next few hours for this type/size of meal? Theoretically, all boluses (given at once) are supposed to last the same amount of time…so they’d each just carry a different amount of oomph to them?
The reason I think about this stuff is that I know it bothers me to scale up my doses when my instinct tells me to…but the math (or rule of thumb) says I shouldn’t…and in the back of my mind I worry that when waiting through the pre-bolus on a larger bolus, what if it just kicks in and tanks me? i’m working on getting less concerned about that, and I don’t know when that crept into my mindset so hardcore, but it has hung on pretty strongly. I’m sure that happened enough times to me on Lantus when it was too strong for the time of day and then I’d take a meal bolus and then while pre-bolusing it would just let loose…and it hasn’t happened recently but it still seems plausible.
Since starting use of CGMS, I gradually stopped carb counting and now just swag it. I eat most meals at home, use a salad bowl for most meals. (I don’t mind food touching each other, some do!)
And from the old days of estimating exchanges, I fill my bowl with about the same serving sizes of carbs, proteins and “free” leafy veggies. Generally bolus around 4-5 units per meal (lunch, dinner).
About 50% of the time I nail it. The other times, the dexcom trend helps me know when to have a snack or add more bolus, or take a walk, etc.
I have zero idea what my carb ratio is right now. I tracked carbs/ratios very closely when I was on Novolog…and then I started using Afrezza at least twice/day, and carb counting fell to the wayside…and along with it any knowledge of my current ICR, since I have had some pretty major (for me) changes in the past year, diabetes progression wise. I do eat a lot of the same things (like an apple and nut butter almost every day, for example, or the same breakfast recipes regularly rotated), so I generally dose the same things for known things. Other things, I just go with what I think I’ll need. Probably 8/10 times it’s enough (and when it’s not, I more often have underestimated, so I also have very few lows, and highs never go above 200). It works for me, so I’m going to stick with it until it doesn’t.
My instinct is to say that carb ratios are (often) garbage for Samson. That said when he was at diabetes camp his openAPS didn’t work and he was totally on manual mode, eating way more carbs than usual. Because we had no feel for such hugely carby meals we just went with our carb ratios and they wound up working well. But for pizza, mac n’ cheese, burritos and other staples of his diet we never bolus upfront for just the number of carbs and call it a day.
The only thing I can say is I use both.I know my C:I ratio is about 3:1. But based on what the food is I may just bump that up a few units.
I eat pretty much everything. I just finished dinner of fried chicken fingers and fries. 65g carbs. But I took 28u because of… Well, because. I’m pretty level now and will probably stay like that through the night.
If I had 65g of baked chicken and rice and vegetable, I would probably take 20u and do fine.
I guess the answer is, It all depends
I do a little of both I guess. I find that for many foods, my carb ratio works out pretty nicely, especially during the day. But then, for many foods, I am SWAGing the carb count so there is a bit of “feel and experience” included. Some foods are weird and require special handling (notable examples include most protein shakes, burrito bowls, pizza, and sushi).
Although I got a reminder today that one should probably retest the “feel and experience” thing carefully if you haven’t tested that food in a while… literally all summer long and a good portion of fall, every day, I had these specific protein shakes for breakfast. They supposedly have 4g of carbs but (because of the protein I think) required a 3.5u bolus, 15 minutes ahead. This worked nicely like clockwork, daily, once I figured it out. After not having the shakes for a couple of months I had one today and dialed in that 3.5u… and my BG tanked, hard, in the middle of my stats class this morning. I literally exhausted my carb sources on hand and had to leave class to grab a gatorade from a vending machine… Whoops! Oh well, lesson learned I guess, have to re-evaluate those shakes if I want to have them regularly again
I have found that my I:C fluctuates throughout the day. I generally run 1:3.5 between 0400 and 1000 hrs, 1:6 between 1000 and 1900 hrs and 1:2.75 between. 2000 and. 0400. That’s not to say that sometimes I don’t add a little swag method based on stress, Illness, and poor food choices.
We are newer at this than most here (it will be 4 years in a couple of months) so we tend to rely on ICRs and scales more.
When we cook at home (or on the road) and weigh, we use ICRs plus a tiny (typically 5% or less) adjustment of swag, and we are exactly on about 95% of the time. We have a portable scale that we use on the road. We almost never have problems. We have 3 different ICRs for different parts of the day
When we eat out (very often in the past 8 months), we have two strategies. For some meals, that are long and progressive, such as tapas, we use several doses and extended boluses, and we eat to the meter. It works really well, about 80% or more of the time.
