Are your blood sugar ranges unpredictable? You probably have insulin-dependent diabetes, you are extra prone to develop diabetes, and it may be troublesome 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 should you do not take note of your IOB, your blood sugar ranges will stay random and unpredictable.
Taking note of your IOB will not resolve all of your every day blood sugar issues, however it may be very useful. It is a key element to bettering diabetes administration, however one that’s typically not talked about or taught sufficient when recognized.
Realizing your IOB may also help you make higher selections, reminiscent of whether or not it is protected to go for a stroll with out your blood sugar dropping, whether or not you could inject extra insulin to right 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 midst of the night time to deal with low blood sugar.
What’s onboard insulin
Insulin onboard refers to how a lot energetic fast-acting insulin is in your physique. I’ve additionally seen it described as BOB (Bolus On Board), or unused insulin.
Fast-acting insulin is a sort of insulin that individuals with insulin-dependent diabetes use when consuming or when they should right excessive ranges. Frequent model names for energetic insulin are Humalog, Novolog, and Fiasp. Additionally it is 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 you could listen not solely to what number of models 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 energetic in your physique varies (3 to five hours). Most insulin pumps are set at 3 hours, and most docs advocate testing your blood sugar about 2 hours after your meal bolus to verify for IOB and whether or not a ample meal bolus has been administered.
In case you are utilizing an insulin pump, the pump will notify you of the IOB from each bolus.
Word, nonetheless, that it doesn’t embody basal insulin (background insulin), which is fast-acting insulin. Overlooking pump basal insulin when discussing energetic insulin is problematic, particularly with train, as an excessive amount of IOB from bolus or pump basal insulin will decrease blood sugar ranges.
Should you use an insulin pen, there are a number of apps that may enable you to calculate and observe your IOB, together with RapidCalc (not FDA authorized) and MySugr (EU solely). A smartpen known 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’ll be able to calculate your IOB your self pretty simply.
This video supplies an instance of the way to calculate “pump basal IOB” and injectable IOB.
We advocate that you just apply calculating your IOB just a few occasions and begin taking note of how completely different ranges of IOB have an effect on your blood sugar ranges in several conditions.
Listed here are two further examples
Primary IOB (Pump) Instance
Assuming that insulin is energetic 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 energetic 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 25% + 1 IU x 75% = 1.25 IOB
Why it’s best to contemplate IOB
Realizing 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 one greatest 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 recognized 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 energetic within the physique.
But when you aren’t getting sufficient insulin on the primary dose, must you wait 3-5 hours whereas your blood sugar is excessive earlier than correcting? The IOB may also help you identify that.
When calculating insulin doses, the IOB should be included as an element within the calculation. The calculation is as follows:
Insulin +/- correction of present blood sugar ranges for ingested carbohydrates – IOB = really useful dose
So to illustrate I have not 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 appears to be like 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’d have simply injected 3 IU and doubtless gotten a low studying.
One other essential issue is decreasing the chance of hypoglycemia. The one motive it’ll drop is when you have an excessive amount of insulin in your physique, i.e. an excessive amount of IOB. So taking note of your IOB’s wants for various actions is vital to realizing if it is applicable for what you are about to do, or should you 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, rising the chance of hypoglycemia. By taking note of your IOB and the way your blood sugar responds once you carry out various kinds of train, you’ll be able to regulate your IOB (by adjusting your insulin just a few hours earlier than train) so that you could train with balanced blood sugar ranges.
Additionally, in conditions the place you’ll be able to’t plan forward, you will know in case your IOB is simply too excessive and you will want a carbohydrate snack.
earlier than going to mattress
Diabetes makes it troublesome to get sufficient sleep, and nobody desires to cope with nighttime hypoglycemia or waking up with a excessive blood sugar hangover after having excessive blood sugar ranges all night time.
Checking your IOB and blood sugar ranges earlier than mattress may also 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 you could take a correction dose for top blood sugar.
Earlier than meals or corrections
IOB needs to be a part of all meal and correction calculations and permits insulin dosing to be extra correct.
Realizing your IOB means that you can take it once you want it, eat it once you need it, and believe in your insulin dosage.
