Does your blood sugar appear unpredictable at instances? For those who stay with insulin-dependent diabetes, it more than likely does, and generally it may be laborious to find out what’s occurring.
That’s why it’s essential to discover ways to calculate your insulin on board (IOB) as a result of in the event you’re not listening to your IOB, your blood sugars will proceed to look random and unpredictable
Whereas listening to your IOB is not going to remedy your whole day by day blood sugar woes, it could make it easier to out immensely. It’s a key part to raised diabetes administration and one thing that’s not introduced up typically or taught sufficient when you’re identified.
Understanding your IOB will help you efficiently decide issues like if it’s secure to go for a stroll with out your blood sugar going low, or in the event you ought to inject extra insulin to right a excessive blood sugar, or in the event you ought to eat a snack earlier than mattress so that you received’t need to get up in the midst of the night time to deal with a low blood sugar.
What’s Insulin On Board
Insulin on board is how a lot energetic rapid-acting insulin you may have in your physique. I’ve additionally seen it described as BOB (Bolus On Board), or unused insulin.
Fast-acting insulin is the kind of insulin folks dwelling with insulin-dependent diabetes use once we eat or must right highs. Frequent model names of energetic 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 essential since injected rapid-acting insulin can final within the physique for 3-5 hours. That implies that you have to be paying consideration not simply to what number of items 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 energetic within the physique is a spread (3-5 hours) as a result of all of us metabolize insulin at a barely completely different charge. Most insulin pumps shall be set to three hours, and most medical doctors suggest testing one’s blood sugar about 2 hours after a meal bolus, partly to test IOB and if a enough meal bolus was administered.
For those who use an insulin pump, the pump will let you know your IOB from all boluses.
Nonetheless, it’s value noting that it doesn’t embrace the basal (background insulin) which can also be rapid-acting insulin. Overlooking the pump basal insulin when discussing energetic insulin is problematic particularly for train, since an excessive amount of IOB, from boluses or pump basal, will make blood sugars drop.
For those who use insulin pens, there are a number of apps accessible that can assist you calculate and hold monitor of your IOB equivalent to RapidCalc (not FDA authorised) or MySugr (EU solely). There’s additionally a smartpen referred to as InPen accessible within the U.S.
Tips on how to calculate IOB
For those who 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’ll be able to calculate your IOB pretty simply by yourself.
On this video, I’ll stroll you thru examples of the right way to calculate your “pump basal IOB” and your IOB from injections.
I’d suggest going by means of the train of calculating your IOB a number of instances and begin listening to how completely different ranges of IOB affect your blood sugar in numerous conditions.
Listed below are two further examples
Basal IOB (pump) Instance
Basal per hour is 1 IU, assuming insulin is energetic for 4 hours within the physique:
1 IU x 25% + 1 IU x 50% + 1 IU x 75% + 1 IU x 100% = Complete: 2.5 IOB
Bolus IOB (MDI) Instance
1 IU injected 1 hour in the past and a pair of IU injected 3 hours in the past, assuming insulin is energetic for 4 hours within the physique:
2 IU x 25% + 1 IU x 75% = 1.25 IOB
Why you must care about IOB
Understanding your IOB could be a essential part to understanding when you’ve got an ample quantity of insulin on board for a given exercise. It’s the only finest indicator of how your blood sugar will react throughout completely different instances and actions.
One of many first issues many individuals are taught after being identified with diabetes is that stacking insulin is dangerous. Stacking insulin means taking multiple dose of rapid-acting insulin throughout the 3-5 hour timeframe whereas it’s energetic within the physique.
However what in the event you didn’t get sufficient insulin throughout the first dose, do you have to simply wait 3-5 hours whereas your blood sugars are excessive earlier than correcting? Your IOB will help decide that.
Whenever you calculate your insulin dose the IOB needs to be a part of the calculation. The calculation is that this:
Insulin for the carbs you eat +/- Correction on your present blood sugar – IOB = Dose advice
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 may 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 more than likely had gone low.
One other essential issue is decreasing the danger of low blood sugars. The one cause why we go low is that if we’ve got an excessive amount of insulin in our programs, an excessive amount of IOB. So listening to our IOB wants for various actions is vital to understanding if it’s acceptable for what we’re about to do or if we’d like a small carbohydrate snack first.
When is it essential to concentrate to IOB?
Whereas it is very important deal with IOB all through the day, these are three of a very powerful instances to pay particular consideration to it:
Whenever you train
Your insulin sensitivity is heightened throughout and after train, rising the danger of low blood sugar. By listening to your IOB, and the way your blood sugars react whenever you do various kinds of train, you’ll be capable of modify your IOB (by adjusting your insulin within the hours earlier than you train) so to train with balanced blood sugars.
And in these conditions the place you’ll be able to’t plan forward, you’ll know when you’ve got an excessive amount of IOB and also you’ll want a carbohydrate snack.
Earlier than mattress
Getting a very good night time’s sleep will be laborious with diabetes and nobody desires to take care of low blood sugars at night time or waking up with a blood sugar hangover after having excessive blood sugars all night time.
Checking your IOB and blood sugars earlier than mattress will help you assess if it’s secure to go to mattress, in the event you want a snack to stop a low blood sugar, or in the event you ought to take a correction dose for a excessive blood sugar.
Earlier than meals or corrections
IOB needs to be a part of each meal and correction calculation and might make your insulin doses extra exact.
Understanding your IOB means that you can dose when wanted, eat whenever you really feel prefer it, and it helps to construct confidence within the insulin doses you are taking.
