Scott Benner 1/5/23 Scott Benner 1/5/23

#822 The Math Behind Setting Insulin Sensitivity Factor

Scott and Jenny break down the math behind setting your insulin sensitivity factor. I really wanted to call this the GOZINTAs of ISF.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

00:02:36 Understanding insulin sensitivity factor.
00:10:43 Adjust insulin sensitivity for accuracy.
00:12:15 Managing diabetes requires adjusting for variables.
00:20:42 Adjust insulin needs as life changes.
00:26:01 Importance of insulin sensitivity factor.
00:28:31 Empowering, informative podcast for diabetics.

Scott Benner 0:00
Hello friends, and welcome to episode 822 of the Juicebox Podcast

Hey everybody, today's episode is Jenny and I helping you figure out your insulin sensitivity factor. There's a little bit of math involved. Don't worry, it's not really like super confusing or anything. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you like Jenny and you want to hire her, you can she works at integrated diabetes.com. Are you a US resident who has type one or is the caregiver of someone with type one? Oh, if you are, this is great news, because you can go to T one D exchange.org. Forward slash juice box and fill out the survey. Every completed survey benefits the podcast and type one diabetes research T one D exchange.org Ford slash juice box. At the end of this episode, I'll tell you about more Juicebox Podcast episodes and series that will help you with insulin sensitivity factor. So hang out to the end

this episode of The Juicebox Podcast is sponsored by touched by type one now you can find touch by type one. Now you can find touch by type one at their website touched by type one.org. You can find them on their Instagram page. And on Facebook. Touched by type one has great programs like their annual conference which I speak at sometimes their awareness campaign Bowling for a cause they're dancing program called dancing for diabetes, the D box they have a golf outing touched by type one is helping people living with type one diabetes. And they'd like you to just to check them out touch by type one that work. That's it for the ads today. So I just wanted to tell you that if you're enjoying the Juicebox Podcast are finding it helpful. The best way you can support the show besides clicking on the sponsor links, or typing them into a browser would be to share the show with someone else. A doctor, a friend, a stranger, somebody who you think may enjoy or benefit from the Juicebox Podcast. Hey, Jenny. Hey, Scott. We're going to talk about setting up insulin sensitivity and getting your numbers right where you start and and how you can figure out where to go from there. Fantastic. How do we set up insulin sensitivity?

Jennifer Smith, CDE 2:51
Yeah, and I like that you call it insulin sensitivity factor or what you might see written down as I S F insulin sensitivity factor. It's also called correction factor. So if you've heard any of those words, it's all representative of the same thing. This idea

Scott Benner 3:11
correction factor, insulin sensitivity and insulin sensitivity factors seem to be the three ones that get used most in the zeitgeist they all mean the same exact thing.

Jennifer Smith, CDE 3:21
Yes. And from an abbreviation most often you'll see I SF I igloos s Sam F. Frank, there you go.

Scott Benner 3:30
I think that you weren't being clear with your enunciation.

Jennifer Smith, CDE 3:33
I thought that Yes.

Scott Benner 3:38
I think more likely, you're just trying to cover for my bed.

Jennifer Smith, CDE 3:42
No, not at all. Not at all. i It's funny, because I say that mainly because just as a side note, I hear I get so many like codes for seeing people's data and whatnot. And if we're talking, I always make sure that I've heard them correctly so that I can input it the right way. Otherwise, the program's like, no, that's not right. And then, you know, so anyway,

Scott Benner 4:06
I just thought I had a weird accent. You're like, there's no way people understood what he just said.

Jennifer Smith, CDE 4:10
If anybody has the weird accent, it's me. So I think

Scott Benner 4:13
of it as insulin sensitivity, I have to admit, when Arden was first diagnosed, I thought of it I guess with the old terminology, older terminology, and then going to a pump brought me to insulin sensitivity factor. And then I think going into looping made me say just insulin sensitivity. And it's not it's more about how I think about it than it is about what you're calling it. If that makes sense. So correct. And

Jennifer Smith, CDE 4:38
that's that's kind of why I like I like I like both terms. Sensitivity, I think gives you more visual to response, right? How you're going to respond to insulin to take your blood sugar to the place you want to get it to. But now Don't get too low, right? correction factor I like because it really, it implies why you're taking that insulin, you're correcting the number that you don't want to be sitting at back to the place that you want it. So I think they're both relative, obviously.

Scott Benner 5:18
But there is no, I don't want to get bogged down in this, but there is value in the words you use, and how they make pictures in your mind. And for me, calling it insulin sensitivity. It just makes the most sense to me. So okay, so what is the insulin sensitivity?

Jennifer Smith, CDE 5:38
Yes, so insulin sensitivity is how many milligrams per deciliter or millimoles, your blood sugar will get dropped by one unit of insulin. Okay, so if your ISF is 51 unit of insulin should bring your blood sugar down 50 milligrams per deciliter, right? Or I say 50 points just to make it easy. From where you're starting? And is it instantaneous? No, it's not, that we've talked about is this, it's rapid insulin, but rapids a bad name, it's going to take some time for that to happen. So you're gonna have to give the correction a little bit of time to get working, see its action. And to fully evaluate, does it bring you back close enough to the target that you're aiming for? within a defined period of time, which may be the active time of rapid insulin,

Scott Benner 6:39
right? Is there an when you're figuring this out? What's that length of time that you consider? Like how long because I can remember, I'm just going to keep using this as an example because I used it in other episodes, but are done with the school. And her sensitivities changed at school, and we had to, we had to change them. So that I just went back to basics, I did what we talked about in the basil episode I got, I made sure I got her basil about where I thought it was gonna be, I set up her carb ratio about where I thought it was gonna be. And then I had to get her insulin sensitivity, right. And basically, what I did was I put her she was sitting very stable, like a, I forget where it was, she was sitting very stable, like 180, while we were figuring this out, and I just gave her a unit of insulin. And I said, Let's not do anything. And we'll wait a couple of hours and see where you end up. And then I that's where I started building from that and the math.

Jennifer Smith, CDE 7:37
Right? And from a fairness standpoint, for any of those people who are using algorithm driven pumps to really analyze correction factor on its own, you have to turn the algorithm off. And I did you write it? I know you did. But just from a, from a reference point, because otherwise you don't, you don't want something else helping you along the way. You just want a point of this as the insulin, everything else was left turned on, Basil was working like it should have. This is where it ended up getting me right. And it you know, an asking of time, not only in that example, were you looking at does the rate show that I used work? Did it get her to the point of where I wanted, you could also have kept it you could have kept it going for a little bit longer to see the point of stabilization, like where did it land at the target? How many hours after the correction was that? Yeah, that gives you a little bit more visual of, of your insulin on board time or your active insulin or duration of insulin action, right? Let's say by three and a half hours after that Bolus, she landed nicely where you wanted. And then she was like, Well, I'm just going to sit on the couch and watch a movie. I'm not eating anything. There was, you know, again, you left your algorithm off. If it settled there, lovely. One, your basil is right. But to the Bolus action time was more defined, you could see where it hit and stabilized. That should be about your active insulin type. Yeah.

Scott Benner 9:16
Yeah. And that's not easy to come up with either No, and especially because those are dummy settings in normal pumps. And in and if you're using an algorithm at this point, now, if you're using the loop, okay, you can figure it out that way. I don't know enough about how control IQ works. And Omnipod five is, you know, kind of does its own thing. So that's even hard to know. It's proprietary.

Enough. There you go. But for me, I Arden was looping at that moment, when we did that I shut the loop off. And I just ran it like a regular pump. I was confident in the base that we had set up. And so I think in the end that one unit moved or Like 45 points. And that's and now Arden's insulin sensitivity is set up somewhere between 41 and 45, depending on the time of day. And that gives the algorithm, the wiggle room, the wiggle room, it needs to do what it needs to do. Like, if I made Arden's insulin sensitivity, one to 40. And she was on a regular pump. And it was just like that constantly. That would be too aggressive. Sure, yeah. So she'd get low at night, if I did that. Right. Anyway. Okay, so what's the math on this one?

