Does your blood sugar appear unpredictable at occasions? In case you dwell with insulin-dependent diabetes, it more than likely does, and typically it may be laborious to find out what’s occurring.
That’s why it’s necessary to learn 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 appear random and unpredictable
Whereas listening to your IOB is not going to remedy your whole day by day blood sugar woes, it might aid you out immensely. It’s a key part to higher diabetes administration and one thing that’s not introduced up typically or taught sufficient if you find yourself recognized.
Realizing your IOB may 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 appropriate a excessive blood sugar, or in the event you ought to eat a snack earlier than mattress so that you gained’t should get up in the course 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 have got 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 individuals residing with insulin-dependent diabetes use after we eat or have to appropriate highs. Widespread 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 necessary since injected rapid-acting insulin can final within the physique for 3-5 hours. That implies that try to be paying consideration not simply to what number of models of insulin you inject but in addition to how a lot is left of that dose as much as 5 hours after your injection(s).
How lengthy insulin is 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 advocate testing one’s blood sugar about 2 hours after a meal bolus, partially to verify IOB and if a enough meal bolus was administered.
In case you use an insulin pump, the pump will inform you your IOB from all boluses.
Nonetheless, it’s price noting that it doesn’t embrace the basal (background insulin) which can 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.
In case you use insulin pens, there are just a few apps accessible that will help you calculate and maintain monitor of your IOB comparable to RapidCalc (not FDA authorized) or MySugr (EU solely). There’s additionally a smartpen known as InPen accessible within the U.S.
The way to calculate IOB
In case you don’t have entry to any gadgets or apps that calculate your IOB for you, or if you wish to know your “pump basal IOB”, you may calculate your IOB pretty simply by yourself.
On this video, I’ll stroll you thru examples of how you can calculate your “pump basal IOB” and your IOB from injections.
I’d advocate going by way of the train of calculating your IOB just a few occasions and begin listening to how completely different ranges of IOB influence your blood sugar in numerous conditions.
Listed here are two further examples
Basal IOB (pump) Instance
Basal per hour is 1 IU, assuming insulin is 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 couple 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 it’s best to care about IOB
Realizing your IOB could be a essential part to understanding you probably have an sufficient quantity of insulin on board for a given exercise. It’s the one greatest indicator of how your blood sugar will react throughout completely different occasions and actions.
One of many first issues many individuals are taught after being recognized with diabetes is that stacking insulin is dangerous. Stacking insulin means taking multiple dose of rapid-acting insulin inside the 3-5 hour timeframe whereas it’s energetic within the physique.
However what in the event you didn’t get sufficient insulin through the first dose, must you simply wait 3-5 hours whereas your blood sugars are excessive earlier than correcting? Your IOB may help decide that.
If you calculate your insulin dose the IOB must be a part of the calculation. The calculation is that this:
Insulin for the carbs you eat +/- Correction to your present blood sugar – IOB = Dose suggestion
So let’s say I’m not consuming, my blood sugar is 250 mg/dL, my goal blood sugar is 100 mg/dL, my correction issue is 50, and my IOB is 1 IU, this is able to be the calculation:
0 IU for carbs + 3 IU Correction dose ((250-100)/50)) – 1 IOB = 2 IU
Had I not taken IOB into consideration, I’d simply have injected the three IU and more than likely had gone low.
One other essential issue is lowering the danger of low blood sugars. The one motive 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 want a small carbohydrate snack first.
When is it necessary to concentrate to IOB?
Whereas it is very important deal with IOB all through the day, these are three of crucial occasions to pay particular consideration to it:
If you train
Your insulin sensitivity is heightened throughout and after train, growing the danger of low blood sugar. By listening to your IOB, and the way your blood sugars react while you do several types of train, you’ll have the ability to regulate your IOB (by adjusting your insulin within the hours earlier than you train) to be able to train with balanced blood sugars.
And in these conditions the place you may’t plan forward, you’ll know you probably have an excessive amount of IOB and also you’ll want a carbohydrate snack.
Earlier than mattress
Getting an excellent night time’s sleep might 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 may 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 must be a part of each meal and correction calculation and might make your insulin doses extra exact.
Realizing your IOB permits you to dose when wanted, eat while you really feel prefer it, and it helps to construct confidence within the insulin doses you are taking.
