It seems like a lot of people employ low carb diets or eat routinely under the same threshold of carbs each meal for tight control. I can certainly see the merits of each approach and there could be a lot of reasons for each. But that also makes it seem like I:C ratios aren’t really employed in those scenarios. Eating the same amount of carbs each meal would seem to indicate that the I:C ratio is not scaleable…which would mean it’s not a ratio at all. And I’m talking about it outside of the obvious point that there are a ton of variables that influence how much insulin you need under different circumstances.
I, personally, have my own current comfort zones for how much insulin I feel comfortable doing a full pre-bolus with. I used to be comfortable taking 11+ units at a full pre-bolus. But that was also when I was in complete control of my schedule and my amount of physical activity. I am in full control of neither of those things in this phase of my life. These days, I feel comfortable doing a full length pre-bolus with 7 units because I feel like if it starts to gain momentum sooner than expected, I can catch it pretty easily. So in that sense, I could see sticking to a carb limit per meal that jives with 7 units just for that comfort level. But it does make it seem like it’s more of a “how much insulin do I want in my system?” vs. a “how much insulin do I need for this meal right now?” strategy. Tail’s kind of wagging the dog for me right now.
The other thing, which I’ve mentioned elsewhere, is that I really think it would be nearly impossible for me to come up with any foolproof equation for handling breakfast. Today was a total disaster…and I did the same strategy as yesterday which was not a total disaster. But either way, I never even used to eat breakfast before I was diabetic. And then people told me I should. So I did. And then they told me I needed to eat more at breakfast to get more calories, so I did. But I gotta say, carbs plus “feet on the floor” phenomenon equal a total trainwreck going into lunch…which means too much IOB from corrections that may or may not take root, which means nerves about fully pre-bolusing for lunch. I gotta get mornings under control or else the rest of my days are going to continue to be shot.
People have said better and mo smarter things in here about their ratios, but I’ll tell you about my recent change… changes. There have been a lot.
I’ve had all of my ratios for a very long time, but I didn’t have much of a reason to think about them as I was just pushing buttons on my pump. With the Bolus Wizard, there was no reason to think about anything more than how many carbs I was gathering as the meal went on… and I could just feed the pump the number and let it do the math.
Then I went to MDI… and had to start with 1 unit pens. Even though I had just been pushing buttons for many years, I still was accustomed to being able to give myself very small fractions of a unit, so when I got ready for my first one unit bolus, I got scared. I was afraid I was really going to need only .4 of it… or .6. My decision boiled down to whether I was going to give myself too much or too little insulin. Even though I was still half-thinking my carb ratios from my pump (which ranged from 1:7 to 1:10), I started finding myself rounding up and down everything. 25 grams of carbs at 6:00 in the evening, which technically should’ve been 3.6 units of insulin became TWO UNITS… if I were active or already dropping or heading out to the store and THREE UNITS if I were pretty stable and in no danger of a rise… and FOUR (OR SIX) if I sensed a celebration of food might be following the first serving.
I know I’m saying a whole lot of nothing, but I’m trying to say that my ratios disappeared. There was still a shadow of them for a ballpark, but it was just a shadow. I have learned, and am continuing to learn, how to use it all in deciding a bolus— and not really worrying too much about calculations at all but being willing to remedy, if need be, an overshoot or undershoot once there have been new developments in my blood sugar. It’s maddening somedays… I love all of these numbers and have surrounded myself with them… but my best days are when I’m working above them.
It hasn’t hurt me to spend as much time as I have with the numbers. They’ve given a lot of very ambiguous events meaning, but I’m learning how to lean less on them. If that makes sense.
This may be true, but it’s not me. I don’t eat low carb, and my meals are anywhere from 10-100ish carbs. Generally the really high carb meals are special occasions or rough days when it’s pizza or chicken nuggets and fries for dinner or something. It does help that I have a pretty small need for insulin compared to most - the max I’ve done at one time recently is 5 units, and that was for an entire small pizza (no regrets, and I did dose additional insulin later, too, for the 2nd rise).
Is it possible to, instead of just eating more, eat more calorie dense foods? I’ve been thinking about my caloric intake recently (pretty sure it needs to go down, but I’m ignoring that for the moment), and so I’m not sure how many calories I normally eat for breakfast, but…it’s probably a decent amount. I usually make almond flour muffins, scones, pancakes, etc and eat off of that for a few days. It takes the carb count down a lot (and the higher fat content for me helps flatten the rise a bit). Breakfast is actually the one meal I’m conpletely content with, BG wise, and I’m most insulin resistant in the AM.
IMHO the I:C ratio is scaleable but at least for us it is not linear. Different but similar in a fashion to the Insulin Sensitivity is scaleable but not linear.
We are carb counters. We also use the on-board bolus calculator. We also guess the insulin by eye-balling the food and mentally factoring in everything without doing actual calculations. Based on all of the above, we decide what to dose. My preference is for this to be a very quick process that is close. I do not believe it can be exact so am not going to try that which I fundamentally do not believe is possible.
EDIT: In terms of measuring, some items are measured and some are not.
For example this morning for breakfast, cold cereal. The cereal is weighed out. Very quick - does not practically add time or slow things up. To me, this makes sense. The amount of cereal is actually hard to eyeball and because it is relatively high carb for the volume and weight, it is easy to misjudge. Pasta is measured out. Pizza and bread have defined slices. But other sorts of servings of food may be eyeballed and guesstimated. So it really is a mix.