Jennifer Smith, CDE 10:36
So what's the math on this? This is where there's another rule that comes into play. Many people start by just saying it's the 1800 rule, right? So you're essentially going to take, again, what is your total daily dose, and you're going to divide that into 1800? To get a starting point for your correction or your sensitivity factor? So if we take 30 units of total daily insulin, and we divide that into 1800, what are you going to get?

Scott Benner 11:07
I'm doing it right now. Oh, really? 8,000,400? And? I have a 6060.

Jennifer Smith, CDE 11:18
Correct? Absolutely. That's easy math, right. 30 into? Yes. So you're gonna start with a 60. And let's say you're, you've looked enough at having corrected insulin, or corrected blood sugars, and you're like, but my factor is already at 55. And my corrections don't work, or my corrections at night, work really awesome at 55. But during the daytime, I'm getting low with this 55. So maybe 60 In the daytime is more what you need more what the math tells you. And maybe at night, you just need it to be more aggressive, the lower the correction factor value or sensitivity factor value, the more insulin you're going to get,

Scott Benner 12:01
right? Also, it's super important to say that if your blood sugar's 130, and you wished it was 90, and you've got your sensitivity factor set up, it was you know, one unit moves me 60 And you and your pumps target is at 90, you're 16 you're like, hey, Bolus, it's gonna take a fraction of that amount of insulin to get you to 90 Correct. But if your blood sugar's 250, and you want to be 90, that factor might not work. Because you're a good point, right? Because there's a lot of other variables that we're not thinking about. And they could be anything from undigested food to a bad, a miscalculated meal Bolus that you're still dealing with, you could have ketones, which would come into a point, you might be dehydrated, there are so many things. So so you're getting these settings set up in. I don't want to say perfect, but near perfect conditions. They work in my perfect conditions. But now when I'm out in the world fighting with it, it's almost like learning jujitsu, I imagine probably you're on them on the mat, it probably works because the other guy across from us doing the same thing. But when you get into a street fight, and you're Indiana Jones, and you know, and you start going, I'm going to do jujitsu, and then Indiana Jones pulls out a gun and shoots you. And then you go, Oh, well that he just didn't help as much. So, like So given the fact that I'm now imagining that a lot of these people have never seen Indiana Jones.

Jennifer Smith, CDE 13:24
But when so sad, go watch it. Yeah, exactly.

Scott Benner 13:28
But but the point is, is that you get these things, right. And then you have to take them out in the world and actually use them. And, you know, variables change.

Jennifer Smith, CDE 13:37
I like that. What you brought in there in terms of a variable, because it's one that I talk to people often about when we're looking at settings and adjustments. My questions often go to, well, this correction never seems to be working well. What are you eating at 10 o'clock at night, your corrections overnight don't work? Well, they may not work, because the data isn't clean, for lack of a better right. If you're sitting down and eating a whole pizza at 10 o'clock at night, and then your correction at one o'clock in the morning isn't working very well. I can guarantee that the reason it's not is because there's food in the picture that your correction factor doesn't know is there. Right? So you're you're unfairly judging this sensitivity in a window of time where you're going to be more resistant.

Scott Benner 14:33
And total daily insulin. We're just not we're not saying it for some reason, but total daily insulin you can get out of your pumps settings. Yeah, tell you how much and you can't just don't just look at yesterday. No, yeah. Because look at yesterday, look at the day. I mean, I don't know how far back do you go to come up with a real one for you? I usually like to look

Jennifer Smith, CDE 14:53
at an average of about seven days in general, especially if it's seven days worth of pretty Typical day, you know, somebody's just come back for vacation and their past seven days is all jacked up. Because, you know, it's been vacation, right? It is what it is. That's not valuable, true insulin amount information, I might need to go back further than that to more typical days and get an average there.

Scott Benner 15:21
Do you knock out the outliers? Like if, if you look at seven days and five of the days, you're right around 50 carbs, or and, and you look Oh, yeah, I used 50 carbs, and then ended up being this much insulin. Let's just say it was just keep using 50. It's I use 50 units of insulin on Friday. He's 50 units of insulin. On Thursday on Wednesday, I use 48. On Tuesday, I use 52. But on Monday, I use 12. Like, do you knock that one out? When you're doing the average? That person, right? Yeah, absolutely. And the same thing as if on Saturday, you were at a birthday party, you're like, Oh, my God, I used 90 units of insulin. So okay, so you take your kind of AV, you got to do an average of those days. Correct. All right. So much math. This is why the Pro Tip series.

Jennifer Smith, CDE 16:09
I know that there is a lot of it. But I think this is important to go along with that. Because I know we did the protests a while ago. Jimmy, holy cow, really? Wow.

Scott Benner 16:23
When we started, there was

Jennifer Smith, CDE 16:24
a while ago, and I'd have to go back to them and listen yet again to remember exactly, but I don't know that they're obviously we're doing this because that wasn't a big piece of

Scott Benner 16:34
well, people. People asked for the math, right? Like, I want to know the math of setting up my Basal my insulin to carb ratio, my insulin sensitivity. And I just keep telling people, I would just go listen to the Pro Tip series, because in my mind, it's mindset, like so much about managing diabetes as mindset. And the math is not not important. It's very important. And so here are the episodes. Right? There's the the five, what is it? How many rules are there? There's the rule of see, I already forget, we've been doing hundreds the rule of 500 for the insulin to carb ratio, right? Yes. Okay. And this one's the 1800 rule for the insulin sensitivity. Yes, and the Basal was.

Jennifer Smith, CDE 17:15
And the Basal was not really a rule, it was based on weight to get either a total daily dose of insulin and then break it down or based on weight. And just looking at what your Basal needs would be all of them factoring in, like age, as well as where you are in activity level.

Scott Benner 17:37
And you hear me say all the time that I think managing diabetes is about its timing and amount, it's about using the right amount of insulin at the right time. So yes, you need the math to know where to start. But then you have to look at what's happening to adjust your math to fit the honesty of like, you know, of the fight you're in, not just what you hope the fight was going to be. You have to you have to take account of the variables in your life, your level of activity, the way you eat, even if you're a hydrated person or not, like you know, we say things like be hydrated. Like, that means that everybody here is gonna go like Oh, okay, and then start hydrating, but I'm going to tell you that a week ago, I promised myself I was going to drink more water. And last night, I went to the bathroom at the end of the day. And I was like, did I drink any water today at all? So so it's nice that good. So it's nice to say you're going to do it. But the truth is, you might not be doing it. And if you're not hydrated, your insulin won't work as well as an example of something that could change, change the urine.

Jennifer Smith, CDE 18:39
And in terms of that activity level, I think it becomes really important. You know, we talk about these rules, 500 1800 whatever, but I think just we you had asked in the Bolus one about 500, could we make this more aggressive with another factor? Could we make it less aggressive? We could, I mean, that is the strategy to in terms of figuring out this 1800 rule. Like I myself actually know that I'm, I'm closer to the needs if I use like a 2000 rule, because of the activity level that I'm at because metabolically I know where my sensitivity lies. And so my insulin needs would, I would be very much too aggressive if I use the 1800 rule and it's a middle ground there's like 16 1700 makes your makes your insulin sensitivity factor more aggressive write a lower number, you get more insulin, whereas like 2000 it makes it more conservative.

