Does your blood sugar appear unpredictable at occasions? If you happen to stay with insulin-dependent diabetes, it probably does, and generally it may be onerous to find out what’s occurring.
That’s why it’s necessary to learn to calculate your insulin on board (IOB) as a result of in case you’re not taking note of your IOB, your blood sugars will proceed to look random and unpredictable
Whereas taking note of your IOB is not going to resolve all your every day blood sugar woes, it will probably show you how to out immensely. It’s a key part to raised diabetes administration and one thing that’s not introduced up usually or taught sufficient when you find yourself recognized.
Understanding your IOB might help you efficiently decide issues like if it’s protected to go for a stroll with out your blood sugar going low, or in case you ought to inject extra insulin to right a excessive blood sugar, or in case you ought to eat a snack earlier than mattress so that you gained’t need to get up in the midst of the night time to deal with a low blood sugar.
What’s Insulin On Board
Insulin on board is how a lot lively rapid-acting insulin you will have in your physique. I’ve additionally seen it described as BOB (Bolus On Board), or unused insulin.
Fast-acting insulin is the kind of insulin folks dwelling with insulin-dependent diabetes use after we eat or have to right highs. Frequent model names of lively insulin are: Humalog, Novolog, and Fiasp. It’s additionally the kind of insulin that’s utilized in insulin pumps.
An excessive amount of IOB will result in low blood sugar (hypoglycemia) and too little to excessive blood sugars (hyperglycemia).
IOB is necessary since injected rapid-acting insulin can final within the physique for 3-5 hours. That signifies that you have to be paying consideration not simply to what number of items of insulin you inject but additionally to how a lot is left of that dose as much as 5 hours after your injection(s).
How lengthy insulin is lively within the physique is a spread (3-5 hours) as a result of all of us metabolize insulin at a barely totally different price. Most insulin pumps can be set to three hours, and most docs advocate testing one’s blood sugar about 2 hours after a meal bolus, partially to verify IOB and if a enough meal bolus was administered.
If you happen to use an insulin pump, the pump will inform you your IOB from all boluses.
Nevertheless, it’s value noting that it doesn’t embody the basal (background insulin) which can be rapid-acting insulin. Overlooking the pump basal insulin when discussing lively insulin is problematic particularly for train, since an excessive amount of IOB, from boluses or pump basal, will make blood sugars drop.
If you happen to use insulin pens, there are a number of apps obtainable that can assist you calculate and hold monitor of your IOB resembling RapidCalc (not FDA permitted) or MySugr (EU solely). There’s additionally a smartpen known as InPen obtainable within the U.S.
Easy methods to calculate IOB
If you happen to don’t have entry to any gadgets or apps that calculate your IOB for you, or if you wish to know your “pump basal IOB”, you possibly can calculate your IOB pretty simply by yourself.
On this video, I’ll stroll you thru examples of learn how to calculate your “pump basal IOB” and your IOB from injections.
I’d advocate going via the train of calculating your IOB a number of occasions and begin taking note of how totally different ranges of IOB influence your blood sugar in numerous conditions.
Listed here are two extra examples
Basal IOB (pump) Instance
Basal per hour is 1 IU, assuming insulin is lively for 4 hours within the physique:
1 IU x 25% + 1 IU x 50% + 1 IU x 75% + 1 IU x 100% = Whole: 2.5 IOB
Bolus IOB (MDI) Instance
1 IU injected 1 hour in the past and a couple of IU injected 3 hours in the past, assuming insulin is lively for 4 hours within the physique:
2 IU x 25% + 1 IU x 75% = 1.25 IOB
Why you must care about IOB
Understanding your IOB is usually a vital part to understanding if in case you have an sufficient quantity of insulin on board for a given exercise. It’s the only greatest indicator of how your blood sugar will react throughout totally different occasions and actions.
One of many first issues many individuals are taught after being recognized with diabetes is that stacking insulin is unhealthy. Stacking insulin means taking multiple dose of rapid-acting insulin inside the 3-5 hour timeframe whereas it’s lively within the physique.
However what in case you didn’t get sufficient insulin throughout the first dose, do you have to simply wait 3-5 hours whereas your blood sugars are excessive earlier than correcting? Your IOB might help decide that.
While you calculate your insulin dose the IOB ought to be a part of the calculation. The calculation is that this:
Insulin for the carbs you eat +/- Correction on your present blood sugar – IOB = Dose suggestion
So let’s say I’m not consuming, my blood sugar is 250 mg/dL, my goal blood sugar is 100 mg/dL, my correction issue is 50, and my IOB is 1 IU, this may be the calculation:
0 IU for carbs + 3 IU Correction dose ((250-100)/50)) – 1 IOB = 2 IU
Had I not taken IOB into consideration, I’d simply have injected the three IU and probably had gone low.
One other vital issue is decreasing the chance of low blood sugars. The one motive why we go low is that if we now have an excessive amount of insulin in our methods, an excessive amount of IOB. So taking note of our IOB wants for various actions is essential to understanding if it’s acceptable for what we’re about to do or if we’d like a small carbohydrate snack first.
When is it necessary to concentrate to IOB?
Whereas you will need to give attention to IOB all through the day, these are three of crucial occasions to pay particular consideration to it:
While you train
Your insulin sensitivity is heightened throughout and after train, rising the chance of low blood sugar. By taking note of your IOB, and the way your blood sugars react once you do several types of train, you’ll be capable to regulate your IOB (by adjusting your insulin within the hours earlier than you train) in an effort to train with balanced blood sugars.
And in these conditions the place you possibly can’t plan forward, you’ll know if in case you have an excessive amount of IOB and also you’ll want a carbohydrate snack.
Earlier than mattress
Getting an excellent night time’s sleep will be onerous with diabetes and nobody desires to cope with low blood sugars at night time or waking up with a blood sugar hangover after having excessive blood sugars all night time.
Checking your IOB and blood sugars earlier than mattress might help you assess if it’s protected to go to mattress, in case you want a snack to forestall a low blood sugar, or in case you ought to take a correction dose for a excessive blood sugar.
Earlier than meals or corrections
IOB ought to be a part of each meal and correction calculation and might make your insulin doses extra exact.
Understanding your IOB means that you can dose when wanted, eat once you really feel prefer it, and it helps to construct confidence within the insulin doses you are taking.