Using Bolus for Diabetes from Insulin to Carbohydrate Ratio and Blood Glucose
I would imagine that most pumpers will be able to relate to what I'm about to confess... Often I'll calculate an insulin bolus on my pump and then override the pump's recommendation and bolus whatever amount feels right. I've had to admit this to my doctor and CDE a few times during the course of this pregnancy. Finally, my CDE asked, "Could you try bolusing based on your insulin to carbohydrate ratio for a full week and see what happens?" Okay, I submitted, I would.
That was several months ago and my adherence to that promise has grown stronger as the weeks pass. The reason for my new trust in my pump and the carefully calibrated insulin to carb ratios? It works!
When I accurately estimate or make a lucky guess on the carbohydrate content of my meal, bolus well in advance of eating, and trust the insulin to carb ratio programmed for that particular time of day, the results are usually great.
For example, I splurged and had a 16 ounce smoothie the other day, which the nutritional information told me, had 67 grams of carbohydrate. It was going to be my dinner and I had a low carb lunch, so I justified the high carb count! My blood sugar was 103 mg/dl before bolusing 10 units to cover the drink. I waited about 20 minutes before ordering the smoothie and then sipped on it for awhile. A little less than an hour after finishing, my blood sugar was 124 mg/dl; an hour later it was 104 mg/dl. Success!
After years of diabetes and insulin boluses, giving myself 10 units all at once feels a little scary. When I'm not pregnant, my normal meal boluses are closer to the 2 to 4 unit range. It's hard to convince myself that I actually need that much insulin and I won't go low from delivering this much insulin all at once. But, the numbers don't lie.
I had a similar experience with having my expectations changed during my first pregnancy. After a lot of experimentation, I realized how early I could bolus for a meal before eating. My blood sugar would be around 90 mg/dl and I'd bolus at least 45 minutes before eating without my blood sugar getting too low. I'd test right before eating and learn, time and again, that my blood sugar had barely started to drop. It was interesting to see the insulin resistance display itself in such a clear, measurable way.
So, pregnant or not, if you find it difficult to trust the insulin to carb ratio that you've set with your healthcare team, try it for a week. Just pay extra attention to calculating the carbohydrates in your meals and then bolus whatever your pump wizard or insulin to carb ratio advises. Then, see what happens. This is obviously a good way to test both your carb counting skills and the accuracy of your ratios.
Or, like me, it might just be a matter of needing to let go and trust the advice you've been given.