Scott Benner 19:38
Do you remember the conversation we had about Arden because do ya cuz you were like you You told me to go with a lower number. And because that we started getting mixed in with the food that she was going to be eating it. But then the interesting thing was in the first handful of days at college, she needed a more aggressive insulin sensitivity factor but then once this the As the day started becoming repetitive, and she was getting a lot more activity, I had to back that off, right. So in the first four or five days before she was really moving around the campus, I had her all the way at 40. And then when she started getting more active, I had to move her more like 4344 45, depending on the day. And that's, that's her insulin sensitivity was 4344. Also, I don't want people to get caught in the idea of well, these are my settings, and then my life change. Now my a one C seven, but it doesn't matter, because these are my settings. So I guess diabetes, is this happening to me your life is changing. Your body is changing, something's changing, you have to meet that need. Correct? That's it. Yeah. And just don't sit sedentary and go, Okay, well, things have changed, but I'm not going to do anything about it. Like you have to do something about it. You know,

Jennifer Smith, CDE 20:53
right. It's so mean life is life is ever changing. It is yeah, you will continue to grow, you will continue to get older, we don't unfortunately, get younger. Your insulin needs will shift and change, you have been a really active college student. Now you've moved into taking your first job, and it's a desk job and, you know, you will have to shift and adjust. You really

Scott Benner 21:18
will, yeah, don't don't, please don't just look at your stuff and go Well, this is this is what's happening now like you can, you can affect those things. And, and I think you can also not to beat a dead horse, but the Pro Tip series will put you in a mindset about managing insulin. I mean, this stuff will be great for you. But it'll really, it'll take you to another level. I mean, those that is really a long, the Pro Tip series ends up being what is now over 25 episodes, I think, but it's just a very long conversation between you and I about what it means to take care of your diabetes, you know, right? Like, I know, you

Jennifer Smith, CDE 21:54
imagine if we had done all of that, that would have been a very long discussion.

Scott Benner 21:58
And insane. Well, no, I mean, it never would have worked. Like you need to like you have a conversation. And you know, people don't know how you and I do this, but like these three episodes were all recorded at the same time. And so you'll see a flow through between the three of them. But the prototype series was recorded over a number of weeks in the beginning, and then we added 15 More episodes over the years. And even the way you talk about diabetes is different than the way you used to. It's not like in, it's not in its tone, your tone is different. And you're more mature, you've had more experience talking to people, you have more like anecdotal like conversations you can reach for and things like that the same things happened to me. I mean, you know, you know, we joke about it all the time. But, you know, you think it's, you know, your eight year olds insulin needs and how to handle them or like, you think they're hard while you're doing it. But when your eight year old turns 14, you'll be like, Oh, I wish the kid was eight again, because that was really easy. And but you then you have those experiences. And then when you're having a larger conversation, the things you think to reach to to make your point become more mature as well. And so I think I think it's been terrific. And, and I think this will add to it. But absolutely, there's more,

Jennifer Smith, CDE 23:16
I think I think the other thing in each of our conversations, too, is that you are very good at knowing the episode number most often. I'm like, I know, we talked about that in another episode. But I think it's nice, because we can continue to refer back and say, Hey, if you want more about this, go listen to this, right? It's really in depth.

Scott Benner 23:38
Yeah. And you're going to need it too. I mean, can you do the math and set it up? And just do what you do? And every six months, look at the math again and change it? I mean, if that's what you want to do, I think that's probably viable. And you'll probably end up with I mean, if you did the math or kept the math up to date Pre-Bolus Your meals and took into account different foods. You probably have an A one C in the mid 60s, right? Yeah. And and as your life changes, you got more sedentary or your eating habits got worse, you might see your agency go up if you didn't adjust. Or if you started walking, you might see it go down a little bit. Right, you know, but but the rest of it the like what to do in the moment without having to think about it. Like I think that's where the podcast shines. Like I think that's where you hear these conversations over hours and weeks and months. And something happens and then you just sort of do the right thing. And you almost don't even know why you're doing it. It's just you heard it talked about so many times. It's just what occurred you to do in that situation. Right? Yeah, right. That's excellent. I can't thank you enough. It's actually as the end of the year comes generally I usually Thank you privately but here I mean, listen, the podcast is it's never going to be what it is without you. So Oh really? apprec No, thank

Jennifer Smith, CDE 25:00
you absolutely no, this is this is wonderful and I'm, I'm proud and really glad that I have the opportunity to help you. Thank you

Scott Benner 25:09
means a lot your friendship and your and your participation mean a lot to a lot of people, but it means a lot. So thank you. Thank you. Well, obviously, we're gonna thank Jenny and remind you that she works at integrated diabetes.com. If you'd like to hire Jenny, that's where you will find her. I'd also like to thank touched by type one, for sponsoring this episode of The Juicebox Podcast, please find them on Facebook, Instagram, and it touched by type one dotwork. I hope these three little episodes have been valuable for you. If you're thinking three episodes, what are you talking about? Well, this was part of episode 828 21 and 822 820, the math around Basal insulin 821 The math around insulin to carb ratio. And of course, this episode was the math around your insulin sensitivity factor. I'm gonna tell you a little more in a second. But thanks so much for listening, I really appreciate it. Now that you understand better how to get your settings close to where they need to be, you should probably learn the rest. If you're new to diabetes, check out the bold beginning series. And if you've been around for a while, and you're feeling comfortable, and you understand the basics, head over to the diabetes Pro Tip series. These are available in your audio app at juicebox podcast.com. And there are lists of them in the feature tab of the private Facebook group Juicebox Podcast type one diabetes, all of this information is absolutely free. It's accessible in your audio app online, or wherever you're comfortable listening. Check it out. You can do it, you really can't. There's a diabetes, we have a defining diabetes Episode Episode 408, called insulin sensitivity factor in case you want to learn more. There's an episode 295 Defining diabetes, insulin resistance, which might help you understand why this setting is important. And don't forget, if you're using an algorithm based pump, understanding your insulin sensitivity is incredibly important in in getting those settings correct as well as as well as Basal insulin to carb ratio, everything we've talked about in these three episodes. But if you want to build on what we've talked about, please go find the diabetes Pro Tip series and the other collections of information within the podcast. I'm going to just I'm going to read you something before you go because I understand that I'm I'm saying here's some information go check out other stuff. And I know a lot of people charge money like they they give a little bit of information and they want you to pay for the rest. I'm not doing that. The entire podcast is free. It always has been it always will be. There's there's no hidden costs anywhere. There's no pay walls, it's all on your time you can do it you know as quickly or as slowly as you want. As far as listening goes. I want you to go find these things because I know they work. So I've gone to a website that keeps track of the reviews for my show. A one C 5.6 Just like you promised from 7.2 Scott empowered me to trust my instincts when dosing and to be bold with insulin. I love listening to this podcast it makes me feel not so alone. I'm just gonna click on More here for you saving my soul never in a million years that I think I would be here but I guess who does this podcast and it's private Facebook group saved my soul in a time when I didn't think it was possible. The earthy, stripped down conversational aspects of Scott make you feel empowered. I'm a type two with a type one granddaughter learn so much from the podcast. This podcast has changed our lives. Just started listening, you're going to feel empowered, positive parent easy to understand management information with a side of laughter to reduce burnout. I'm telling you right now I could read these all day. I'm not reading them to you to boast. I'm reading them to you. So you'll go find the other series diabetes variables, mental wellness, diabetes pro tip F there's just they're there. Just go take please. I made them for you. Go listen to them. juicebox podcast.com. On top in the menu, you can see a list of a bunch of the series where like I said in the private Facebook group, which is a font of information and support of its own Juicebox Podcast type one diabetes. I hope you check them out. I hope these podcast episodes have been helpful for you. I'm going to be back very soon with another episode of The Juicebox Podcast. Thank you so much for listening

#821 The Math Behind Setting Insulin to Carb Ratio

Scott and Jenny break down the math behind setting your insulin to carb ratio. I really wanted to call this the GOZINTAs of ICR.

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00:00:19 Insulin to carb ratio calculation.
00:11:22 Starting point for insulin-to-carb ratio.
00:15:11 Consider insulin sensitivity when calculating insulin dosages.
00:18:22 Defining diabetes and managing it.

