Conditions For Testing Dia
2:00am: 9.53:00am: 9.6
BG readings dropped from 10pm to 2am , then did not drop further after that. Therefore, it makes sense to set the DIA setting at 4 hours. If your childs pump allows IOB to be set in half hour increments, you could check BG at half-hour points after the 3-hour mark, to see if your childs individual IOB setting is actually 3.5 hours. In this case, in the context of the above example, if the 1:30am BG reading was 9.5, then the insulin actually stopped lowering BG at 1:30 , so you may choose to set IOB at 3.5 hours, rather than 4 hours. If the 1:30am reading was 10.2, then BG did not stop dropping until 2 am, so you may choose to set DIA/IOB at 4 hours.
Insulin On Board: How Does It Work
Some people can set their insulin on board at 3.5h or 5h, rather than 4h, as we explained in the example above.
If we want to know what works best for us, we should check our blood glucose level every hour right after getting bolus, to know how our blood sugar will react in that situation.
Before the insulin on board was available, many individuals with diabetes would have high blood sugar for one or two hours after eating. They always needed to get a correction bolus to balance their blood sugar levels.
But, the problem with this is that they often didnt account for the insulin on board they already had in the body. In the end, the overcorrecting proved more harmful than useful.
Now, with the help of insulin on board, by adjusting a blood sugar of 250 into the pump, this problem is taken care of. The pump accounts for the insulin on board and suggests a separate correction bolus, which can prove useful for avoiding dangerously low blood sugar levels.
Why Do Clinicians And Patients Use Inappropriately Short Dia Times
Pump users have no intuitive basis on which to select an appropriate DIA. Personal experience often reinforces the belief that insulin works faster than it really does. For example, it seems logical to blame the bolus just given when a low blood glucose occurs an hour or so after a meal, rather than the BOB that was still active from a bolus given a few hours earlier. It is also easy to misinterpret an excessive bolus dose as very fast insulin action.
The most common error in DIA times by patients and clinicians is to select a DIA that is too short. In an online discussion, pump wearers were asked what DIA setting they were using. Nineteen respondents reported a median DIA time of 3 hours and an average time of 3.4 hours, with a range between 2.5 and 5 hours.
A common belief among parents of children with diabetes and the physicians who care for them is that with the small insulin doses used by younger children will have a DIA of approximately 3 hours. However, bolus dose sizes in U/kg body weight are similar between children and adults with type 1 diabetes. PD studies in children aged 3.5 to 6.9 years old show a persistent insulin activity for at least 5 hours following a bolus of a rapid-acting insulin analog, with no significant differences in PD between children and adults.,- Use of an inappropriately short DIA time of 3 hours in a BC makes insulin stacking especially common in children who tend to bolus more frequently.
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Using Iob Around Sports
Most athletes understand that aerobic exercise can lower blood sugar so it is prudent to raise blood sugar higher than normal prior to starting the competition. Some athletes may experience high blood sugar prior to a game from a miscalculated bolus earlier in the day or often due to frayed nerves about the competition. This anxiety can cause the body to release stress hormones which causes the liver to release glucose , raising blood sugar to an unwanted 300 mg/dl. After inputting the 300 mg/dl into the pump set the target for exercise instead of a normal range of say 100 mg/dl. The exercise target blood sugar can be calculated in the pump by having the correction factor to the individual already determined through the setup menu.
Following the example above of a blood glucose reading of 150 mg/dl two hours after eating a pre event meal and just prior to competition the plan may seem to be on target but in reality it may not after checking the insulin on board feature. With increased activity, insulin may get ahead of the food eaten causing blood sugar to plummet. The exercise can increase blood flow and ultimately increase the sensitivity to insulin. Therefore, if there are 4 units of insulin on board it may be a sign to eat some carbs to avoid a low blood sugar. How much depends on many factors but it is recommended that individuals eat 15-30 grams of carbs for every 30-60 minutes of exercise.
Rick Philbin, MBA, M.Ed., ATC
Set Your Carb To Insulin Ratio
The Carb to Insulin Ratio is used by the bolus calculator to calculate the amount of insulin that you need to inject for your meal. Therefore the bolus calculator needs to know the amount of carbs in your meal to provide you with an accurate insulin recommendation.
Set in your ways when it comes to thinking about your insulin at mealtimes? Does, Thats a four unit sandwich, and, Id need at least ten units for that meal, sound familiar?
But we need to do the work from the opposite direction to uncover a piece of the equation.
If youre counting carbs by grams, we need to know how much work a single unit of insulin can do. In other words, how many grams of carbs can you eat for one unit of insulin? If youre counting carbs by exchanges, the mySugr Bolus Calculator will ask you how many units of insulin you take for one exchange.