When it is a single meal, we swag with some carb estimates. Our success rate is much lower, although not zero. In Africa, when we spent a few hours in the desert, we had to swag most meals and we ended up with postprandial peaks most of the time until the last week when we started figuring it out. The meals were all local meals and very hard for us (my son w a bit if feedback from his parents) to swag.
I think there is a difference between swagging meals you are accustomed to eating and meals that are really new to you, such as a new type of cooking, as it was for us.
My son is definitely able to swag regular meals much better than in the past, and can be amazingly on, when he eats to the meter. But new style meals are very hard for us to swag.
Nonetheless, for most meals that do not have a ridiculous amounts of fat and protein (American pizza etc.) ICR works really well for us when we weigh. I look forward to seeing my son’s swag capacity get better as he grows up. He is 14 right now.
How often do people here have to feed the tail of their meal insulin? Is your definition of getting your I:C ratio “right” that you time it right, don’t spike huge, and return to normal all on that dose? Or is it that you don’t spike and you feed the tail later, too?
Yes. I very rarely have to feed the tail, and I try not to dose to where that’s necessary. Instead, if I start at 90 and end up just flatlining between 100-120 hours after (as often happens now since I eat a decent amount of fat), I’ll just dose a tiny correction to bump it back down.
Yes. We also very rarely need to feed the tail. If we do it’s a fail. Our tail is about 5.5 hours long btw.
Thank you for the input.
Getting into tight control as a mom is so totally different for me than when I was in tight control pre-kids. I was a really aggressive bolus-er pre-kids and that way I could have snacks between meals due to tail feeding. That didn’t work so well with babies/toddlers in the house bc so much unplanned activity (run to get a bottle, run to change a diaper blow out, take a walk to calm them down, get “stuck” in the rocking chair while they’re almost asleep for a nap) with that much bolus in my system would lead to tanks. Now that they’re older, our whole schedule is tighter due to errands, pick ups, activities, etc…so finding the time to properly pre-bolus is challenging…yet getting into somewhat inflexible situations with any extra IOB isn’t working too hot, either. I’m going to have to figure out the best current lifestyle strategy for this point in my life to get to eat and be controlled and meet the demands of everyday. Not sure which strategy is best so far…I was climbing from breakfast just now, but then the mad dash to get thru the rain with kiddos to get inside at swim lessons, hustle through changing for the pool, and sitting in a hot pool area, it’s reversing that trend on it’s own. Every situation is SO freakin’ different.
Give Fiasp a try and see if it works for you?
If your insurance covers Novolog, good chance it covers Fiasp.
I’ve toyed with that idea…
IMHO not much of a downside to giving it a try.
This is why Afrezza has been a lifesaver. Novolog’s 45 min pre-bolus for me is so hard with toddlers. A faster insulin would change your life…
We would love to get on the Afrwzza bandwagon as well. It seems, @T1Allison, that your way of life would greatly benefit from it.
I’m a swag-er. After 40 years, I’ve got a bit of gastroparesis, so digestion for me sometimes takes longer, depending on what I eat. Due to that, I often swag my bolus a little low and keep an eye on my CGM to see if my BG starts to rise post meal, and deal with it then. For me, that’s much easier than eating a meal with a perfect bolus swag, then, 20 minutes after I eat, ending up at 45 and having to eat some glucose to get me back over 80, only to end up over 200 two hours later when my food is finally digesting.
The above situation doesn’t happen remarkably often, but the OP is right, when I’m swag-ing my bolus, my theoretical I:C changes by time of day, amount of exercise if gotten, even if I’ve done a bunch of walking over a few days and my metabolism is higher.
The later. We were very careful to measure everything for about the first year, but now we just make an educated guess and correct as needed. It’s so much less work.
I use the IC ratio as the starting point. My ratios are nicely tuned (for now), and I like to figure out my carbs exactly – it’s one less variable – so when I’m at home I weigh and calculate, and get the pump’s bolus suggestion, and then adjust that based on The Zillion Variables, which is where the “feel” comes in. It generally works out well.
But for me, going exclusively by feel often ends badly. A slice of bread at home can vary in weight by up to 50 g, or 25 g carb, which is significant but also means I can’t simply look at a slice of bread and decide with much accuracy what its carb value is. When I was recently on holiday in a place where they like to eat heavy, dark breads and cakes and cakes made primarily of marzipan and cookies and buns, it was just one big guessing game, and general feel and experience weren’t much help. Luckily some of our hosts had kitchen scales, and on those days my BG results were much better.