Scott Benner 0:00
Hello friends, and welcome to episode 821 of the Juicebox Podcast

welcome back today Jenny and I are gonna be going over the mathematical equation that will help you come up with your insulin to carb ratio. Don't worry, it's not really like super confusing or anything. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you like Jenny and you want to hire her, you can she works at integrated diabetes.com. Are you a US resident who has type one or is the caregiver of someone with type one? Oh, if you are, this is great news, because you can go to T one D exchange.org. Forward slash juice box and fill out the survey. Every completed survey benefits the podcast and type one diabetes research. T one D exchange.org Ford slash juice box. At the end of this episode, I'll tell you about more Juicebox Podcast episodes and series that will help you with insulin to carb ratio. So hang out till the very end

this episode of The Juicebox Podcast is brought to you today by the Contour Next One blood glucose meter. Learn more at contour next one.com forward slash juicebox. This is my favorite meter. It's incredibly accurate, easy to carry. I'll tell you more about in a little bit. But contour next.com forward slash juice box get yourself a great meter. The podcast is also sponsored today, by ag one from athletic greens. Are you looking for a green drink that tastes good? You're looking for ag one. I'm using it every day. You could go to athletic greens.com forward slash juicebox to get a book by the way, why would you use my link? Because when you do you get a free year supply of vitamin D and five free travel packs on top of your order. Athletic greens.com forward slash juice box. Alright Jenny, we're gonna have this little three episode series about setting doing the math, the math, I want to say maths like funny, but I can't get that out right the math of of diabetes. So we've, we've recorded about setting up your Basal insulin, this episode is going to be setting up your insulin to carb ratio. So the total grams of carbs versus the total insulin you need. Basic is basic idea. If your insulin to carb ratio is one to 10, then you use one unit of insulin to cover 10 carbohydrates. Right? Okay, so how does someone who's insulin to carb ratio is one to 10? How do they know that? Who told them? And what if they want to change it?

Jennifer Smith, CDE 3:14
I think the first question is, usually it starts with some type of educator or physician endocrinologist that says you know we're going to use we're going to use the strategy of allowing you to choose the food that you eat and count up carbohydrates. That's, you know, we're very our job centered in diabetes education. And so we're going to use a ratio of every time you eat 15 grams, you need to take one unit of insulin, I think 15 is the most commonly used, there's insulin to carb ratio.

Scott Benner 3:53
Oh, no kidding. Okay,

Jennifer Smith, CDE 3:54
at least on an initial like, we're going to set you up your one to 15. I mean, when I was first set up, I know that I didn't need one to 50. But that's what I was set up with is a wonder 15. Which leads to why we are talking about this because you need to have an idea of how to adjust that. Right. Which brings in a rule. It's called the 500 rule. Do you know the 500 rule? Scott?

Scott Benner 4:22
I don't think I mean, do I know it off the top of my head? No?

Jennifer Smith, CDE 4:28
No. Okay. Well, the 500 rule essentially. I don't know I'm not gonna say I know who decided on the 500 rule. But essentially, it's assuming the on average consumption of the average person of their carbs, and what their liver is sort of like outputting naturally. And so we use this rule of 500 and you take your total daily insulin dose So total daily is both basil and Bolus together. So let's say you use 30 units of insulin a day total. Okay? You're going to divide 30 into 500. And that's going to give you an average insulin to carb ratio of about 16.

Scott Benner 5:25
Okay, okay. Yes, I did it wrong, but okay.

Jennifer Smith, CDE 5:32
500 divided by 30. I don't know. Okay, so it's actually 16.6. But you know, we don't do like half. So it wasn't

Scott Benner 5:43
15,000 Because I was like, I know I'm doing this

Jennifer Smith, CDE 5:47
for it's not 15,000 No, I promise I stopped paying attention

Scott Benner 5:50
to the school around seventh grade is what I just figured out.

Jennifer Smith, CDE 5:55
Okay, are math paying attention to?

Scott Benner 5:58
So it takes the 500 I have a 3030 units, my total daily insulin? Yeah. And I take the 500 I do this math, I come up with 16.6. So this is my starting insulin to carb ratio, why would be a

Jennifer Smith, CDE 6:11
general starting place, especially if you are trying to figure out where to make some adjustments? Let's say that you are, let's say, and I will say that the 500 rule is, as I said earlier, it's more to the conservative, right? I mean, I know that my insulin to carb ratios, I on average, somewhere between about 25 to 28 units a day, total insulin, that's my total my insulin to carb ratios are more aggressive.

Scott Benner 6:54
Listen, if you're using insulin, or you have diabetes, you need a blood glucose meter. And you would like that meter to be accurate and easy to use. Am I right? Of course I am. I mean, this is not any greater stretch of the imagination. Well, guess what? I know the meter for you. It's called the Contour Next One blood glucose meter. My daughter has been using it for many years now. It is incredibly accurate. And it has Second Chance test strips. These are pretty much the big parts of why I'm telling you about it today. Accuracy is key of course and not wasting test trips is nice because they're expensive right? Now why else may you want this little dream of a meter? Well, it's easy to carry easy to use, easy to read has a bright light for nighttime viewing. And I mean it's it's pretty Jimmy's nice. You know what I mean? Contour next.com forward slash juicebox. Head over there for more information about a blood glucose meter than you'll ever need. Actually, there are also links there in case you want to buy the meter now online, you can there's like six different places you can buy the meter from right now online at my link, you will see all of them contour next one.com forward slash juice box. Easy to use, easy to carry. Second Chance test strips may be cheaper in cash than the meter you have now is through your insurance. You should check it out. Contour next one.com forward slash juice box. Are you looking for a green drink that doesn't taste like a green drink? If you are, you're looking for a G one from athletic greens. I started taking ag one because I was never quite sure of the quality of my diet and wanted to make sure that I was getting the essential vitamins that I may be missing. And now I take it every day and you could too. I find that AG one eases my digestion and leaves me feeling energetic. Ag one is great for any lifestyle keto paleo vegan dairy free, you name it gluten free, and it only has one actually less than one gram of sugar per serving. There's no GMOs, no nasty chemicals or artificial anything. You should check it out. Athletic greens.com forward slash juice box actually athletic greens is trying to make this a good experience for you. They're gonna give you a free one year supply of immune supporting vitamin D and five free travel packs with your first purchase. All you have to do is visit my link athletic greens.com forward slash juice box. Did you know that Athletic Greens was created when the founder experienced a ton of gut health issues and ended up on a complicated and expensive supplement routine. That's right. And now here we have it. Ag 110 A powder you just scoop in the water shake up drink. You're done. I think I must spend my first 30 to 60 seconds every morning with ag one but that's it. It's not a big commitment of time but it is paying me back athletic greens.com forward slash juice box. There are links to AG one and the Contour Next One blog glucose meter, as well as all the sponsors in the show notes of the podcast player you're listening in now, and at juicebox podcast.com, where you can just type in the links, athletic greens.com, forward slash juice box, contour next one.com forward slash juice box, when you use my links, you're supporting the production of the show. And I very much appreciate it. Let me get back now to Jenny, and the math.

Jennifer Smith, CDE 10:24
My insulin to carb ratios are more aggressive than what that 500 Rule factors out to be okay. But it is a very good starting place until you are able to evaluate your trends and assess where you need to shift that a little bit. So again, if it's from a starting place, if you have absolutely no idea what you're doing, and you're just all you know, is that, gosh, I use about 50 units today. Fantastic. Then, let's and you're really wanting to get into better coverage of your mealtimes and everything. And right now you're just sort of willy nilly taking some doses. Right, I'll give you a very fair starting place.

Scott Benner 11:11
Okay, is this statement that I have found at the NIH, the 500 rule 500 divided by total daily insulin is often used to find a starting point for the insulin to carb ratio. That is how many grams of carbs one unit of insulin cover. So that's a that's a perfect statement for what we're talking about. Okay. Absolutely. Perfect statement. Yes. Okay. So. Okay, so we've been diagnosed, and somebody's you've heard the episode about setting your Basal insulin, you've got your Basal insulin set pretty well. And you're seeing nothing like what you want, you have stability, let's say your Basal insulins good so you have stability away from food and away from carbs. So like when you're sleeping overnight, or you know, when it's been three hours since a meal and you're just sitting around your blood sugar is sitting stable where you want it to be, and now, but you're seeing like wonkiness at your mealtimes first thing to think about is m. I mean, I know this doesn't belong here based on the title, but I still think you have to say, am I Pre-Bolus? thing? My meals? Correct? Yeah, right. Absolutely. Yeah. So this, yeah, this is math, four. This is how much insulin I need for this many carbs. If we're setting up a fair fight between the insulin and the carbs, not if I eat and then shoot the insulin and later or eat at the same time that I'm shooting or something like that.

