Diabetes Tips

23 July  2020

I know what you’re thinking… “but carb counting is how I dose!”

And yes, carbohydrate counting to help determine your insulin dose is very important and fundamental in blood sugar management, but there are many more factors that should be considered first:

One of the first things you want to consider before any insulin dose is what is my current blood sugar?

If you are using a continuous glucose monitoring system (CGMS) then you can look at your current blood sugar and determine how your sugar is trending – meaning is it increasing or decreasing?

If you’re not using a CGM then go ahead and do a good ole finger stick!

This number will not only affect how much insulin you are giving, but will help determine if you need a pre-bolus for your dose or if you need to wait to inject.

Remember, even if your blood sugar is currently high, you may have active insulin on board (IOB), so you may not need as much insulin as you think.

Always check IOB on your insulin pump or think about the timing of insulin and when your last injection was.

Rapid insulin starts lowering blood sugar levels within 10 min, peaks after 1.5hrs and stops working after 4 hrs. So even though you ate two hours ago, that insulin is still working.

Another huge factor in dosing is activity.

Are you going to be active for the next 15 min – 2 hrs?

Did you just complete a workout and blood sugar levels are dropping steadily?

Remember, even if you are using an insulin pump, many pumps do not know you are being active or will start activity within the next 10 min. so you need to potentially take less insulin or put your pump on a reduced insulin rate for activity.

Even activities such as grocery shopping, vacuuming or walking the dog can lower blood sugars, so always be mindful of activity levels.

Speaking of activity, there may be certain days, time of day or weekends, where you are more active – so talk to your doctor about how to adjust for morning doses versus evening doses or weekday versus weekend doses depending on your schedule!

Composition of a meal is one of the most overlooked components of insulin dosing. The amount of fat, fiber and protein do play a role on how a meal will affect blood sugars. All of these nutrients delay digestion and therefore, slow down blood sugar spikes. When consuming a high fat, high carb meal especially, you may notice a much slower blood sugar rise – often 2 – 4 hrs after a meal. This may lead to using an extended bolus, dual wave bolus or later correction.

A high simple-carbohydrate meal that converts into glucose quickly, such as cereal, may spike blood sugars quicker than your insulin has time to work. Therefore, a pre-bolus may be needed, depending on your current blood sugar level.

Understanding how your body responds to certain foods can provide much insight into how much insulin or when to dose your insulin, so let your CGM or log book be the guide. 

Other factors that may influence insulin doses include hydration level, stress levels, weight changes, menstruation, changes in your schedule, sleep deprivation and other medications, so talking with your healthcare provider can help you obtain more resources, insight or help you with changing your insulin doses as needed.