Forty Days of Diabetes - Day 30

Caitlin's blood sugar is 179, she has 1.75 units of active insulin on board, she ate a protein bar with 25g of carbohydrates 2 hours ago, she's getting ready to eat 1 slice of pizza, a small apple, and 1 cup of milk. Her insulin to carb ration is 1:20 for lunch, her target blood sugar is 120, and her correction factor is 1:75. She's going to run the mile in gym after lunch and is coming down with a virus.

This is a ridiculous amount of information to have to process just to eat lunch. But why is it all important? Because accurate carb counting and insulin dosing are the only way to maintain control of blood sugars.

Every person with T1D works tirelessly with their endocrinologist to come up with a plan that works best for them. We meet with our team every three months to review numbers and tweak what needs to be tweaked. We have target blood sugars for different times of the day, higher during the night to keep her safe wile sleeping. Insulin to carb ratios to mimic the human pancreas; she needs far more insulin for her breakfast than at an other time of the day. And a correction factor which is how many points her blood sugar will drop from 1 unit of insulin, 1:75 for Caitlin.

But why is all the other information important? That  she has insulin on board, had a snack, is going to run, is getting sick? Because it's not just the math. A number of other things must be factored in as well. Active insulin must be subtracted from her correction and lunch bolus to minimize the risk of "stacking insulin" and causing a hypoglycemic event. Has she fully digested her protein bar yet? Protein slows absorption of carbs and can enter the bloodstream up to 3-4 hours after eaten. This in turn can cause a hypoglycemic event, because the insulin acts before the food absorbs, followed by a hyperglycemic event. And strenuous physical activity drops blood sugar while illness raises it. 

The pump does the math, thankfully. Calculates the IOB (insulin on board), I:C (insulin to carb ratio), CF (correction factor) but the rest is up to us. And up to her when we're not with her which is happening more frequently as she gets older. Sometimes we nail it and other times we fail miserably. 

So the next time you belly up to the buffet try eyeballing the foods you're loading up on and carb counting them. Then think about fat, protein, and fiber content and try to guess how long it will take your body to absorb them. Three years ago a buffet would have terrified me. Now? Challenge accepted!