Jennifer Smith, CDE 12:31
Correct? Do you have to have the the second piece for analysis to evaluate from a starting place? I'm going to try this ratio. But you have to give the insulin a fair fight.

Scott Benner 12:42
Right, right. So again, protip series, you're probably should listen to that about how to actually use insulin. I think there's a Pre-Bolus episode. But I would listen, in the end, this is all great. I would just tell you to listen to the prototype series if you want to understand how insulin works. But to get this actual rule, this piece of math, this is it right here. One more time, Jenny, let's just make up a different number. I look at my I look at my pump. I've had diabetes forever. And I look at my pump and I say I use I'm just gonna make crazy numbers. I use 48 units of insulin every day on an average between I don't know 50 and 46. I'm calling it 48. Okay, I take 500 and divide it by 48. Yes. Am I insulin to carb ratio is one per about 10.4. Correct? Yes, you have no idea how proud I am of myself.

Jennifer Smith, CDE 13:37
Your math teacher would be very, very proud. No,

Scott Benner 13:39
every math teacher I ever had, I think thought I had bumped my head right before I walked into the door. So I was like, Hi, I'm here to not learn math today. Very bad at it. But okay, that's it. All right. Super simple, right?

Jennifer Smith, CDE 13:54
For the final rule, the 500 rule that's for insulin for your food.

Scott Benner 14:00
Yes. Right. But how about the moment when Arden moves into college, and I'm calling you from a target while we're shopping for things? And you say don't use 500? What did you tell me to do? You gave me a different number, I think,

Jennifer Smith, CDE 14:13
right? You can, you can make that a little bit more conservative, or you can make it a little bit more aggressive by just notching it up or down. Right. And that, I mean, it brings in to the next next part of bolusing, our corrective insulin right, where you can make the factor to figure out a little bit more aggressive, a little bit more conservative. So you know, you could certainly say, the 400 rule instead of the 500 rule, but in general, that 500 rule is really going to give you a starting place, a good starting place. And I think it's easier to remember than cash. It could go up a little bit, go down a little bit where you're going to do that Anyway, in your tweaking, right. Now, in terms of a good place to start, you may also consider that sensitivity for every person in a general statement is often that heavier weight, less activity, you are going to require more insulin than somebody who is a lower weight and more active or potentially, maybe they're the same weight as you, but their weight is based on more muscle based mass. And they are much more active than you. That person even though they're the same weight, as you may have heightened sensitivity to insulin, right, their insulin needs may be very much reduced compared to where you are.

Scott Benner 15:51
Even though we don't talk about it very much. Although there are episodes about digestion, that person might also be more likely to be eating cleaner food that's going through their system not impacting their blood sugar is longer during the digestion process, a lot of things to think of So, okay, so are we good here on this? We'll move on to making an episode about insulin sensitivity. Yes, yeah. And will we be talking about something that has 1500 in it when we get there? No, no. Do something. Oh, that's okay. I'll see you in the next episode. Okay, bye. All right. A huge thanks to AG one from athletic greens, head over there right now, athletic greens.com forward slash juice box, get your first order five free travel bags and a year's worth of vitamin D, athletic greens.com forward slash juice box. I also want to thank the Contour Next One blood glucose meter and remind you to go to contour next one.com forward slash juice box, find out about the little meter that could like you know the little engine that could just a great meter, I just I count on it. And it comes through contour next one.com forward slash juice box. And of course Jenny who works at integrated diabetes.com You can find her there. Alright, I'm gonna thank you right now for listening, and then give you some more episodes to listen to about insulin to carb ratio. So this is interesting because I think the defining diabetes episode about carb absorption digestion would be helpful here episode 668. I think that the episode called the perfect Bolus in the Pro Tip series would help me to find out what that one is for you. Sorry, you might think I would have done this before. But episode 226. Again, the entire Pro Tip series would be incredibly valuable. If you're new to diabetes, check out the bold beginning series. Some of these terms are lost on you. You're looking for the defining diabetes series, all the terms are listed out there. There's part of me that also thinks you should find the pro tip about fat and protein. And a lot of the other episodes we have to about how to Bolus for fat and protein. And if you're thinking to yourself, why would I Bolus for fat and protein? Scott, they don't have carbs in them. Oh, well, then you're really going to love them. Episode 263 diabetes, pro tip fat and protein. Episode 471 bolusing insulin for fat. What else do we have here? If you need that explained to you episode 360 is a defining diabetes episode. That's called defining diabetes, fat and protein rise. There's a lot here that would help you. In general, your carb ratio is the beginning, right? But it doesn't. It doesn't cover everything because of the glycemic load and glycemic index of foods, which reminds me that you're looking for episode 391 diabetes pro tip glycemic index and load. Again, if you don't know why you're looking for that there's a defining diabetes episode about it. Listen. If you're new beginning series, it's available in your in your app. It's available at juicebox podcast.com. You can find a list of the episodes that are in the series at juicebox podcast.com, or in the private Facebook group in the feature tab. Really, if you're new, please start with that one. Then move on if you'd like to the defining diabetes episodes, all these terms and many more are defined in short episodes. And then there's the diabetes pro tip episodes which really digs into how to take care of yourself. So get the beginning series, get your feet wet. Learn about the different terms and what they mean. And then go listen to that Pro Tip series. Get the a one C that you want, and deserve. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#820 The Math Behind Setting Basal Insulin

Scott and Jenny break down the math behind setting your basal insulin. I really wanted to call this the GOZINTAs of Basal.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 820 of the Juicebox Podcast.

In today's episode, Jenny Smith and I will be talking about the math behind figuring out a Basal rate. While you're listening today, please remember a few things first, nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Remember this as well. This is Episode 820, episode 821. And episode 822. Go together with this one. You're going to learn about basil in this episode, in Episode A 21. We're going to talk about insulin to carb ratios and how to get them set up. And then, in the last episode, insulin sensitivity, these three settings are huge and will help you in every aspect of your diabetes care. Listen to the end of all three episodes, for hints about what other episodes of the podcast will build on what you've heard today. If you're a US resident who has type one, or is the caregiver of someone with type one, please head to T one D exchange.org. Forward slash juice box and fill out the survey completely. When you do. You're helping to move type one diabetes research forward without ever leaving your home. T one D exchange.org. Forward slash juice box. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com. Forward slash juicebox. Today's episode of The Juicebox Podcast is also sponsored by Dexcom, makers of the Dexcom G six and Dexcom G seven continuous glucose monitors, get started today, learn more or see if you're eligible for a free 10 day trial of the Dexcom g six@dexcom.com. Forward slash juice box. I've been asked, Can you just tell me what the math is for setting up my Basal insulin for setting up my insulin to carb ratio for setting up my insulin sensitivity? And I don't know why we've just never gotten around to it probably because I have an aversion to math. But as you pointed out right before we started recording, yes, there's math here. But there's also other things to understand. So Right.

Jennifer Smith, CDE 2:33
And I, you know, I think as I said before, it is it's a lot to do with the fact that I would say to the newer people on insulin, I think many people just end up tweaking from where they're currently at. And once they've started learning more about how to adjust their overall insulin. Unless they really are the more I guess, precise, for lack of a better word. I just want to know why I need this much insulin and how to adjust it with a math equation. Many people just, ah, looks like I need a little more I'll add a little more heat. Like I need a little bit less, I'll take a little bit away. And there's not much math that they're considering. They're just adjusting,

Scott Benner 3:21
right? Yeah. And they also don't know where to start sometimes, like where to begin, because we all leave a doctor's office with I guess my assumption is the doctor uses these equations to come up with something for you to get you started to get you close enough, right baseline. Yes. But nobody's telling you that when you're leaving the office, they're not they're not saying to you hey, I made your basil point eight an hour because you know what we're going to talk about now? Yes, absolutely. But but then you get home, and it works or doesn't work. If you come up a few come along this podcast, you're going to hear an episode about setting Basal insulin that's, you know, basically me saying, use a little more if you're if your blood sugar has been high, and use a little less in these situations where you come along and clarify a little bit. And but people are asking for like, where do I really start? So I guess going to basil first? How does your Basal insulin get set on day one, you just were diagnosed and you're sitting in the office and someone's giving you either an amount to inject or an amount to put into your pump probably to inject right so where does that come from?

