How much short-acting insulin?

I was just curious as to the most amount of short-acting insulin people have taken for a meal? And if you split your bolus, what’s the most amount of short-acting insulin you’ve taken at one time?

I’ve had T1D for a year now. I’ve taken 12 units for a meal a few times so far (my carb ratio is 9 carbs/unit, w/ adjustments depending, of course), but even 10 units is uncommon, and I’ve only taken 6 units at one time. For some reason taking more than that still scares me, even if that would be the amount needed for whatever amount of carbs are in the meal! haha. Anyway, just curious as to others’ experiences…

@BKN480 fourteen units. Followed by 4 more at 2 hours. General Tso Chicken. It’s like a circus high wire act if you ask me. Typical i:c for me is 1:10. If I am riding my bike it’s more like 1:100. So you can see… it varies. :four_leaf_clover:

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Hi Becky @BKN480 , my off-the-cuf response to your question, is just enough to cover the food I’m eating plus or minus any correction and then substract suspected active insulin from a prior bolus. Okay, that is also a wise-guy response.

Like you, my breakfast ICR is currently 1 unit of insulin for every 9 grams of carb; my usual breakfast is 44 grams of carb so that bolus is almost always 4.9 units or a little less because my morning BG is often close to 100. My evening ICR is 1:18, so when I have a supper of 80 grams of carb my bolus is about 4.5.

My pump has a setting that will not permit a bolus in excess of 7 units; with now four days of parties going on here [the Country, our daughter’s birthday and my birthday] I’ve had to split bolus doses, but the largest was 6 units.

An interesting expansion of your thought might be: “What is your daily Basal to Bolus Ratio?” or, “What percent of your daily insulin dose is Bolus?”. Using 30-day averages, 68% of my daily dose is Food Bolus and, 4.8% of daily dose is correction, including the bolus fixes added by Control IQ.

We’ll put you all to shame. My daughter’s biggest food bolus has probably been 24 units. She’s growing like mad (I:C ratio is 1:5 at the moment), and on a France trip (pre-COVID, of course), she drank something like 4 cups of hot chocolate at the hotel breakfast bar. We did lots of walking, though, so it was all good. :sunglasses:

Oh, and when she’s riding her bike, she turns her basal down to 0, drinks Gatorade throughout, eats a granola bar every hour, and drinks regular soda with her potato chips at lunch (none of which she boluses for — I’m not kidding), and still sometimes goes low. So, yeah. It definitely varies!

My carb ratio is 1:10 so on average my meal bolus is between 4 and 6 units (rounded). There are times I have a high carb/high fat meal - okay, I confess to having the occasional McDonald’s meal complete with fries and soda. I’ve found the true bolus for that (including glucose portion) would be exceed my 10 unit max, and is more than I need. I’ve found even with those, much more that 6 units sends me low. Go figure🤪.

Oh, and we never have split boluses, no matter how large. Our endo said not to, and we didn’t press. Definitely interested in hearing other people’s experiences, though!

I would encourage you to look into split boluses on your own. Your endo seems totally wrong, imo, no offense, I’m being honest in the name of what I think is good T1D management. My endo encouraged it, herself. If you read up on how T1D is managed, the latest info on all the credible sights, split bolusing is commonplace, even for MDI (multiple daily injections, like I do), not just for pump users. If I didn’t do split boluses, I would go hypo in the short-term and way high a few hours later, there’s just no way I could do it and manage my blood sugar well. Best advice I got (which is from the Juicebox podcast, on Arden’s Day blog) is, good insulin dosing is a function of amount PLUS timing. Please be encouraged to learn about and manage T1D in a way that makes you the expert and you in charge. Go to credible, up-to-date sources/web sites. Many endos, sorry to say, have bad advice and a lack of knowledge and understanding about how to deal with this disease (though I’m not discrediting at all your endo in anything else, or in anything else they have said, as obviously I cannot judge that, I’m only responding to your comment). Best, Becky

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Also, I should add that, of course, I don’t know if you have special circumstances or some other reason I’m unaware of (since I’m not a general expert, only getting to be an expert on my own management!) that would require you not to split boluses. So again, I’m just putting my two cents in, which may or may not be valuable to you!

