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Why did my blood glucose go high yesterday? I didn’t enter the correct carbohydrate count in my insulin pump. Why did I not enter the correct count? I was afraid of going low… Sometimes incorrect counts are the result of poor guesswork, but for me, more times than not, it’s because of fear.
The Insulin to Carb Ratio
A big part of managing diabetes when using an insulin pump is the insulin-to-carb ratio. This ratio determines mealtime insulin dosage (bolus) based on carbohydrate count. Abbreviated as “I:C” this ratio is very individualized. When setting up an insulin pump, this ratio is configured. It can be set differently for different times of the day. Everyone has a different insulin requirement, but what tends to hold true is that the more carbohydrates in the food, the higher the amount of insulin will be required. At mealtime, I just enter the number of carbohydrates into my insulin pump, and the pump calculates the insulin dosage required based on the carbohydrate count.
The Fear of Low Blood Sugar while Exercising
Why did I look at my pump at least 6 times during my hour walk today? I was afraid the exercise would make me go low. Exercise can really make my blood sugar nosedive. To combat this, I try to plan ahead of time for exercise by setting my pump’s “Temp Target” setting, and also eating a small snack beforehand. I generally try to exercise before meals, but if it’s going to be after a meal, I will take less insulin for the meal.
The Fear of Low Blood Sugar at Mealtime
When I am sitting at 96 mg/dL before lunch and that number is slowly dropping, it’s hard for me to get the courage to dose for the full upcoming meal I’m about to eat, because I’m afraid that the insulin will kick in faster than the food will, leaving me low… What I sometimes do is only dose for part of the meal and then dose for the rest when I see that my glucose is rising… This doesn’t always work out well. Sometimes my glucose spikes.
Overcoming my Fears
The truth is that insulin doesn’t kick in immediately and it takes awhile to peak, so most likely it will all work out. But I’m still afraid.
While the rest of the world has been struggling with the fear of COVID-19, I’ve been struggling over the fear of a very powerful necessity called insulin.
I think this fear may be because I’d only had my insulin pump for a short amount of time. I think that with experience, the fear will decrease. I do have my insulin pump set to warn me before low, and often eating just a few candies is enough to prevent the low, so it’s not usually a big deal.
However, I know that things can go wrong, and hypoglycemia is a serious issue that we all need to be prepared for. I ALWAYS carry something with sugar on me, like candy or a juicebox, because life is spontaneous and things can happen to cause blood glucose to drop…. Unexpected things happen all of the time.
Some of my fear is from reading stories online about people who have had urgent lows (hypoglycemia) and how scary that can be. I mean, it is possible to die from it… AND technology is not perfect. AND human bodies are not 100% predictable. So I feel that the fear is warranted. Insulin is powerful. Most medications, if you take a little too much, nothing is going to happen. Not true with insulin.
- Insulin-to-Carb Ratios Made Easy (PDF) by Gary Scheiner MS, CDE
- Hypoglycemia (Low Blood Glucose) – Signs and symptoms. American Diabetes Association.