Jennifer Smith, CDE 4:27
Well in initially it will come from just weight, your body weight, truly just your body weight and some doctors do a 5050 they calculate total insulin estimated need based on your body weight. And then they'll say okay, well 50% of this or so should come from your basil and the other 50% should come from your Bolus insulin and so they work out the math that way right. And in general, some some may set you up by actually asking a little bit more, are you a really active person? Are you really sedentary person, what is your age, you know, as you go through different stages of your life, your insulin needs will shift and change, you may be more insulin sensitive, you may be more insulin resistant at certain points in time. So, if they're doing a really awesome job for you in estimating this initial dosing, besides your weight, they may also factor in your activity level, right. And then in terms of the life, right, the stage of life that you're in, you may be in need of more insulin or less insulin just based on your age, right. So a certain amount of total insulin goes in based on whether you're five years old versus 65 years old, in general.

Scott Benner 5:50
See already, this is this for people listening, this is why there's not just a, here's the math of setting your Basal insulin, because there's so much that goes into it. You just said depending on your age, it's also a lot of that is where you are in your life. You know, people might not understand that, you know, once you get past the honeymoon stage, and your Basal needs, or your excuse me, your insulin needs are pretty stabilized. Right? As a young person, they might be very stable, right up until you get to where you're starting to see hormones in your life. And then that goes crazy. And then your hormones might stabilize. But some of you, for some of you it might not like some women might struggle with hormonal problems, you know, for decades, where there's a lot of fluctuation and then correct, you know, it's just there's so much happening.

Jennifer Smith, CDE 6:39
And in terms of the, you know, the direct math, I guess a good example is that much of much of medical math is based on kilogram weight. And here in the US, we use pounds, right? So to find your weight in kilograms, all you really have to do is take your weight in pounds and divide it by 2.2. And then you have your weight in kilograms, okay? I won't make you figure out your weight in kilograms for everybody to know,

Scott Benner 7:02
I'm not telling anybody my weight, I'm gonna just take 100 pounds in kilograms, so I have somewhere to go from.

Jennifer Smith, CDE 7:09
So you might be like a middle school, or let's say, if you're 100 pounds, give or take, right? That's just an estimate. So you divide that by 2.2. So the 100 pound person of some age is about 45 kilograms, right? And so if you're figuring out let's say, you've got a 45 kilogram or 100 pound kid, right? If they are inactive, that kid could have insulin needs total daily insulin needs of anywhere between like, point six to like, one 1.2 per units per kilogram. Okay? Right. So I mean, and that's a big range, right? That's a big range. Do you need point six units per kilogram if you're 45 kilograms, or all the way up to like one unit per kilogram, and again, this is total daily dose. This is both Basal and Bolus. So right together, I've

Scott Benner 8:06
gotten out a calculator. So your example, point six would then be times 45 kilograms, which 27 units a day,

Jennifer Smith, CDE 8:15
total exam, this is inactive, right? This is like an inactive kid, right? If you have the kid who is entirely like, I do two hours of soccer four times a week, and then a tournament every weekend, that's like four, you got a busy kid. So anytime activity level, most often I should say anytime activity level goes up, you're metabolically using food better, your body is responding better, from the muscle level to the insulin doses. So your insulin sensitivity is going to increase, which means that your doses decrease. Yeah. Right. So a really, really heavily active kid, same way it is, you know, going to need somewhere, let's say between point four 2.8.

Scott Benner 9:05
Okay, so interesting, because we said half of it right at point six for the inactive kid, you're 27 But one, you're 45 for that inactive get. So you could be somewhere between 27 total units a day split between Basal and Bolus and 45 for the inactive 100 pounder. But for a more active one, you're saying more like point four.

Jennifer Smith, CDE 9:26
Right? About 3.8

Scott Benner 9:29
Yeah, so that goes from like 18 to sorry, I'm clicking, doing the math. Yeah. 36 I

Jennifer Smith, CDE 9:37
just don't want to get upset I got my calculator out for you. I could have done it.

Scott Benner 9:40
I just realized I don't own a calculator. So I like the computer has one. But But I didn't want to like I don't want to I don't want to say the wrong numbers over and over again and people be like, Okay, so there's a huge swing, like there is so on the on the high end for that active 100 pounder you're at like 36 but on the high end for an inactive person, you can be up to as much as four 45 or 35 is a lot more insulin,

Jennifer Smith, CDE 10:02
right? So and then it changes based on stage in life, right? Then we've got adolescence, then we've got like more like adult age, and then we've also got older adults, right? So you can see where the math isn't a direct. If you're this age, or this weight specifically, you're just going to need this amount of insulin. And I hear that question often when I work with people. And also I see that question come up a lot in all of the online communities. It's like, well, how you know, Mike, my kid is seven years old. How much insulin does your seven year old use? That's, that's not purposeful. Right? Right. That's not going to help you figure out your seven year olds insulin need, yeah.

Scott Benner 10:44
Also, we just use the example of activity. But you could also use another variable and say, you know, I don't know what if in the household. Here's one, what if there's somebody in the household who has celiac, and you're using gluten free, which oftentimes has more carbs in it, you can be in a car beer situation? What if you're somebody who stops at McDonald's four times a week versus somebody who's, you know, having salads and, you know, a small piece of chicken with, you know, like that kind of thing? Correct?

Jennifer Smith, CDE 11:14
Right, right. Absolutely. So then you're going to, again, from a comparison standpoint, you're looking at total insulin, in a known situation, a very different intake of food, maybe activity level. And also, then the insulin doses are going to be very, very different. Okay, so comparison wise, again, that's why I think this is important to know, like, where did the math come from? Where is a good place that if you're trying to redo things, it could be a starting point? I mean, there are certainly, could you Google it, you certainly could, but I think you're gonna get a lot less directive information. There are a couple of really good books that have charts and everything already set for you to read and manually sort of figure it out. I mean, John Walsh's pumping insulin book is a really good reference to think like a pancreas book. They're, they're awesome in terms of like, this is the math, this is how to sit down and figure it out if you really wanted to, but sometimes they think it's nice to have somebody sort of walk you through

Scott Benner 12:20
it a little bit, instead of looking at the graph and thinking I want to do something wrong here, right, come up. That's got to be someone's fears that I'm going to do. I'm going to do my guest sentence, and then I'm going to use way, way too much insulin. Right, right. Yeah.

Jennifer Smith, CDE 12:35
And I think that actually brings up a good point, actually, that, especially for those newer diagnosed who may be questioning the math and or seeing shifts in their insulin need already and wondering, well, my doctor is telling me to shift it this way. Most often, they're, they're erring on the side of caution and shifting your insulin for you, right. So you may be seeing numbers that aren't necessarily where you really would like them to be, or where you've learned that many people are getting their numbers to be. They're airing, you know, clinically, they're erring on the side of the lower amount before they get some data to show that they can increase safely,

Scott Benner 13:18
right? Because imagine if you are using point six an hour, let's do that for people point six times 24. So you're on a pump, or you're shooting it, I guess. So point six an hour if you're pumping, or it would be 14 and a half units a day if you were shooting it. But that's just basil. That's just basil we're talking about for a second. But you let's say it should be a unit. But instead it's point six. So you should have 24, but you're using 14, and then your blood sugars are high and your meals are spiking. And you start and that coming down. Yeah. And then you start seeing ghosts, which I talked about a lot. Like you know, my example here would be if the doctor told you look, your basil is point six, but really it should be one. Now you're deficient point for an hour of basil. Then you come along and Bolus something your blood sugar goes up. And you think, Oh, my insulin to carb ratio is wrong, but it might not be your insulin to carb ratio might be right, your Basal insulin is wrong. Right. And for every unit you're shooting for food, point four of it is really kind of just going to cover loss Basal because you're right or wrong, right? Correct.

