IC ratios

Hi all! I’m sorry I keep posting so much but curious on this. I’ve had diabetes for years but throughout my treatment of it I’ve never had to change things as much as I have this year. I’ve had to redefine both basal and IC due to intentional weight loss.
Question around endo appointment and insulin adjustment: my endo was very firm that with the amount of insulin I’m taking per day my IC should be 1:12 units for all meals. Obviously know I known more about my body then my endo does, but it’s not bad that I seem to need more aggressive ratios?

So for example my current settings are 1:9 for breakfast, 1:8 for lunch(may need to try 1:7 because it’s my carbier meal of the day and I just tend to be higher still a couple hours after eating and sometimes come back without correction but more often than not I don’t) and then 1:10 for dinner. I want to make sure I’m not giving myself too much insulin but based off the fact that I’m not going low I’d assume this is okay?

Also- with basal, how do doctors figure it out? My endo says She’s getting .83 units per hour so we went up to .85 with my pump which some days seems spot on and other days (especially if I’m minimally active the day before) it seems way off. Any suggestions?

When I started on a pump 20+ years ago and my doctor set my initial basal rate/s I asked how he knew what to use. He said he based it on what was average for a woman my age, weight and activity level. If course that was just to start and there was some fine tuning later.
I don’t know how they determine them now but I do periodic basal rate tests - just did one recently as a matter of fact. Aside from fasting there are guidelines to follow. I don’t know if they’re universal so suggest you check with your doctor to see what they have their patients use.
It’s usually recommended that you do segments of the day separately but I like to stay in the morning and see how long I have to go before I have to stop, either due to my numbers or because I’m “hangry.” Doing one segment at a time and making any changes one by one may be more practical. If you do make any changes allow 2-3 days at least to see how they “settle in.” I find very small changes (1/10 of a unit for me) can be all it takes to see improvement, so start small. True confession - the very very very first time I tweaked my basal rate on my own, I did it by a full unit​:flushed::grimacing::cold_sweat:! Let’s just say it didn’t take long for me to figure out my mistake.
PS - don’t apologize for posting. All sorts of things affect our numbers, and congratulations on your success with weight loss. What reason did your doctor give for insisting on a 1:12 ratio? If mine is too high and I’m taking in too much insulin CIQ can only do so much and I find myself needing to snack, which is counterproductive. That’s one thing that keys me know I may need to make some changes.

Taylor @Tee25 , keep asking questions, make observations about how insulin and foods affect your body and, let your doctors know what you learn. There isn’t any textbook [as doctors who teach this stuff in medical schools have told me] that have the story right. As your body ages, and your diabetes “matures”, you may find that you will need to make insulin adjustments more frequently; I’ve made more changes this year than I made in my first 15 years.

As for your I:C ratios, you need to take sufficient insulin with a meal to cover ALL food eaten and bring you back to your pre-meal level within 4 hours of beginning the meal. Naturally, you will make an adjustment in your meal bolus, plus or minus, if your pre-meal BGL was not where it should have been. What you DO NOT WANT TO DO, is to use basal insulin to compensate for incorrect I:C ratio. It is acceptable to use an increased ICR to compensate for regularly occurring events such as dawn phenomenon. Mealtime insulin can also be reduced at meals following certain activities that you know usually cause YOU to go low without insulin.

Another hint when calculating a bolus, don’t look just at your BGL number, but look at where your BGL has been during the past hour - and especially observe arrows that are currently, or recently been, displayed by your CGM.

A constant ICR throughout the day is not common with true TypeOne; it is more prevalent with weight-induced Lifestyle diabetes management. Also with pimp-induced “Double D” where people with TypeOne find taking additional insulin to cover too much food is easy and add weight-induced diabetes to their T1D. Current teaching tells us that total insulin infusion/injection per day should not exceed 0.5 upk [units per kilogram] of body weight. This metric is included on user profile of the Tidepool display. The 0.5 upk rule does not apply in cases of severe insulin resistance which is more commonly associated with T2.

