Days of a Conscientious Diabetic

ADB Log - Diabetic Treatments

Days in the Life of a Conscientious Type 1 Diabetic

 

This log documents my treatments for diabetes, using two types of injected insulin, a glucose meter, a balanced diet, and counting the grams of carbohydrates that I consume. ​​ My “plan” is to maintain blood glucose readings within a “safe” range (80 – 200 milligrams/deciliter).

 

I inject insulin four or more times daily. ​​ My meter is a continuous glucose monitor (CGM). ​​ I constantly adjust my dose, based more on the anticipated insulin effectiveness than to changes in my diet. ​​ ​​ By the way, I’d advise Type 1 diabetics who eat a variety of foods to include carbohydrate counts in their insulin-dose plans.

 

My dose adjustments are based on some of the same principles used to automate insulin delivery by pumps in conjunction with CGMs. [1, 2] ​​ Pumps can operate continuously delivering both small ‘basal’ streams as well as occasional large boluses. ​​ When a pump is not used, all doses, small and large, are delivered with a syringe. ​​ 

 

I have included narratives of several consecutive days. ​​ After the several days of narrative, I’ll switch to a tabular presentation.

 

Here are some terms and abbreviations for readers not familiar with them:

  • Novolog (insulin): injectable hormone solution for lowering blood glucose; it stimulates cells to take up and metabolize glucose; its effectiveness lasts for about 5 hours; its level of activity varies over that 5 hour period;

  • Lantus (insulin): injectable hormone solution for lowering blood glucose, active during 24 hours; its activity is fairly constant over the 24 hour period;

  • mg/dL: milligrams of glucose per deci-liter, a standard blood glucose concentration available on glucose meters;

  • Glucose: ​​ the source of energy for most tissues in the human body (brain, muscles, etc.); Note: insulin stimulates tissues to receive glucose; without insulin, glucose accumulates in the bloodstream and passes out in urine; a CGM reports the amount of glucose currently in the bloodstream;

  • CGM: continuous glucose monitor; this system comprises a transmitter+sensor which is attached to the skin; the user carries a miniature battery-powered radio receiver which has a screen graph readout that allows the user to observe their glucose reading at any time;

  • Carbohydrate: starch and similar foodstuff digested by the human body to produce glucose;

  • Carbohydrate Ratio (CR): the number of grams of carbohydrates that 1 unit of insulin can compensate for, so that blood glucose concentration remains unchanged.

  • Insulin sensitivity factor (ISF): ​​ the amount by which blood glucose readings in mg/dL will be decreased by use of 1 unit of insulin.

 

References

[1]https://openaps.readthedocs.io/en/latest/

[2]https://openaps.readthedocs.io/en/latest/docs/While%20You%20Wait%20For%20Gear/Understand-determine-basal.html#basic-diabetes-math

[3]Scheiner, Gary, Think Like a Pancreas. ​​ Managing Diabetes with Insulin (Da Capo Press, 2011, www.dacapopress.com), pg. 110.

 

November 1, 2020

 

I stayed “on plan” this day, adjusting insulin doses to avoid big swings in my CGM readings.

 

Morning Lantus dose:

  • Overnight my (continuous glucose) meter (CGM) readings were 154 at 10 PM, ​​ then rose to 170 around 6 AM, and then to 230 at 7:15 AM. ​​ (These units are in mg/dL.) ​​ I’m happy with these results, so I will again take 12 units of Lantus (my 24-hour insulin) in the morning.

 

Morning Novolog Dose:

  • I plan to take a 5 mile hike this morning. ​​ Typically, my Carbohydrate Ratio (CR) is 8.5 – 9 grams of carbodydrates per unit of insulin while hiking. ​​ I plan to have a breakfast comprising 53 grams of carbohydrates (based on food package labels). ​​ Thus I should take 53/8.7 = 6.09 units of Novolog.