No worries, and thanks for responding. I’m pretty tough to offend. :slightly_smiling_face:

And we’re on board with how important timing is. But that usually takes care of itself: she’s a pretty fast eater. :grinning_face_with_smiling_eyes:

But if there’s going to a lag between dinner and dessert, say, then she’ll bolus for dessert later because those carbs aren’t imminent. Is that what you mean?

This may then be down to different experiences with how bodies work. If I bolus more than ~60% of my insulin pre-meal, I’m almost certainly going to go low later no matter how many carbs and units I’m taking, especially if I’m active later (doing chores, etc.). On top of that, if I take all the insulin up front, as my body is still metabolising carbs later, there won’t be enough insulin left to have enough potency to keep me from going way too high in the long term. It’s just what I’ve learned from experience. It doesn’t matter what or how fast I eat. For example, even if I have a slice of cake (which I do every once in a while, yolo, etc.), and I need 10 units for it, if I take more than 6 or 7 up front, I’m going hypo in the next hour or two, and staying there, until the carbs “catch up” to the insulin. Maybe my digestion process is slower. :slight_smile: (I also pre-bolus, usually for 15 mins., more or less depending on types of carbs/where my blood sugar’s at, so that might be a factor as well. But pre-bolusing like that helps dampen short-term post-meal spikes, as opposed to taking insulin right before eating. But working with a kid, espcially depending on how old they are, I know is different, and different strategies need to be used. The podcast I mentioned is all about that, too, since it’s hosted by a dad of a T1D daughter, just fyi. Anyway, kudos to you!!)

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Definitely sounds like a question of metabolism — and hers is crazy-fast right now.

Honestly, I wish she would prebolus more consistently than she does, because you are 100% about those post-meal spikes, but I’m picking my battles. She even programmed her PDM to remind her 15 minutes before every meal — her idea, not mine! — and she still doesn’t do it. Overall, though, she’s extremely responsible with her management, and I’m trying to have healthy boundaries with my individuating adolescent. :slightly_smiling_face: So I let that one go, and I’m grateful.

I bet if she DID prebolus more consistently, we’d see more of the issue you’re describing. It really is all about matching those curves….

Oh! And I just realized you probably also mean “extended” boluses, as well as “split.” Since she’s on a pump now, we have the option of delivering her boluses at, say, 50% up front and the other 50% over a few hours, which is better for slow-release things like lasagna. I just wasn’t thinking of extended as “split.” But of course on MDI, split is the way to accomplish that. Sorry to be so dense!

Exactly! Anyway no worries - I’m not totally masterful of the terminology, myself…

It sounds like both you and your daughter are doing great in managing, and I agree, helping her achieve independence (in general) is just as important as good T1D management (which it sounds like she’s pretty on top of!). So yeah that’s awesome. I really empathize with having this disease, both as a child and as a parent… (I was just diagnosed a year ago age 32, and especially empathize w/ anyone/any family who has to deal with this in childhood and how much harder it must be (and it’s already super hard)…)

Thanks, and kudos to you on managing as well as you are! Funny, I’ve always thought we were lucky (relatively speaking, you know) that she got it at 6. Old enough to tell us what she’s feeling and start doing a lot of the management for herself, but young enough that she mostly doesn’t know any different, so there’s less of a sense of loss. (But now we really ARE off-topic, so I’ll stop here. Anyone who wants to pursue that thought can start a new thread. :slightly_smiling_face:)

I used to regularly take 20-something units with dinner. Switching to a pump lowered my insulin resistance a bit, so my carb ratio is up to 1:5. I usually aim for about 60g for dinner, so I typically take 12 units now.

As others have said, it’s all very individual. Depends on your metabolism, insulin resistance, and the particular foods you’re eating.