For example, if you count 15 grams of carbs as one exchange , and would inject one unit of insulin for that, then your carb to insulin ratio is 1.
If you dont know your carbs to insulin ratio, start by talking with your doctor. They can help you find a good starting point, and you can do some testing to fine-tune the settings.
You might have different ratios at different times of the day, which you can set as needed.
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Tips From The Trenches
We have had to learn this lesson over and over and over again!Our son typically has a bedtime snack within 2 hours after supper. When we use the Bolus Calculator for this snack, we see the daunting amount of IOB quoted on the screen and often fear a low. But if we follow the pump recommendations and reduce his snack bolus to take this active insulin into account, quite predictably our sons blood sugar is crazy high a few hours later. We are learning to ignore the IOB for his bedtime snack if that snack falls 2 hours or less after supper, as all that seemingly excess insulin on board is not excess at all its needed to cover the still-digesting food from supper. Therefore, our sons body still needs insulin to cover the carbs in the bedtime snack. ~Michelle
- Calculations of Active Insulin Remaining are influenced by other programmed rates, such as Duration of Insulin Action and the Target BG:
Recap: What You Need To Know About The Fasting Insulin Test
- Blood sugar conditions take years to develop, and most standard tests fail to detect the signs of pre-pre-diabetes.
- The fasting insulin test can help you detect insulin resistance early.
- Optimal insulin levels are below 8.
- You want optimal levels, not just normal or high-normal levels.
- While genetics can play a role, lifestyle changes can often prevent insulin problems.
- Diet, exercise, sleep, and stress management all play key roles in keeping insulin levels balanced.
- Studies have shown that working with a Health Coach like those at Knew significantly helped people manage chronic conditions, like blood sugar issues.
Do you need help with a blood sugar issue? Or do you suspect you may be at risk for developing such a condition? If so, we encourage you to reach out to your healthcare provider.
Visit our Services page to learn more about how Knew Health can empower you to be more proactive with your health. We provide you with the resources you need to reach and maintain your optimal, individual wellness, and we have your back when unexpected accidents and illnesses happen.
Joshua Rosenthal
Knew Health is only available in the US, excluding Vermont , Alaska, Washington. Please contact us with any questions.
Evexia provides comprehensive, cutting-edge lab services at convenient locations nationwide. Knew Health members have access to free and discounted tests, panels, and specialty kits with no prior approval needed.
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What Is Basal Insulin
You may also hear it called background insulin. Thatâs what âbasalâ means. Your pancreas normally makes set amounts of insulin around the clock. Basal insulin mimics that process, and your body absorbs it slowly and uses it throughout the day.
You need less insulin when youâre not eating, but everyone needs a steady flow of it.
If youâve been diagnosed with type 2, your doctor may start you on basal insulin. One shot a day may be enough. If not, your doctor may recommend adding more rapid-acting bolus âmealâ insulin just before or after you eat.
When Is It Important To Pay Attention To Iob
While it is important to focus on IOB throughout the day, these are three of the most important times to pay special attention to it:
When you exercise
Your insulin sensitivity is heightened during and after exercise, increasing the risk of low blood sugar. By paying attention to your IOB, and how your blood sugars react when you do different types of exercise, youll be able to adjust your IOB so that you can exercise with balanced blood sugars.
And in those situations where you cant plan ahead, youll know if you have too much IOB and youll need a carbohydrate snack.
Before bed
Getting a good nights sleep can be hard with diabetes and no one wants to deal with low blood sugars at night or waking up with a blood sugar hangover after having high blood sugars all night.
Checking your IOB and blood sugars before bed can help you assess if its safe to go to bed, if you need a snack to prevent a low blood sugar, or if you should take a correction dose for a high blood sugar.
Before meals or corrections
IOB should be part of every meal and correction calculation and can make your insulin doses more precise.
Knowing your IOB allows you to dose when needed, eat when you feel like it, and it helps to build confidence in the insulin doses you take.
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Things To Note About Active Insulin:
- Active Insulin Remaining does not involve basal insulin it only takes bolus insulin into account. For this reason, Bolus On Board might be a more accurate label for this feature.
- Insulin on Board will only be taken into account if you add your child’s current BG to a Carb Bolus. That is, if you have not checked BG lately, or if you have checked but don’t enter it into the calculation when giving a carb or correction bolus, the remaining active insulin will not be taken into account when the pump calculates a recommended insulin dose.
- IOB recommendations are not very useful in the 90 to 120 minutes post-meal. During this time, the effect of the food is still being worked out, so much of the current remaining insulin will likely be used to cover the still-digesting carbs . Some pumpers choose to disregard IOB during this time, instead covering the intake of any additional carbs with a full carb bolus.
