Type 1 Type 2 on Insulin

Million dollar bolus question

When we start bolus insulin on patients, we have several different approaches.  One textbook which involves formulas and calculations and all complicated like, or another which is just based on gut feeling and what ever you feel like doing.

Well, I do both, the gut feeling first and then move on to the cerebral one.

I tell patients that this insulin is to cover your meals.  If you eat a big meal, you will need a lot of it, maybe 20 units, and if you eat a small meal, then you will need less of it, maybe 5 units.  So, when do you take 10 or 15 or 25 or 5?  That is the million dollar question.

I give them a starting point 5 or 10 depending on the patient, and then given them a max amount, again based on the patient- maybe 15-20 units.  I tell them to play with it for a week or so.  Give more with bigger meals and less with smaller meals.  Just a gun shot approach.  Start with that and we will talk more next time.

The next time they come in, they tell me stories of highs and lows they got and how frustrated they are because they don’t know how much to take.  I let this week go because what I tell them will now make sense.

To answer the million dollar question, you need to first figure out how many carbs you are eating.  The insulin you take is all based on the amount of carbs you eat.  You must learn to count carbs.  Ok, then what.  How does that carb number translate into insulin?

That is where the insulin to carb ratio comes in.

Insulin:carbs  1:10 or 1:5

You take the amount of carbs and divide it by 5 or 10 to give you the amount of insulin to take.

What is my number, 5 or 10?  It all depends.  And get this, it can be different for different meals.  You can have a ratio that is 1:5 for breakfast and the rest of the day is 1:10.  Yes, it gets confusing.

This million dollar answer is very hard and it will take months and months to get good at it.  We are here to walk you through it.

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