Does your blood sugar appear unpredictable at occasions? In case you dwell with insulin-dependent diabetes, it almost definitely does, and typically it may be exhausting to find out what’s happening.
That’s why it’s necessary to discover ways to calculate your insulin on board (IOB) as a result of if you happen to’re not listening to your IOB, your blood sugars will proceed to appear random and unpredictable
Whereas listening to your IOB is not going to remedy all your every day blood sugar woes, it might probably show you how to out immensely. It’s a key element to higher diabetes administration and one thing that’s not introduced up usually or taught sufficient when you find yourself recognized.
Realizing your IOB may also help you efficiently decide issues like if it’s secure to go for a stroll with out your blood sugar going low, or if you happen to ought to inject extra insulin to appropriate a excessive blood sugar, or if you happen to ought to eat a snack earlier than mattress so that you received’t need to get up in the midst of the evening to deal with a low blood sugar.
What’s Insulin On Board
Insulin on board is how a lot lively rapid-acting insulin you might have in your physique. I’ve additionally seen it described as BOB (Bolus On Board), or unused insulin.
Speedy-acting insulin is the kind of insulin individuals residing with insulin-dependent diabetes use once we eat or have to appropriate highs. Frequent model names of lively insulin are: Humalog, Novolog, and Fiasp. It’s additionally the kind of insulin that’s utilized in insulin pumps.
An excessive amount of IOB will result in low blood sugar (hypoglycemia) and too little to excessive blood sugars (hyperglycemia).
IOB is necessary since injected rapid-acting insulin can final within the physique for 3-5 hours. That signifies that you ought to be paying consideration not simply to what number of models of insulin you inject but in addition to how a lot is left of that dose as much as 5 hours after your injection(s).
How lengthy insulin is lively within the physique is a variety (3-5 hours) as a result of all of us metabolize insulin at a barely totally different price. Most insulin pumps shall be set to three hours, and most docs advocate testing one’s blood sugar about 2 hours after a meal bolus, partly to verify IOB and if a ample meal bolus was administered.
In case you use an insulin pump, the pump will inform you your IOB from all boluses.
Nonetheless, it’s value noting that it doesn’t embody the basal (background insulin) which can also be rapid-acting insulin. Overlooking the pump basal insulin when discussing lively insulin is problematic particularly for train, since an excessive amount of IOB, from boluses or pump basal, will make blood sugars drop.
In case you use insulin pens, there are a couple of apps out there that will help you calculate and hold observe of your IOB comparable to RapidCalc (not FDA authorized) or MySugr (EU solely). There may be additionally a smartpen referred to as InPen out there within the U.S.
The way to calculate IOB
In case you don’t have entry to any units or apps that calculate your IOB for you, or if you wish to know your “pump basal IOB”, you may calculate your IOB pretty simply by yourself.
On this video, I’ll stroll you thru examples of the best way to calculate your “pump basal IOB” and your IOB from injections.
I’d advocate going by means of the train of calculating your IOB a couple of occasions and begin listening to how totally different ranges of IOB influence your blood sugar in numerous conditions.
Listed here are two further examples
Basal IOB (pump) Instance
Basal per hour is 1 IU, assuming insulin is lively for 4 hours within the physique:
1 IU x 25% + 1 IU x 50% + 1 IU x 75% + 1 IU x 100% = Whole: 2.5 IOB
Bolus IOB (MDI) Instance
1 IU injected 1 hour in the past and a couple of IU injected 3 hours in the past, assuming insulin is lively for 4 hours within the physique:
2 IU x 25% + 1 IU x 75% = 1.25 IOB
Why you must care about IOB
Realizing your IOB generally is a crucial element to understanding if in case you have an sufficient quantity of insulin on board for a given exercise. It’s the one greatest indicator of how your blood sugar will react throughout totally different occasions and actions.
One of many first issues many individuals are taught after being recognized with diabetes is that stacking insulin is dangerous. Stacking insulin means taking multiple dose of rapid-acting insulin inside the 3-5 hour timeframe whereas it’s lively within the physique.
However what if you happen to didn’t get sufficient insulin in the course of the first dose, do you have to simply wait 3-5 hours whereas your blood sugars are excessive earlier than correcting? Your IOB may also help decide that.
While you calculate your insulin dose the IOB ought to be a element of the calculation. The calculation is that this:
Insulin for the carbs you eat +/- Correction on your present blood sugar – IOB = Dose suggestion
So let’s say I’m not consuming, my blood sugar is 250 mg/dL, my goal blood sugar is 100 mg/dL, my correction issue is 50, and my IOB is 1 IU, this is able to be the calculation:
0 IU for carbs + 3 IU Correction dose ((250-100)/50)) – 1 IOB = 2 IU
Had I not taken IOB into consideration, I’d simply have injected the three IU and almost definitely had gone low.
One other crucial issue is decreasing the chance of low blood sugars. The one motive why we go low is that if we now have an excessive amount of insulin in our methods, an excessive amount of IOB. So listening to our IOB wants for various actions is essential to figuring out if it’s acceptable for what we’re about to do or if we want a small carbohydrate snack first.
When is it necessary to concentrate to IOB?
Whereas you will need to concentrate on IOB all through the day, these are three of crucial occasions to pay particular consideration to it:
While you train
Your insulin sensitivity is heightened throughout and after train, rising the chance of low blood sugar. By listening to your IOB, and the way your blood sugars react once you do several types of train, you’ll be capable of alter your IOB (by adjusting your insulin within the hours earlier than you train) as a way to train with balanced blood sugars.
And in these conditions the place you may’t plan forward, you’ll know if in case you have an excessive amount of IOB and also you’ll want a carbohydrate snack.
Earlier than mattress
Getting an excellent evening’s sleep may be exhausting with diabetes and nobody needs to cope with low blood sugars at evening or waking up with a blood sugar hangover after having excessive blood sugars all evening.
Checking your IOB and blood sugars earlier than mattress may also help you assess if it’s secure to go to mattress, if you happen to want a snack to stop a low blood sugar, or if you happen to ought to take a correction dose for a excessive blood sugar.
Earlier than meals or corrections
IOB ought to be a part of each meal and correction calculation and may make your insulin doses extra exact.
Realizing your IOB permits you to dose when wanted, eat once you really feel prefer it, and it helps to construct confidence within the insulin doses you’re taking.