What Does It Mean
Active insulin is a safety factor for pumps or to manually count to prevent low blood sugars. It allows the pump to subtract out “insulin on board” from previous doses.
So, let’s say your blood sugar is 300 and you give a dose. If you check again in an hour and it is 200, and you enter 200 into your pump, it will not give you another correction. It knows that you still have “insulin on board” from the previous dose.
If you bolus for carbs only, then go back an hour or so later with a high blood sugar, a pump will subtract out part of the correction dose for the “active insulin” from the carbs.
The pumps are very smart, so trust the doses recommended. If you are having to override the suggested doses, it means your pump settings are not correct. Talk with your doctor about setting changes. Kids may need frequent changes due to growth and increased insulin needs as they age.
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What Does Very Low Insulin Levels Mean
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Clinic Chat: Active Insulin Time And Target Blood Glucose
Over the past few editions of clinic chat, we have looked at how to test and adjust basal insulin, insulin-to-carbohydrate ratios and insulin sensitivity factors. This month we look at active insulin time and target blood glucose. Like insulin-to-carbohydrate ratios and insulin sensitivity factors, these are programmed into your pump or bolus calculator if you use these devices, and will impact the insulin bolus advice they offer.
Target blood glucose
Insulin pumps and bolus calculators will calculate the amount of insulin you need to bring blood glucose levels back to a certain target after eating or correcting for a high blood glucose level. Your target blood glucose may be a specific number, such as 6mmol/L, or a target range, such as 5.5-6.5mmol/L.
The target set in your insulin pump or bolus calculator is important. You might have different target blood glucose levels for different times of the day. For example, during the day while you can actively monitor and manage your blood glucose levels, you may be happy to aim for 5mmol/L. For night-time corrections, however, some people feel safer aiming for a slightly higher target.
Active insulin time
How does active insulin impact the dose my bolus calculator recommends?
Giving a bolus when blood glucose levels are high
Giving a carbohydrate bolus
Calculating active insulin time
What you need
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Therefore The Pump Settings You Program In For Duration Of Insulin Action And Target Bg Are Critical For The Insulin On Board Function To Work Effectively
We suggest that you review and make any necessary changes to the DIA and BG Target settings in order to get the most out of the BOB feature of your childs insulin pump. For more information on how to individualize these settings for your childs needs, consult your childs diabetes health care team and check out the following WaltzingTheDragon.ca articles:
What Is Insulin On Board
Insulin on board is how much active rapid-acting insulin you have in your body. Ive also seen it described as BOB , or unused insulin.
Rapid-acting insulin is the type of insulin people living with insulin-dependent diabetes use when we eat or need to correct highs. Common brand names of active insulin are: Humalog, Novolog, and Fiasp. Its also the type of insulin that is used in insulin pumps.
Too much IOB will lead to low blood sugar and too little to high blood sugars .
IOB is important since injected rapid-acting insulin can last in the body for 3-5 hours. That means that you should be paying attention not just to how many units of insulin you inject but also to how much is left of that dose up to 5 hours after your injection.
How long insulin is active in the body is a range because we all metabolize insulin at a slightly different rate. Most insulin pumps will be set to 3 hours, and most doctors recommend testing ones blood sugar about 2 hours after a meal bolus, in part to check IOB and if a sufficient meal bolus was administered.
If you use an insulin pump, the pump will tell you your IOB from all boluses.
However, its worth noting that it does not include the basal which is also rapid-acting insulin. Overlooking the pump basal insulin when discussing active insulin is problematic especially for exercise, since too much IOB, from boluses or pump basal, will make blood sugars drop.
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Solution : It Provides Automatic Record
Your doctor wants you to keep a record of all your doses, but who has time for that?
Easy and automatic data tracking really sets S-pens apart from traditional dumb pens or the original vial and syringe method of administering insulin. Compared to the traditional method of keeping paper records, electronic logging allows for easier review and more comprehensive understanding of your blood glucose data.
In fact, Erik T. Verhoef, president of Seagrove Partners, a data-driven research company that recently studied S-pens, thinks this could be the real power of these devices. He told DiabetesMine, The biggest benefit of an S-pen is to replace the manual logbook or lack of data capture that is all too common with MDI patients. This allows the clinician to better follow how the patients therapy is going.
And Verhoef isnt alone. Maggie Pfeiffer of Eli Lilly, which has a connected insulin pen platform in the works, tells us: We believe the community has only scratched the surface of the potential value that can be unlocked as data from the devices are more widely leveraged.
She points out that future systems could not only report on what were doing, but what were not doing. For example, the frequency of missed doses. While that sounds a bit creepy, it can help you and your doctor ferret out problems.