I strive for a balance between optimal care and optimal life.
It is not easy and my personal may tend towards to obsessive so I consciously try to be aware and not go overboard. I have a firm believe that balance is appropriate even if it is not the most natural thing for me nor the easiest approach.
Woke up. Took 3 units. Eventually had 3 cups of coffee bc I could. And my blood sugar is beautiful.
My mornings are too hectic and too resistant to be able to carefully prebolus AND eat at some point 45-75 minutes later. I just have to take too much insulin to be comfortable waiting that long to eat in the AM. Smaller amount of insulin in my system gives me much better peace of mind for this highly variable segment of my day. I’ll make up for it with an early lunch and big afternoon snack.
Update: And I got to eat two hours after the bolus to fend off a slow low. Almost equaled the calories I would have normally eaten with half the insulin and none of the stress.
I was thinking about you this morning. My mornings are pure chaos. I give myself about 13 minutes after my alarm goes off to coordinate myself enough to begin. Coffee helps, and I despise having to wait for it in the morning. I used to base my first bolus off of how low I was upon heading downstairs, but I don’t do that any more. I know my coffee’s going to give me a bump, and if I throw a bunch of insulin in front of it, I don’t have to rise, sometimes, at all. On the other end, especially with that high variability and fast pace, I have to watch the crash because it’s coming if I’m not careful. But if I play my cards right, and that’s a very reasonable expectation, I get my coffee, a banana, my eggs… I feel normal. This morning I had 3 pancakes with sugar free syrup. I could’ve lived without them, but the starts aligned, and now they’re in my belly.
I don’t want to sound like I’m pitching keep it simple, stupid advice because it’s… not that simple. I just want you to know I feel your pain with the morning routine. Maybe the addition of kids is what makes it all the more difficult to get a handle on. What I am saying is that I have found something that is working for the moment, but it took abandonment of my old thinking.
Which now sounds like I’m nailing you on old thinking… can’t win for losing.
In my case, it’s probably going to be doing what I always did that saves me. I’m convinced that five years of trying what other people do has put me in a mess on this one!
Funny thing is, for me, what I ended up doing strategy-wise for mornings (which I decided on back before CGM, but CGM then reinforced my choice about it since it worked), Diabetes Experts thought was too strict. Anyone who found out my approach was like, “You shouldn’t have to do that. I couldn’t live like that.” So then I thought I was being too zealous on my own care.
Turns out…it’s probably the only thing that works consistently for me. And then it gives me a stable platform going into lunch without a ton of potential energy in my system that May or May Not materialize.
So…maybe I shouldn’t have to “live this way”. But I am diabetic. My mornings are highly variable. I don’t like eating in the mornings, anyway. And I happen to be posting my best morning numbers in a long, long, long time.
I understand what you’re saying… obviously. I’ve made the exact same arguments on many an occasion. I’m not sure to whom I’ve made them or why, but I have said those very words because they were 100% true. What’s interesting is that it’s taken hearing them from you to remind me of how true they were. I’m somewhere off in another diabetes pasture right now, and I’m seeing different things, but even so, it doesn’t nullify your truth. In fact, I think it’s incredibly human, and not just a diabetes-related need, to need to reset and find something that you can grasp. It’s all coming back to me now… Yes, that’s right… I’ve done it one million times for one million reasons and have had, to be fair, a half million successes. Sure, it’s not the ideal thing to have to live a burdensome routine, but not all routine is burdensome. At this point, casual decisions might prove more troublesome so why not do what is familiar and what you know will work? The kids these days scare me to no end with some of their ideas, but I think they’ve got one right… you do you. I think you’ve gotta go with that for right now and not worry about the experts. Worry about how to navigate your mornings so you’re coming out on top.
Power to the people, @T1Allison. I’m going to go ride out this buzz over at the coffee pot.
I’m with @Nickyghaleb on this one - who cares what others say about how you choose to manage your d. It’s YOUR body, and you know its responses to various things better than anyone else. Other people’s opinions (even the experts) are just helpful information and knowledge to examine and pull from that what works for you.
And I’ve seen about people wanting to get half unit pens…and I wish that mattered in my world. But a half unit of either Novolog or Humalog just doesn’t do anything in my system. My dosing is deciding between 6, or 7, or 8 or 9 units…a half unit has just never mattered. And I add a lot of walking after meals to get it to work.
I came to the same conclusion, with the help of CGMS. If I didn’t have dexcom, I would probably go back to more accurate counting and dosing, and likely higher A1C.
I used to carb count meticulously (weigh/measure everything), but stopped doing that when I began eating low-carb and carbs didn’t matter so much… However, as I got farther along in that way of eating I learned that I’d have to start weighing/measuring protein if I wanted to shoot for a sub-6% A1c, which I was never able to hit, but that partly defeated the purpose of being easier for me. Shortly after that point I started eating carbs again, but didn’t start detailed carb counting, though I do weigh and measure some things… I don’t even use the calculation functions on my pump, just a manual bolus. However, I do think my control would be better if I counted carbs a little better (because of my vision I do have a hard time just “eyeballing” things). So I might start back with that at some point.
Generally the really high carb meals are special occasions or rough days when it’s pizza or chicken nuggets and fries for dinner or something. It does help that I have a pretty small need for insulin compared to most - the max I’ve done at one time recently is 5 units, and that was for an entire small pizza (no regrets, and I did dose additional insulin later, too, for the 2nd rise).