  • My CGM reading was 236, significantly higher than my target for hiking, which is 150 mg/dL, ​​ so I will take a small amount of additional Novolog with the aim of reducing that 236 to 150. ​​ My insulin sensitivity factor (ISF) has been around 90 lately, so I will add (236-150)/90 ​​ = 0.89 units of Novolog.

  • My total Novolog dose is 6.09 + 0.89 = 6.98 units. ​​ But my syringe can deliver only multiples of 0.5 units. ​​ So I will take 6.5 units of Novolog. ​​ (I almost always round downwards to the nearest multiple of 0.5 units.)

  • I took this dose at 6:50 AM.

 

After the hike:

  • At 10:47 AM my CGM reading was 121. ​​ That is close to the target CGM reading but surprisingly lower ​​ already. ​​ I’ve only used about 5.8 units out of the 6.5. ​​ The remaining 0.7 units could drive my CGM readings still lower: ​​ 0.7 * ISF = 63. ​​ 

  • I do not want the reading to be near 60, so I will have a snack: maybe half an energyt bar, or maybe some popcorn. ​​ I’ll limit it to about 6-8 grams of carbohydrate.

  • Perhaps my CR above was a little too low, or my ISF above was a little too low. ​​ (My Novolog did an even better job than I though it would.) ​​ 

  • I’ll make a note that the CR and ISF values that I used were too low.

 

Noon Novolog Dose

  • Time: ​​ 12:45 PM. ​​ Typically, my Carbohydrate Ratio (CR) at this hour is 7.5 grams of carbodydrates per unit of insulin. ​​ I plan to have a lunch comprising 53 grams of carbohydrates (based on food package labels). ​​ Thus I should take 53/7.5 = 7.06 units of Novolog.

  • My CGM reading was 170 (milligram%/liter), significantly higher than my target for hiking, 120 mg/d, so I will take a small amount of additional Novolog with the aim of reducing that 170 to 120. ​​ My insulin sensitivity factor (ISF) has been around 90 lately, so I will add (170-120)/90 ​​ = 0.55 units of Novolog.

  • My total Novolog dose is 7.06 + 0.55 = 7.61 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 7.5 units of Novolog. ​​ (I almost always round downwards to the nearest multiple of 0.5 units.)

  • I took this dose at 12:50 PM.

 

Mid Afternoon:

  • CGM reading around 200

 

Dinnertime Novolog Dose

  • Time: ​​ 5:45 PM. ​​ Typically, my Carbohydrate Ratio (CR) at this hour is 7 grams of carbodydrates per unit of insulin. ​​ I plan to have a dinner comprising 68 grams of carbohydrates (based on food package labels). ​​ Thus I should take 68/7 = 9.71 units of Novolog.

  • My CGM reading was 170 (mg/dL), which is higher than my evening target of 150 mg/dL. ​​ I will therefore take a small amount of additional Novolog with the aim of reducing that 170 to 150. ​​ My insulin sensitivity factor (ISF) has been around 94 lately, so I will add (170-150) / 94 ​​ = 0.21 units of Novolog.

  • My total Novolog dose is 9.71 + 0.21 = 9.92 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 9.5 units of Novolog. ​​ (I almost always round downwards to the nearest multiple of 0.5 units, because I prefer to err on the side of a higher rather than lower blood glucose and CGM reading.)

  • I took this dose at 5:50 PM.

 

My sensor expired and so I replaced it around 8 PM. ​​ The new one requires a two hour warm up period. ​​ After those two hours, I used a finger-stick test and learned that my blood glucose was 215 MPC. ​​ Although the CGM read ‘162’ when it emerged from the warmup period, I used its calibration feature to set it the CGM reading to 215.

