Folks with sort 1 diabetes who prefer to fluctuate their day by day consumption of carbohydrates can use an insulin-to- carbohydrate ratio (ICR). It will make it easier to get the correct quantity of insulin for the carbohydrates you’ll be consuming.
The ICR signifies that you’re taking one unit of basal or rapid-acting insulin for a specific quantity of carbs.
For instance, in case your ICR is 1:12 you would need to take one unit of Apidra, Fiasp, Humalog, or Novorapid for each 12 grams of carbohydrate eaten. If the meal incorporates 36 grams of carb and you’ve got an ICR of 1:12, it might imply you want 3 models of rapid-acting insulin for this specific meal (36 divided by 12 = 3). An individual with an ICR of 1:8 would wish 4.5 models for a similar quantity of carbohydrates.
Your credentialled diabetes educator (CDE) or your endocrinologist might help you resolve on what your ICR ought to be.
Many diabetes healthcare professionals use what is known as the 500-rule to calculate ICR. They take the quantity 500 and divide it by your present whole day by day dosage of insulin.
So first we have to set up what the Complete Each day Dosage (TDD) is. It’s derived by including all basal or long-acting and all bolus or rapid-acting insulin that’s taken in a 24-hour interval.
In case your insulin consumption varies from sooner or later to the following it’s typically really useful to do that for a couple of days and take the common over, for instance, three to 4 days.
To offer an instance, for those who take Levemir, with 12 models within the morning and 14 models at evening and you’re taking 8 models of Novorapid at breakfast, lunch and dinner, your TDD can be: 12+14+8+8+8=50; and 500 divided by 50 is 10.
Which means that in case your ICR is 1:10 you want 1 unit of rapid-acting insulin for each 10g of carbs. This may be written as 1.5 models per 15g serve of carbs.
To test in case your ICR is right it is best to test your BGL two to a few hours after consuming. If the BGL is 1-2 mmol/l increased than it was earlier than the meal your ICR was spot on (and also you estimated the carbs for that meal brilliantly).
In case your after-meal BGL is greater than 3 mmol increased than what it was earlier than the meal, you have to take into account making your carb ratio stronger (by decreasing the quantity) or evaluation your carb counting expertise.
Few individuals use an insulin pen system that may present half models, so generally you’ll have to spherical off the overall quantity of insulin to the closest full unit.
Must you spherical up or down?
This relies on your sensor glucose (SG) or blood glucose degree (BGL) on the time. (In case you are utilizing steady or flash glucose monitoring gadgets it is best to do not forget that for some gadgets a finger prick is required for insulin dosing. Discuss to your CDE for extra particulars).
Typically talking, in case your BGL is excessive on the time it’s often really useful that you simply spherical up. But when your BGL is on the decrease aspect it’s worthwhile rounding down (and hopefully avert a hypo). You also needs to take into account what you’ll be doing throughout the following couple of hours.
If you’re going to be sitting round chances are you’ll need to spherical up, however if you’re planning bodily exercise you’ll do properly to spherical it down.
- Even for those who use an ICR it’s nonetheless necessary to recollect to bolus earlier than the meal. Typically 10-Quarter-hour earlier than you begin consuming is right.
- Many individuals have completely different ICRs for various meals. For instance: you could have an ICR of 1:10 for breakfast, 1:8 for lunch and 1:12 for dinner.
- For the ICR to work precisely, it can be crucial that you simply rely the carbs accurately. The protein and fats content material of meals can even have an effect on BGLs and should must be thought of.
- You might also must bolus for bigger carb snacks.
- Taking insulin earlier than consuming after which not consuming all the deliberate carbohydrate might trigger a hypo when the rapid-acting insulin peaks.
- Taking bolus insulin after consuming will lead to a excessive blood sugar a couple of hours later.
See Diabetes NSW & ACT’s occasions web page for Carb Good, a Nationwide Diabetes Companies Scheme workshop that gives sensible details about carbohydrate selections and their affect on blood glucose ranges.
By Carolien Koreneff
Credentialled Diabetes Educator, Registered Nurse, FADEA