Dorie, it appears that you doctor employed “The Rule of 1,800” which is in common practice when adding insulin management tp people with T2. Some doctors use 1.600 instead of 1,800 on the calculations.

Thanks as always @Dennis!

She said it had something to do with my total daily units. I feel like I did an IC of 12 at all meals I’d definitely be high for hours after breakfast and lunch. I tend to play with mine a bit too depending on what I eat since I know certain things I just need more insulin for (example did 1:8 yesterday for a piece of cake instead of 1:10 and was within range the entire time and ended at 116 versus if I have a low carb meal I know 1:10 will work better for me personally)

It just seems to me that individual diabetes needs are so different and it’s so much more than a basic math problem

That’s good to know! My doctors just seem to think I’m crazy for not wanting constant across the board things. For example, my endo strongly encouraged that I do .85 units of basal across the board. Like clockwork, I spike up between 10pm-3-am but they thought it was weird that I would want to adjust beyond that. But in my opinion that’s the advantage of having a pump versus MDI being able to really fine tune different areas.

Exactly. I’m trying to figure out where your endo is coming from - when I was training for my pump I was taught that the bodies of those without Type1 need varying amounts from time to time and adjust as needed. If that’s the case, why shouldn’t we?

Exactly my thoughts.

Also I’m going to try basal testing on my own! My endo and team say they strongly discourage people from doing the fasting for them, but I personally think it’s pretty beneficial since then you know. I’ve been reading about it in think like a pancreas and totally makes sense to me!

That book is good - and I found it a fun read as well! I’ve occasionally tweaked my basal rates without checking them (going fire the best) but found testing while fasting to be much more effective. At least with a pump that’s kind of the point - to be able to keep your numbers on an even keel - well as close as we can get😊 - so we don’t have to be tied to as rigid a schedule as we may have been on shots.
I’ve actually been surprised how long I could go before needing to stop so the tasting wasn’t as bad as I thought. Remember to check the guidelines to make sure you’re on track and know if you reach the point when you should stop.

As you probably know Taylor @Tee25 , when using a pump [and also MDI], basal rates should be as “good” as possible before bolus ratios can be accurately determined. Your basal should be adjusted to manage your dawn phenomenon.

Before doing the fasting method for validating your basal rates, I suggest that you set a pump Profile/Pattern with “timed periods” every two hours - yes, at the beginning some can be duplicates. Use a utility like Tidepool [sponsored by JDRF, is free and can upload from all pumps, all CGM and about 20 BGM] and observe bow your BGL and basal interact. The daily Tidepool has three graphs together - CGM, Food/Bolus, and Basal - see picture.

What you would want to do, is to notice areas where your BGL does not stat relatively level and then to either increase the basal - beginning with a time about 30 to 60 minutes before - if BGL is too high; or decrease basal where needed. My chart is not my usual - I have a Profile with elevated basal rates and increased ICR currently running to compensate for surgery done a week ago. In the middle graph, the numbers in yellow circles are carbs and, the blue vertical bars is bolus delivered.

Amazing! I’m going to give that a shot. Thanks for the tip!

Just wanted to say I hope all went well with your surgery. Your usual analytical, expository and writing skills are still good as ever so whatever you do, don’t let them mess with your brain😊!
All the best in your recovery my friend.

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LOL dorie @wadawabbit we will wait and see if my brain has been affected. I was “out” for 3+ hours with a general anesthesia, and affected by a “nerve blocker” for 21 to 22 hours. Recovering well.

What helped me get through, I constructed a Surgery Profile and fully tested it a week before surgery date. Then a Post Surgery Profile I’m still using with elevated basal and bolus settings.

Wow! Like Dorie said wishing you a full and speedy recovery. Thanks as always for all the help!

Yes indeed. Take your doctor’s suggestions into consideration, but ultimately trust yourself and your own observations. T1D management is best done by an observant, engaged patient, more so than a doctor. Your quote perfectly encompasses why. It sounds like you’ve found good ratios for e/ time of the day, and if that works better than a one-size-fits all ratio provided by your doctor, it’s probably b/c it really is a better ratio for you.

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