By Doris Dickson for Body1
(Continued from Part 1)
So, how can an insulin-dependent diabetic more accurately dose for a well-rounded meal, complete with carbohydrates, protein and fat?
Note: This article is derived from personal experience and research. The techniques are somewhat complicated and may not be suitable for all insulin dependent diabetics. Please consult your medical team as appropriate.
A complete meal consists of not just simple carbohydrates that digest at the rate the rapid-acting insulin manufacturer’s project. It consists of several ounces of protein, a starch, vegetables and likely some amount of fat. Nor is each item in a meal eaten independently. Each item is eaten in conjunction with the others, thus affecting how each item digests in total. In addition, the time of day and the current and post-meal activity levels affect digestion rate and blood sugar.
- Both basal and carb to insulin ratios are accurate.
- Basal rate is not over-estimated to compensate for late digesting food or to extend duration.
- Pre-meal blood sugar is in target range.
Due to the variety of variables involved, there is no exact science to properly time dosing for “complex” meals. Each meal is different from the next. Each day is different from the next. However, through trial and error, there are “tricks” to more successfully balance the timing of insulin and the digestion of food.
Following is an list of some of the techniques to improve dose timing:
- Know the peak of and total duration of the mealtime (bolus) insulin products.
- Know your body. Do you digest food quickly? Do you digest fat and protein more slowly?
- Did you recently or will you exercise shortly after the meal? Will you become a “couch potato” shortly after eating?
- Know the contents of the meal. Individually and combined, does the meal consist of fairly simple, complex, or very complex ingredients?
- Use a scale and/or measuring cups, as appropriate, to achieve an accurate measurement of food quantity. Whether using multiple insulin doses or an insulin pump, precise insulin doses are less than useful if there is no precision in food measurement.
- Write down the amount of carbohydrates and protein (as well as fat if possible) of the planned meal.
- Using the previously established insulin to carb ratio, calculate the amount of rapid and/or intermediate acting insulin necessary for the planned carbohydrates.
- Using the calculation in Dr. Bernstein’s Diabetes Solution, calculate the amount of insulin needed for the protein portion of the meal. Keep in mind, the calculation is based on using Regular insulin and is based on a body weight of 140. Adjust if you exclusively use analog insulin products and for weight.
- Estimate, based on previously asked questions and personal experience, the total amount of time the meal takes to digest (and, therefore affects blood sugar).
- Again, estimate, based on previously asked questions and, personal experience, the total amount of insulin necessary for the meal.
- Now the challenging part – break the insulin into multiple doses that will last the duration of the estimated digestion period.
- The meal requires four total units of Rapid Acting insulin for carbohydrates and three total units of Regular insulin for slower protein.
Note: This example assumes syringe use. However, insulin pump users can accomplish the same tasks using “combo” or “extended” bolus functions.
- Take approximately 50% of the rapid acting insulin prior to or at the start of eating the meal.
- At 30 - 45 minutes after eating, check blood sugar (write down the results). Are the carbohydrates very rapidly digesting? Take the remaining rapid acting insulin or postpone second dose to 60-75 plus minutes based on the blood sugar results and previous experience with that food.
- The goal is to take enough insulin, to keep a blood sugar spike from occurring, but not so much that blood sugar drops before food digests.
- At about 75 minutes to two-hours post-meal, check blood sugar again. At this point, the insulin dose for the protein comes into play. The timing depends as much on digestion rates as to whether using slower Regular insulin or faster Rapid Acting insulin. Timing may also be dependent on which Rapid Acting insulin is used, since their speeds vary greatly. Take the estimated protein dose of insulin.
- Continue to test blood sugar to check on progress. Write down all information for further analysis.
- Analyze the data accumulated.
- What were the results? Was there a post meal blood sugar spike or a post meal blood sugar drop? The next time a similar meal is eaten, adjust the initial insulin dose appropriately.
- Did the insulin doses for the slower digesting foods “work” – was blood sugar in target range at 3, 4, 5 or 6 hours? The next time a similar meal is eaten, adjust the initial insulin dose appropriately.
- Use the techniques for a variety of meal combinations. Take notes to use for future meals. Soon the techniques will become second nature and post-meal blood sugar will much more closely match digestion.
It may take a few attempts to conquer certain food combinations. Indeed, you may decide to avoid certain food combinations because the current insulin products just do not match the food digestion. However, do not give up. As previously stated, due to the variety of “moving targets” involved in every day life, there is no exact or perfect science to insulin dosing. Variations and deviations occur in every aspect of life; diabetes is no exception.