Differing insulin ratios, is it a real thing?

[himtoo]

A number of people here reporting that they have to increase their I:C ratios for meals with lots of carbs, to me suggests that in a lot of cases the use of different I:C ratios during the day is covering up for just having the basal rates wrong. I'm with @smidge on this. Those of you who use different I:C ratios, are you sure that you have your basal rates flat, and you aren't just compensating for basal fluctuations?

The beauty of an I:C ratio is that it gives you the flexibility to eat as much or as little carbohydrate as you choose while still maintaining good blood sugar control. It is common to require different I:C ratios at different times of day due to changes in hormone levels (which affect insulin sensitivity), physical activity (which enhances insulin sensitivity) and the amount of basal / long-acting insulin overlapping with the mealtime insulin.

It is best to confirm your basal insulin levels before attempting to fine-tune your mealtime I:C ratios.

Because strange things can happen on any given day, I like to consider 10-14 days of data when coming to a decision regarding the I:C ratio. Allow the carb content of your meals to vary somewhat, and continue to adjust your insulin doses based on your pre-meal blood glucose levels during your evaluation phase. Then go back and assess: Which I:C ratios tend to result in a blood sugar rise from one meal to the next? Which ratios result in a drop? And which ones tend to hold your blood sugar steady? Steady is what you’re looking for when choosing a ratio.

Fine-tuning your I:C formulas can be a challenging proposition, even for the most highly trained and experienced person with diabetes. The more detailed you keep your records, the better. You might discover certain factors that have a subtle influence on your blood sugar levels: days of the week, work/school schedules, time of the month, physical/recreational activities, changes in pump infusion sets or insulin vials/cartridges, injection/infusion sites, dining in vs. out, medication schedules, and even social engagements.

 

[Spiker]

It is best to confirm your basal insulin levels before attempting to fine-tune your mealtime I:C ratios.

I completely agree (and the rest of your advice is excellent too). But I wonder if some people are glossing over checking their basal rate properly, before they go looking for the right I:C ratio(s). After all it is a hassle to get basal rates right. It takes time, patience, and some kind of fasting.

 

[noblehead]

I completely agree (and the rest of your advice is excellent too). But I wonder if some people are glossing over checking their basal rate properly, before they go looking for the right I:C ratio(s). After all it is a hassle to get basal rates right. It takes time, patience, and some kind of fasting.

Absolutely, it can never be said how important it is to get the basal dose right.

Nice to see you back Spiker, how have you been keeping, did you get the issues with your pump resolved?

 

[Spiker]

Nice to see you back Spiker, how have you been keeping, did you get the issues with your pump resolved?

Thanks, it's nice to be back. I've been ok, thanks. I've had generally high BG recently but it comes down to the Christmas season and my lack of discipline to resist it. Unfortunately Father Christmas did not bring me a pack of CGM sensors. These have a massive effect on my BG control. Which sort of proves how undisciplined I can be. :-/

 

[mrman]

for me, yes my basal profile is as flat as it could be , and tested regularly or when I start seeing different numbers to the usual. Agree very important to test basal but would like to add that at different times of the year when basal rates do change, my bolus ratio also changes, but stays consistent in the fact I need more am, less in the afternoon and in-between evening. To me makes sense when you know you have to adjust for activity, and after sleeping all night would need more bolus am than in the afternoon when you have eaten breakfast and kick started your metabolism. Interestingly, if I do miss breakfast, I need to revert back to my am bolus ratio in the afternoon.

 

[Emmotha]

I need to basal test again as I think my honeymoon is over :'(

 

[noblehead]

for me, yes my basal profile is as flat as it could be , and tested regularly or when I start seeing different numbers to the usual. Agree very important to test basal but would like to add that at different times of the year when basal rates do change, my bolus ratio also changes, but stays consistent in the fact I need more am, less in the afternoon and in-between evening. To me makes sense when you know you have to adjust for activity, and after sleeping all night would need more bolus am than in the afternoon when you have eaten breakfast and kick started your metabolism. Interestingly, if I do miss breakfast, I need to revert back to my am bolus ratio in the afternoon.

Nice to see you back too Brett, not seen you on the forum for a while