How I Track and Fix My Insulin Dosage For Maximum Time In Range
Why a type-1 diabetic MUST track and log everything
There’s no article that doesn’t mention how important it is to track and log everything for a type-1 diabetic (I am a big fan of journaling). This article is no exception: you must track everything if you live with type-1 diabetes. What you eat, how many carbs, how many fats, when, how much insulin you had to inject, the blood glucose before and after, etc.
This is not an attempt to elevate myself to some sort of “guru” who only tells others what to do as much as a way to remind my own self to stay on the rails and never forget that diabetes is not to be managed randomly. Never.
So, if you experience chronically elevated blood glucose levels, or experience frequent lows (both of which are EXTREMELY EXTREMELY EXTREMELY DANGEROUS FOR YOUR LONGE TERM HEALTH), before you seek explanations outside or put the blame on this or that like I did, simply ask yourself: am I tracking everything I need to track? Am I making informed decisions about my insulin injections? If the answer is “no”, then you know what’s wrong.
The bad news is that now you have no excuse not to put in the work - provided that you care about your health.
The good news is that if you put in the work to track everything, you’re likely to experience a dramatic improvements in your overall health from time in range to energy levels, to insulin sensitivity and all the good stuff.
In this blog I will share the system I use to nail (the vast majority of) my injections, to know at each moment what is my insulin:carb ratio and living pretty much as if diabetes was not there.
Eating whole plant based foods, high in carbohydrates and naturally low in fats (like fruits) helps a ton. But when you have a tracking-and-logging system in place and you make informed decisions, all the hurdles of living with diabetes become a thing of the past. You’ won’t be enslaved by your highs and lows anymore, and you can get on with life and enjoy any activity you want to enjoy.
The digital solution
In a previous post I explained how I automate this entire process. I don’t always have the time the material (pen and journal) to sit down and do the math to get my insulin:carb ratio. Also, sometimes I just have to do plug everything on the fly and a spreadsheet with prefilled calculations definitely speeds things up.
This is how I’ve been tracking stuff every day for the past two year, the spreadsheet has grown into a monster, but I have all my historical data at one glance.
You can download the Seven Questions that have
changed my life and made me a better type-1 diabetic (and person!).
It’s free! 😁
BUT. I noticed that recently this has become a sort of automatic action, a routine I was not paying attention to anymore, or at least not to the same degree I used to. By the time I caught myself simply filling the cells out of duty, I knew I had so find a way to bring that awareness and intentionality back.
Solution: back to pen-and-paper.
The pen-and-paper solution
So here we are, back to the old fashioned method. Let’s go straight in.
Instead of having one row for each day, I keep rows for every new injection and/or meal I have (so I will have multiple rows for one single day). This allows me to have a view that is consequential and establish direct cause-effect relationships between the things I eat and the stuff I do.
The columns are:
Time: the hour of day of the entry
Blood glucose: current BG level
Carbs (g): how many carbs I ate
Fats (g): how many fats I ate
Predicted: my estimated C:I ratio, based on previous meals
Injected: the units I end up injecting
Actual C:I ratio: the actual ratio, based on the blood glucose after the meal
Food/activity: what I ate and other notes, such as any physical activity before or after the meal.
Let’s make an couple examples.
5.30 am and I wake up to a blood glucose of 180. Based on my previous day, my estimated C:I ratio is 20:1 (one unit of insulin takes care of 20 grams of carbs). My goal blood glucose is 100, so I have an excess of 180-100=80 in my bloodstream. To reach the ideal blood glucose of 100, I divide those 80 by 20 (from my estimated ratio), and conclude I need 80/20=4 units of insulin. I don’t eat anything, so I’ll just inject that. Two hours later my BG is 110, so mission accomplished, and I can reuse my C:I ratio of 20:1 for my next meal.
8.00 am, time for breakfast. I am at 115, and I’ll have my usual oatmeal with banana, one apple, chia seeds, blueberries, a piece of dark chocolate and a coffee. This amounts to 145g of carbs and 20g of fats. My estimated ratio is still 20:1, so I divide 145 by 20 and find my bolus units for this meal: 145/20=7.