 

At 8:30 PM I felt hunger pangs that might indicate lower blood glucose, but I did not have use of my CGM. ​​ Nevertheless I consumed about 8 grams of carbohydrate in the form of a small helping of popcorn and an ounce of Bailey’s Irish Cream. ​​ 

Bedtime Novolog Dose:

  • Time: ​​ 10:23 PM. ​​ I will use 7.6 and and 98 as the respective CR and ISF. ​​ Why? ​​ Because my previous estimates, CR=7 and ISF=84 were too low. ​​ My actual CGM reading (215) is lower than the predicted CGM reading (297) given the insulin dose (9.5) and the consumed grams of carbohydrate (68+8=76): ​​ 76/9.5 = 8. ​​ I have nudged both the CR and ISF upward a bit based on looking back at the effectiveness of the most recent insulin dose.

  • I will not consume any carbohydrates, so there is no insulin dose needed to compensate for carbohydrates.

  • My CGM reading is 215, which is higher than my overnight target level of 150. ​​ Therefore I will take a small dose of Novolog to attempt to bring my CGM reading down from 215 to 150. ​​ My ISF is about 90, so my calculated dose is (215 – 150) / 90 = 0.66 Units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 0.5 units of Novolog. ​​ (I almost always round downwards to the nearest multiple of 0.5 units.)

 

 

November 2, 2020

 

I stayed “on plan” this day both by adjusting insulin doses and by consuming additional carbohydrates (i.e., snacking).

 

Morning Lantus dose:

  • Overnight my (continuous glucose) meter (CGM) readings ranged from 215 at 10 PM to 300 around 2 AM, and then back to 200 at 6:15 AM. ​​ Perhaps the wider range is characteristic of a newly installed sensor. ​​ The CGM readings were flat during the last 3-4 hours, so I will again take 12 units of Lantus (my 24-hour insulin).

 

Morning Novolog Dose:

  • Typically, my Carbohydrate Ratio (CR) in the morning housrs is 6.5 grams of carbodydrates per unit of insulin. ​​ I plan to have a breakfast comprising 45 grams of carbohydrates (based on food package labels). ​​ Thus I should take 45/6.5 = 6.92 units of Novolog.

  • My CGM reading was 200 mg/dL, significantly higher than my target of 120 mg/dL, so I will take a small amount of additional Novolog with the aim of reducing that 200 to 120. ​​ My insulin sensitivity factor (ISF) has been around 90 lately, so I will add (200-120)/90 ​​ = 0.89 units of Novolog.

  • My total Novolog dose is 6.92 + 0.89 = 7.81 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 7.5 units of Novolog. ​​ (I almost always round downwards to the nearest multiple of 0.5 units.)

  • I took this dose at 6:40 AM.

  • Apparently overnight my ISF was not 90, but something lower. ​​ Given the wanderings of the CGM I’ll postpone re-estimating ISF. ​​ 

 

Mid-morning:

  • At 9:48 AM my CGM reading was 103. ​​ That is already lower than my target, plus I’ve only used about 5.15 units of the 7.5. ​​ (A dose is typically active over a course of 5 hours, but it has only been 3 hours.)  ​​​​ 

  • The remaining 2.35 units could drive my blood glucose down below 60, so I will consume another snack – a banana comprising 20 grams of carbohydrate.

  • My initial CR and ISF estimates were too low; the insulin was more effective than initially guessed, so I must again nudge those estimates upward. ​​ I’ll use CR=7.5 and ISF=95 for the next Novolog dose.

 

Noon Novolog Dose

  • Time: ​​ 12:15 PM. ​​ I’ll use the above CR and ISF.  ​​​​ I plan to have a lunch comprising 53 grams of carbohydrates (based on food package labels). ​​ Thus I should take 53/7.5 = 7.06 units of Novolog.

  • My CGM reading was 188 (milligram%/liter), significantly higher than my target, which is 120 mg/dL. ​​ I will take a small amount of additional Novolog with the aim of reducing that 188 to 120. ​​ Using ISF = 95 I will add (188-120)/95 ​​ = 0.69 units of Novolog.

  • My total Novolog dose is 7.06 + 0.69 = 7.75 units. ​​ My syringe can deliver only multiples of 0.5 units. ​​ So I will take 7.5 units of Novolog. ​​ 

  • I took this dose at 12:20 PM.

