Folks with kind 1 diabetes who wish to differ their every day consumption of carbohydrates can use an insulin-to- carbohydrate ratio (ICR). This may assist you to get the correct amount of insulin for the carbohydrates you’ll be consuming.
The ICR implies 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 comprises 36 grams of carb and you’ve got an ICR of 1:12, it could imply you want 3 items of rapid-acting insulin for this explicit meal (36 divided by 12 = 3). An individual with an ICR of 1:8 would wish 4.5 items for a similar quantity of carbohydrates.
Your credentialled diabetes educator (CDE) or your endocrinologist may help you determine 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 complete every day dosage of insulin.
So first we have to set up what the Complete Day by 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 someday to the subsequent 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 provide an instance, should you take Levemir, with 12 items within the morning and 14 items at night time and you’re taking 8 items of Novorapid at breakfast, lunch and dinner, your TDD will likely be: 12+14+8+8+8=50; and 500 divided by 50 is 10.
Which means 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 items per 15g serve of carbs.
To test in case your ICR is right it is best to test your BGL two to 3 hours after consuming. If the BGL is 1-2 mmol/l greater 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 greater than what it was earlier than the meal, you must contemplate making your carb ratio stronger (by decreasing the quantity) or overview your carb counting abilities.
Few folks use an insulin pen machine that may present half items, so usually you’ll have to spherical off the entire quantity of insulin to the closest full unit.
Do you have to spherical up or down?
This relies on your sensor glucose (SG) or blood glucose stage (BGL) on the time. (In case you are utilizing steady or flash glucose monitoring units it is best to do not forget that for some units 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 normally really useful that you just 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 contemplate what you’ll be doing throughout the following couple of hours.
If you’re going to be sitting round chances are you’ll wish to spherical up, however in case you are planning bodily exercise you’ll do effectively to spherical it down.
- Even should you use an ICR it’s nonetheless vital to recollect to bolus earlier than the meal. Generally 10-Quarter-hour earlier than you begin consuming is good.
- 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’s important that you just depend the carbs accurately. The protein and fats content material of meals may also have an effect on BGLs and should have to be thought of.
- You might also have to bolus for bigger carb snacks.
- Taking insulin earlier than consuming after which not consuming the entire deliberate carbohydrate could 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 Sensible, a Nationwide Diabetes Companies Scheme workshop that gives sensible details about carbohydrate selections and their impression on blood glucose ranges.
By Carolien Koreneff
Credentialled Diabetes Educator, Registered Nurse, FADEA