Two hours later my BG is 156, and has been rising slowing but constantly since breakfast. That is probably the effect of fats, so I take note of that and make my correction: 156-100=56, so I need to take care of 56 excess grams of glucose in my blood to get to the ideal value of 100. 56/20=3, so I need three units of insulin for the job. This means that I must also review my ratio: 7 units were not enough to cover 145g carb, and I had to inject 4 extra units. So my predicted ratio was 20:1 (140:7=20), but my actual ratio is 13:1 (140:11=13, approximately)
Log your food, get grams of carbs and fats, and write them down
An explained example. Seems overwhelming at first, becomes second nature after just a couple of days.
And on and on. You get how it works: each action is informed by the previous one and informs the next one. If you take the time to pay attention to weight your meals and log your food into a food tracking app (like Cronometer) to know how many grams of carbs and fats you’re consuming, then nailing every injection is a simple and quick math trick.
Of course, you have to put in those few seconds to log your stuff and get your pen and paper. Nobody is going to do for you, and if you don’t do that you’re pretty much guaranteed to be enslaved by the highs and lows of an unmanageable type-1 diabetes. If you don’t take care of your health you’re screwed, but you’re the only one to blame really.
If you, as I used to do, just randomly inject random units and cross your fingers that it will be just enough, not too much and not too little, you’ll either see your blood glucose skyrocket or violently drop to the red zone of hypoglycemia. Even more, if you don’t take the time to analyse how the type of food you eat affects your time in range, you’ll never get out of this: 100 grams of oats and 100 grams of some McDonald pizza slice are both carbohydrates, but they have wildly different impact on how your body responds.
You can only get this info by writing it down, reflecting on it, and iterate on the process. Every day.
Recap: the sequence
Get your pen and paper and open your food logging app of choice (Cronometer, My Fitness Pal, Lifesum or others),
If you haven’t yet, weight your foods,
Put the amounts of each food inside the food tracking and pull out the grams of carbohydrates and fats you’re about to eat
On the paper, make an entry and write down
your current blood sugar,
your estimated C:I Ratio,
the grams of carbs and fats you got from the app,
Calculate how much insulin you need by dividing the grams of carbs according to the predicted C:I ratio,
Inject and enjoy your food (if whole food and plant based, it will be make your diabetes management much easier),
Check your BG and make any needed adjustments throughout the day
At the end of the day, sum up the total carbs and the total units of insulin (both rapid and slow acting insulin), and divide TOTAL CARBS/TOTAL INSULIN to get your overall ratio for the day,
Refer to that ratio to guide your next day,
Enjoy your time in range!
Write it down, it will be transformative
Reverting to pen and paper will increase your awareness and force you to slow down and take the time to make more informed decisions. It is almost impossible to not see a positive change in your diabetes management.
At first it might be tedious and boring, but it will soon become an almost entirely automated process: you’ll know what foods to eat, in what quantities, their effects on your blood glucose and consequently how to modify your insulin intake to tame those effects.
More days like this, please!
The steps outline above may seem a lot at first, but after only a couple of days you’ll do that without thinking, and with experience and consistency you’ll be able to skip several steps, such as weighing the food and counting the carbs. The entire thing requires 1 or 2 minutes, 3 if you write slowly.
Standardizing your meals will be a huge help to speed up operations, because you’ll no longer have to figure out how much grams of carbs you’re eating, it’s the same meal you always eat, and its nutritional content is pretty much fixed.
This has been one of the most powerful exercises in 10 years of diabetes management. I’ve been since able to run for hours at once without ever experiencing a low. I’ve been eating tons of my favourite foods while keeping my insulin doses extremely low and achieving higher and higher time in range (i.e.: becoming very insulin sensitive, which is what you should be aiming for). Nothing is casual, everything is intentional, diabetes is not a problem anymore and you’re free to enjoy your life.