Jennifer Smith, CDE 14:25
So from a from a Basal only standpoint, if you you know, that initial equation was really for figuring what on average should my total daily truly be daily being everything basil Bolus is corrections, everything in the mix. If you really just want the math for doing kind of same example, like a young inactive kid, just Basal dosing is going to be somewhere around point 2.25 upwards of maybe point six. Again, per kilogram of body weight. So that'll break it down a little bit further so that you can just say, okay, my kids getting this much. They're about in that bracket. They're not very active. This is about right. If however, like you just said, you're constantly noticing, well, gosh, we never really get down despite all the work that we're doing. And you plug in the equation, you're like, Well, gosh, maybe we're deficient in basil. You know, the equation is here. We're kind of under that by a unit or two, we'll maybe you could nudge it up a little bit and then be able to see whether that's working.

Scott Benner 15:39
What if I'm a 200 pound grown person? And I got diagnosed yesterday and I'm six three or whatever.

Jennifer Smith, CDE 15:47
And are you Are you pretty active or are you just moderately active Are you just kind of a couch potato? What would you like to be?

Scott Benner 16:00
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Jennifer Smith, CDE 18:21
Kind of the couch potato What would you like to be

Scott Benner 18:25
this feels like an attack Jenny? Not I mean, how about just how about a person that gets up in the morning and goes to a job and probably gets around 8000 steps a day and you know, gets the gym twice a week? You know that twice a week?

Jennifer Smith, CDE 18:39
Sure. Yeah, I mean that I mean, I would call that at least mild to moderately active. Honestly, you're getting a good number of steps more than just the daily activity of 5000. Right. So again, an adult fully grown, no more growth hormone kind of stuff happening somewhere between point two to point five per kilogram of body weight and that's just Basal.

Scott Benner 19:02
Okay, so it can be somewhere point two times 90 kilograms already did the kilogram now. You did the weight. Thank you. 18. It's up 2.5 times the 9045. And that's a total daily insulin. No, that's basil. Excuse me. Yep, that's just Basal literally. Yep, you have the word basil six times in front of me. And so again, there's a big swing right at 45. It's, you know, I imagine always like parents thinking about 45 units in a syringe, and they're probably just like, wait, what?

Jennifer Smith, CDE 19:37
Right? Many, many people in a syringe now may actually only have the 30 cc or the 30 unit syringes. So they may think, Well, gosh, my syringe does the amount of insulin I need to take at one time

Scott Benner 19:53
right? Yeah, I just did the math there for the for the larger amount, and even in a pump split up over You know, 24 separate hours? It's 1.8 an hour. Correct? Right?

Jennifer Smith, CDE 20:04
Which could be I mean, when you talk about like, that seems like a lot. But gosh, if you look at what do you think the heaviest age group for insulin needs is?

Scott Benner 20:14
My guess. Oh, gosh, what? What do I think the heaviest group is? Girls who get their periods? In the beginning? I don't know. 15 or 1430? Yeah, adolescents, right,

Jennifer Smith, CDE 20:27
that teen preteen upwards into maybe even early college, right? And really their needs in an inactive state? Or let's call it moderately active. I don't even know what moderately active is for a team these days. Like, what are you doing? It's,

Scott Benner 20:48
it's your finger moving very quickly.

Jennifer Smith, CDE 20:50
Right? Yeah, exactly. So really inactive, let's say somewhere between for adolescents, somewhere between point three and point, it's about one ish. If you're moderately active, like you go to gym a couple of times a week or PE, right. You may bike down to the mall or whatever with your friends, again, so far outside of that age range, but it's like point three, like point seven with some activity. So you can see that the more active you get, the lower overall your insulin needs will be because you're metabolically able to be more sensitive to using and your body using seeing and responding to insulin, better to give

Scott Benner 21:33
a little focus for people like That's why if you are a person who's moderately active, and you have all your insulin set well, and then you decide on Saturday afternoon, you're gonna go play basketball, and an hour into it, you're looking at a stranger going, there's juice in my bag, like, right, yeah, I have helped me, that's going to be because you were set up as an in a more inactive person who suddenly got very active and your settings, you didn't change your settings to go play basketball. Right.

Jennifer Smith, CDE 22:05
So and I think that brings in and of itself a really good point. Like, if you went and did that, like once a week, you're most likely still going to be only moderately active, whereas, and your insulin needs for that day may shift. Yeah, or maybe into the next day, maybe 36, even 48 hours of reaping the benefit of that high activity. But that doesn't mean your overall settings need to be adjusted. Right? Yeah, that's applying another factor. Right?

Scott Benner 22:34
Right. That's just the point of, you know, what stable can look like, right until you throw a variable into the mix.

Jennifer Smith, CDE 22:40
Right. So But over time, if you added more consistently, like you joined, you know, the basketball team and you're practicing a couple of nights a week and you're doing that, like rec league, or whatever, on the weekends or tournaments. Now, over time, you're metabolically going to become more sensitive, your insulin needs may come down. And I see that with a lot of the teams that I work with, you know, in the season versus the offseason shifts in need can happen in a very considerable way.

Scott Benner 23:11
So to make this episode valuable for anybody who trips over it, whether they have a kid, I don't know. Like also, does this count when you're honeymooning, nothing counts when you're honeymooning. Right. Yeah. Does it?

Jennifer Smith, CDE 23:24
Does it count? I think from an from a place of analysis, you can see where are you and as you become more sensitive, because your body is still helping you or has increased if the help that it's giving you in that time period, then some of this math may definitely go out the window. I mean, we've had, you know, many kiddos who can just use a Basal insulin of one unit a day and they're not even bolusing. Yeah. Right. So then, yeah, so then as the math will not be helpful, but

Scott Benner 23:57
as needs shift, you can redo the math and then look at the range and and say, Oh, well, I'm already at the low part of the range. It doesn't seem to be enough. And you can see at least where, at least I guess my point is if you're at point five and point fives not working, but you know, your range based on the math might be point five to I don't know, one, that at least you because some people were like, I don't know how far to turn it. Like I want to give more right, but I don't know, is it point five to three? No, it's not.

Jennifer Smith, CDE 24:25
Yes, no, no, no,

Scott Benner 24:26
no. It's hard to put yourself back into the position of a person who has no earthly idea what they're talking about, you know, because it's hard to know where to go. But okay, so maybe you're honeymooning and you'll be on the on the cautious side, you'll see your needs change. You'll do the math and you're just within the range. But But is this is this episode good for somebody whether they're eight or and just found the podcast. I've had diabetes two years where they're 15 or the 35. Or they're 60 Like this. It works for everybody. Yes, that's it. Okay. Say it one more time. For me, just the math. Just the math. Yeah.

Jennifer Smith, CDE 25:03
Okay. The total daily dose or just the Basal

Scott Benner 25:08
start over Jenny, I walk into the room. I'm like, Jennifer, I need your help setting my Basal insulin. Hi, I'm Scott. I'm 30 years old. I weigh 180 pounds. What do I do?

Jennifer Smith, CDE 25:20
Yeah, so 180 pounds. I'm sure you probably all did already did the math on your fancy computer. You wanted a half kilograms. They are at one and a half kilograms. And we're going to essentially take that you said you're 30 years old, right there and take 81 and your age is 30. And, Scott, how active are you?

Scott Benner 25:39
I have to be honest, Jenny. I've been watching. I've been watching Battlestar Galactica on Sci Fi. I'm Monday, I'm going to season five. And I'm going right from that to Yellowstone. So I'm not doing much.

Jennifer Smith, CDE 25:49
I'm sitting right. And on your side time you're doing a podcast. Yes, I

Scott Benner 25:53
sit when I work, and I sit when I'm enjoying myself. And I eat I eat well, though, I don't eat a lot, I don't eat a lot of junk food. I don't have any, I don't have any processed oils, I stay away from processed food. I eat protein, not a ton of carbs, maybe candy once in a while. Okay,

Jennifer Smith, CDE 26:12
so your overall inactive, age wise kind of were is a nice age to be. So we're really looking at taking your kilogram weight 81 kilograms. And you're going to multiply that if we want to start with just a total daily sort of estimate of where your insulin needs to be. In an inactive adult, you're looking at about point five to about 1.2 point 5.6 up to about 1.2 units per kilogram. And again, this is your total insulin needed in a day.

