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[IP] Re: Insulin to Carb Ratio

Date: Thu, 17 Oct 2002 09:20:38 -0400
>My ratio is 8:1 in the morning and 10:1 in the evening and I'm 
>extremely sensitive to insulin (Novolog).  I average about 12-13 units 
>a day total.  
>However, I also find that certain foods have their own ratio.  For 
>instance, salad or vegetables may require only 12 or 14:1, and my 
>numbers stay relatively flat, but a higher-glycemic index food (like a 
>burrito or pasta) might need 8 or 7:1, and my numbers still spike 
>afterwards.  I'm having a hard time finding the right balance for 
>foods like those - numbers either too high afterwards or too low, so 
>I'm eliminating those things from my diet.  I have my best results 
>when I follow Dr. Bernstein's diet.


A few thoughts.  When you calculate your bolus for salads/vegetables, 
are you remembering to SUBTRACT the fiber from the carbs?  Most of the 
carbs in salad and most vegetables come from fiber, and do NOT affect 
your BGL.  So, that might explain why you are having to use a different 
ratio for those...because you are calculating by INCLUDING fiber, which 
you shouldn't.  For example, a side salad from Wendy's has 7 
carbs...but 3 of the grams of carbs are fiber.  So you should calculate 
your bolus based on 4, not 7.  So, if you usually use 8:1, then 4/8 
= .5 units.  But, if you need to use 14:1 on salads, that 7/14 = .5.  
So, even though you end up with the same number of units, you are 
unnecessarily using a different bolus ratio.  In short, do NOT include 
fiber in your bolus calculations, and you might find that your ratios 
end up being the same.

Second, regarding the spike after certain foods, such as pasta/pizza.  
It turns out that certain foods can trigger a "glucagon" effect.  So, 
in addition to your normal carb requirements, you will need ADDITIONAL 
insulin to cover a production of glucagon as a result of these foods.  
Typically, this insulin would be given in a wave instead of part of 
your bolus, because it is a delayed rise.  Also, the amount of the wave 
will probably be consistant regardless of the amount of food you eat.  
(In other words, that extra wave bolus will be the same whether you eat 
1/2 cup or 3 cups of pasta, although your normal bolus will obviously 
adjust according to your carb intake.)  Personally, I have found that 
when I eat pizza, I need to give 2 units in a 3 1/2 hour wave bolus in 
additional to my meal bolus to counter the glucagon effect.  This 2 
units is consistant no matter how many pieces of pizza I eat.

So, again, you might find that you use the same exact bolus ratio (8:1) 
for pasta, but include an additional square wave bolus to counter the 
delayed glucagon effect.

Do with this information what you will. ;-)

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