Are your blood sugar ranges unpredictable? When you have insulin-dependent diabetes, you are extra more likely to develop diabetes, and it may be tough to inform what is going on on.
That is why it is essential to discover ways to calculate insulin on board (IOB). As a result of if you happen to do not take note of your IOB, your blood sugar ranges will stay random and unpredictable.
Being attentive to your IOB will not remedy all of your day by day blood sugar issues, however it may be very useful. It is a key element to enhancing diabetes administration, however one that’s typically not talked about or taught sufficient when identified.
Figuring out your IOB may help you make higher selections, corresponding to whether or not it is protected to go for a stroll with out your blood sugar dropping, whether or not that you must inject extra insulin to appropriate excessive blood sugar, or whether or not it’s best to eat a snack earlier than mattress to keep away from having to get up in the course of the evening to deal with low blood sugar.
What’s onboard insulin
Insulin onboard refers to how a lot lively fast-acting insulin is in your physique. I’ve additionally seen it described as BOB (Bolus On Board), or unused insulin.
Speedy-acting insulin is a kind of insulin that folks with insulin-dependent diabetes use when consuming or when they should appropriate excessive ranges. Frequent model names for lively insulin are Humalog, Novolog, and Fiasp. It’s also the kind of insulin utilized in insulin pumps.
An excessive amount of IOB causes hypoglycemia (hypoglycemia), and too little causes hyperglycemia (hyperglycemia).
IOB is essential as a result of injected fast-acting insulin lasts 3 to five hours within the physique. This implies that you must concentrate not solely to what number of items of insulin you inject, but additionally how a lot of that dose is left inside 5 hours after the injection.
Everybody metabolizes insulin at barely completely different charges, so the period of time insulin is lively in your physique varies (3 to five hours). Most insulin pumps are set at 3 hours, and most medical doctors advocate testing your blood sugar about 2 hours after your meal bolus to examine for IOB and whether or not a enough meal bolus has been administered.
If you’re utilizing an insulin pump, the pump will notify you of the IOB from each bolus.
Observe, nonetheless, that it doesn’t embrace basal insulin (background insulin), which is fast-acting insulin. Overlooking pump basal insulin when discussing lively insulin is problematic, particularly with train, as an excessive amount of IOB from bolus or pump basal insulin will decrease blood sugar ranges.
In case you use an insulin pen, there are a number of apps that may provide help to calculate and monitor your IOB, together with RapidCalc (not FDA accredited) and MySugr (EU solely). A smartpen referred to as InPen can be accessible within the US.
The right way to calculate IOB
If you do not have entry to a tool or app that calculates your IOB, otherwise you need to know your “pump fundamental IOB,” you possibly can calculate your IOB your self pretty simply.
This video offers an instance of how you can calculate “pump basal IOB” and injectable IOB.
We advocate that you simply observe calculating your IOB a couple of occasions and begin listening to how completely different ranges of IOB have an effect on your blood sugar ranges in several conditions.
Listed here are two further examples
Fundamental IOB (Pump) Instance
Assuming that insulin is lively within the physique for 4 hours, the basal dose is 1 IU per hour.
1 IU x 25% + 1 IU x 50% + 1 IU x 75% + 1 IU x 100% = Complete: 2.5 IOB
Bolus IOB (MDI) instance
Assuming that insulin is lively within the physique for 4 hours, I injected 1 IU 1 hour earlier than and a couple of IU 3 hours earlier than.
2 Iu x% + 1 Iu x 75% = 1.25
Why it’s best to take into account IOB
Figuring out your IOB is a crucial consider understanding whether or not you’re getting the suitable quantity of insulin in your particular exercise. That is the only finest indicator of how your blood sugar will reply at completely different occasions and through completely different actions.
One of many first issues most individuals are taught after being identified with diabetes is that it is not a good suggestion to proceed utilizing insulin. Insulin stacking means taking a number of doses of fast-acting insulin inside 3 to five hours whereas the fast-acting insulin is lively within the physique.
But when you do not get sufficient insulin on the primary dose, must you wait 3-5 hours whereas your blood sugar is excessive earlier than correcting? The IOB may help you establish that.
When calculating insulin doses, the IOB have to be included as a element of the calculation. The calculation is as follows:
Insulin +/- correction of present blood sugar ranges for ingested carbohydrates – IOB = advisable dose
So to illustrate I have never eaten and my blood sugar is 250 mg/dL, my blood sugar goal is 100 mg/dL, my correction issue is 50, and my IOB is 1 IU. The calculation seems like this:
0 IU + 3 IU correction dose of carbohydrates ((250-100)/50)) – 1 IOB = 2 IU
If I hadn’t taken IOB under consideration, I might have simply injected 3 IU and would most likely have gotten a low studying.
One other essential issue is lowering the chance of hypoglycemia. The one motive it would drop is if in case you have an excessive amount of insulin in your system, i.e. an excessive amount of IOB. So listening to your IOB’s wants for various actions is essential to understanding if it is acceptable for what you are about to do, or if you happen to want a small carbohydrate snack first.
When is it essential to concentrate to IOB?
Whereas it is essential to focus in your IOB all through the day, the three most essential occasions to pay particular consideration to are:
when exercising
Throughout and after train, insulin sensitivity will increase, growing the chance of hypoglycemia. By listening to your IOB and the way your blood sugar responds while you carry out various kinds of train, you possibly can regulate your IOB (by adjusting your insulin a couple of hours earlier than train) so that you could train with balanced blood sugar ranges.
Additionally, in conditions the place you possibly can’t plan forward, you will know in case your IOB is just too excessive and you will want a carbohydrate snack.
earlier than going to mattress
Diabetes makes it tough to get sufficient sleep, and nobody needs to take care of nighttime hypoglycemia or waking up with a excessive blood sugar hangover after having excessive blood sugar ranges all evening.
Checking your IOB and blood sugar ranges earlier than mattress may help you assess whether or not it is protected to go to mattress, whether or not you want a snack to stop hypoglycemia, or whether or not that you must take a correction dose for prime blood sugar.
Earlier than meals or corrections
IOB ought to be a part of all meal and correction calculations and permits insulin dosing to be extra correct.
Figuring out your IOB permits you to take it while you want it, eat it while you need it, and have faith in your insulin dosage.