Scott Benner 26:45
So I'm at 40 and a half. Okay, point five,

Jennifer Smith, CDE 26:49
of which about about half give or take, again, based on an inactive level is going to be basil. Okay? Now, if you really want, you know, dosing strategy just for basil, and then when we talk again, we can see how well that's working for you, then we kind of start with just looking at Basal insulin needs. And from an again, inactive adult gotta get to doing more than Battlestar Galactica or whatever it

Scott Benner 27:13
was it while I'm thinking about going for a walk,

Jennifer Smith, CDE 27:17
you're thinking about going for a walk. Okay. So that would add in some mild activity, but I would still start you on somewhere between point two, five all the way up to maybe point six units per kilogram, and this is going to be just your Basal insulin needs. So if we took, let's say, say middle ground in between there, point four units, okay. So you take your 81 kilograms times point four, gives you about 30 to 32.7. So let's say 33 units of just Basal insulin a day.

Scott Benner 27:49
Okay. All right. So if I'm shooting it, I'm shooting that much. Does it matter if I'm shooting to SIBO? Or Lantis? Or no? Okay, no. And if I'm on a pump, I'm going to divide that number by 24. And make my Basal rate about 1.35. an hour?

Jennifer Smith, CDE 28:04
Yes, good math. Absolutely. Okay.

Scott Benner 28:07
But so is the chart really the important part? Like I know, you mentioned that there are a couple of books there. So I'm putting like, put yourself in the, like, this episode will be downloaded just 10s of 1000s of times. And it's going to be by everybody in every age, and they're going to hear it overall. But where did so where did they go to start? So now I can't tell you how much they weigh, or how old they are. But what should they do?

Jennifer Smith, CDE 28:32
Right? I think honestly, then if they're looking for the math, the books would be a good if they'd be a definite advantage. Because then the charts are, they're very easy to look at that you can say, Okay, I've got a kid who is not like pre puberty or even puberty, they are a kid, my kid is moderately active. And I can look at what should the math figure out to be knowing how to determine what they are in kilograms versus their pound weight. All they have to do is look at the chart and do the math and say, okay, my kid is right here. It looks like we're in this range. And my kid is still sitting high. So that's where then you have to take it a little further. And you have to look at the data from what if you're using a CGM, that's most advantageous. Obviously, you have the most in terms of trends. You can say, we want to nudge this down. It looks like we're staying high no matter what, right? We're not terribly floxie Up and down. But we've got some stability just at a higher level than we want to be. And what we've been using for Bolus is doesn't ever seem to get us to come back down. Right. So could it be Basal it could be could it also be that the Bolus ratios just are not working heavy, heavy enough either. Because remembering that our Bolus doses when we take them are really what's supposed to get us back down to the target that we're aiming for. And it's So if the Bolus is aren't doing that, despite doing some basil testing, and when you're using whether you're using MDI, or you're using a pump, you can do some base Basal testing to evaluate stability. Because remembering that Basal insulin supposed to hold you where you are, and not allow you to drop or rise more than about, let's call it 20 ish points. So if that's the case, and you're holding stable, maybe that's because that's where your Bolus has left you off.

Scott Benner 30:30
I have to I have two big questions. Yeah. These charts? Are they like copyrighted information? Like if we posted them on my like, I'd have a look at that right on my web, I think stealing from somebody if we put it up because I could make a webpage, where this episode sits along with the chart and the math right now.

Jennifer Smith, CDE 30:52
And the math written out? Yeah, I'd have to look in the I'd have to look in my books to see whether or not underneath the charts that are in both of the ones that I have. Again, both John Walsh's and then Gary's book, both of them have charts. I don't know if they have a specific,

Unknown Speaker 31:11
you know, horse

Jennifer Smith, CDE 31:12
noted,

Scott Benner 31:13
like, is something that isn't something that Gary sat down was like, I'm gonna figure this out on my own, or is it something that the world knew when he put it in there?

Jennifer Smith, CDE 31:20
No, that's definitely not I mean, it's not like Gary or John sat down and was like, these are definite used. They're used charts. Right. This is what a peds. This is what an endo may or could potentially look, look at. So the math is a set math kind of rule. Well, no, it's not. It's not their work.

Scott Benner 31:44
Okay, well, then I'm going to just put it down. I am going to make a web page that goes along with this episode, then. Sure, I'm probably gonna ask you for help. So

Jennifer Smith, CDE 31:53
I'm happy to help you.

Scott Benner 31:54
Here's my last question. I'm a person that have had diabetes forever. And I'm hearing this episode and thinking, God, is my basil wrong? Do I just take my total daily insulin go over what I've heard and take a look and see like, oh, maybe my basil isn't right. Like, because? Because it does happen, right, that people get set up one way. And then you just sort of you, I think it's very common for people to get to the right answer the wrong way. In a lot of facets of life, diabetes is an example. So say, one day, 10 years ago, I know it sounds crazy, but 10 years ago, a doctor put you on a Basal insulin, and he gave you too little, and your blood sugars were high, but you found ways around it with, you know, corrections or that. And eventually, it just works for you. It doesn't mean your settings are right, it means that you found a way to work with bad settings. Right. Right. So it's not it is worth going back and looking at a little bit.

Jennifer Smith, CDE 32:53
It is absolutely because as you said, you know, if you really think something is off, I mean, you can go back to what we've talked about in the pro tips, which are all about testing your insulin factors, right? The first one being basil, because that's, that's supposed to be your foundation, it's supposed to hold you really nice and stable. If you just decided all day long. Today, I'm going to fast or it is your fasting time of the year or whatever it might be, you should be confident that your basil is doing a good job. And Could your basil change? Absolutely based on some of the variables that we've already talked about, you've added in exercise, or you've now got a really active job when you used to have a very sedentary job, that could all factor in and you may need a

Scott Benner 33:40
shift. I'll just say it here again, if your basil is wrong, nothing else works. And you really should go find the Pro Tip series and listen to it because I think you would have a better idea of how to use your insulin. Right. Well, thank you very much. I appreciate Of course, yes. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that g VOKEGLUC. Ag o n.com. Forward slash juicebox. Thanks also to Dexcom, makers of the Dexcom G six and that Dexcom G seven that's coming just any day here in the United States. It's already available in Europe dexcom.com forward slash juice box, see if you're eligible for a free 10 day trial of the Dexcom G six. All right, I want to thank you for listening here, but after the music, I'm going to tell you about some other episodes that will help you with your Basal insulin.

Before I tell you about those other episodes, I want you to know that the chart that Jenny and I spoke about is that juicebox podcast.com forward slash Basal if you're new to diabetes, Nice, you should check out the bolt beginning series that's available at juicebox podcast.com. Go to the top, click on bold beginnings, or by looking in your podcast player for bold beginnings. Use that search function. If you're not so new to everything, you may be looking for the diabetes Pro Tip series. These are again available in your audio app, whichever, wherever you're listening right now, or at juicebox podcast.com. But if you just want to drill down on Basal insulin, find episode 237. It's all about basil, and it's part of the Pro Tip series. If all this is too confusing, just go to Google and type in juice box, one word, podcast, Basal. And all this will come back and return. On top of all that, there are lists of all the series available in the private Facebook group in the featured tab. So that's juicebox podcast.com In the private Facebook group under the feature tab, or in any audio app that you want to listen in, this information is here for you. I hope you get your Basal set well. It is really the core of your diabetes care. And don't forget to go to Episode 821 and 822. To figure out insulin to carb ratio, and insulin sensitivity factor these three settings together, they're going to make a big difference for you. Last thing is I just really can't recommend enough that you take the time to listen to the diabetes Pro Tip series. If you're looking for stable a one sees less variability, overall greater health. The diabetes Pro Tip series from the Juicebox Podcast will help you thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

To caclulate Basal/background insulin dose take Total Daily Insulin Requirement(in units of insulin) = Weight in Pounds ÷ 4

Total Daily Insulin Requirement (in units of insulin) = 0.55 X Total Weight in Kilograms

Basal/background Insulin Dose = 40-50% of Total Daily Insulin Dose