 

Mid Afternoon

  • CGM reading was 80 at 3 PM. ​​ Accordingly I had a snack of about 8 grams of carbohydrate (popcorn).

 

Dinnertime Novolog Dose

  • Time: ​​ 5:45 PM. ​​ Typically, my Carbohydrate Ratio (CR) at this hour is 7 grams of carbodydrates per unit of insulin. ​​ However, my 3 PM CGM reading of only 80 suggests that the CR=7 is too low, so I’ll use CR=7.5 and ISF = 95..I plan to have a dinner comprising 68 grams of carbohydrates (based on food package labels). ​​ Thus I should take 68/7.5 ​​ = 9.07 units of Novolog.

  • My 5:45 PM CGM reading was 220 mg/dL, higher than my evening target of 150 mg/dL. ​​ I will therefore take a small amount of additional Novolog with the aim of reducing that 220 to 150. ​​ I will add (220-150) / 95 ​​ = 0.74 units of Novolog.

  • My total Novolog dose is 9.07 + 0.74 = 9.81 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 9.5 units of Novolog. ​​ 

  • I took this dose at 5:50 PM.

 

Bedtime Novolog Dose:

  • Time: ​​ 10:12 PM. ​​ I will use 7.5 and and 95 as the respective CR and ISF. ​​ Why? ​​ Because my actual CGM reading (193) closely ​​ matches the predicted CGM reading (196) given the insulin dose (9.5) and the consumed grams of carbohydrate (68): I have consumed only 8.68 units of the 9.5 taken at 5:45. ​​ 68/8.68 = 7.8. ​​ The remaining units (0.82) will bring me perhaps to 120. ​​ 

  • I will not consume any additional carbohydrates, so there is no insulin dose needed to compensate for carbohydrates.

  • My CGM reading is 193, which is higher than my overnight target level of 150. ​​ I expect it to go lower with the remaining 0.82 units of Novolog still in my body. ​​ 

  • Therefore I will not take additional Novolog.  ​​​​ Instead, I will set a bottle of Stonyfield Smoothie® by my beside, in case my CGM readings go still lower than 120. ​​ 

  • Update 11:00 PM, CGM now at 246. ​​ Sorry, but it didn’t go down like I hoped. ​​ I will lower my CR and ISF estimates because I missed the 150 target. ​​ I did not ‘cheat’ with extra snacks, by the way. ​​ Instead of 7.5 and 95, I will use 6.95 and 91.4. ​​ (I will explain later the basis of these estimates.) ​​ 

  • Therefore I will take a small dose of Novolog after all, to attempt to bring my CGM reading down from 246 to 150. ​​ My ISF is 91.4, so my calculated dose is (246 – 150) / 91.4 = 1.05 Units. ​​ Since my syringe can deliver only multiples of 0.5 units, I will take 1 unit of Novolog. ​​ ​​ 

 

Although the Dexcom G6 system claims not to need finger-stick blood test calibrations twice per day, as did its predecessor G5 system, I try to do a calibration once per day. ​​ Tonight the meter reads 212, and the finger stick test reads 231. ​​ This is close, but it may drift further with additional time. ​​ 

 

November 3, 2020

 

Today my initial CGM reading was surprisingly high. ​​ I treated this with higher Lantus and Novolog doses throughout the day in an effort to get back on the plan

 

Morning Novolog and Lantus Dose:

  • Overnight my CGM only decreased to 200 MPC, whereas I had hoped it would decrease to 150 MPC. ​​ This means that my ISF was effectively around 40, versus near 90. ​​ This also means that I should lower both my CR and ISF for dose calculations. ​​ I will try CR= 6 and ISF=75.

  • Overnight my CGM readings increased from 200 up to 304. ​​ This is a larger increase than I want, so I will increase my Lantus dose to 13 units. ​​ 

  • I plan to consume 45 grams of carbohydrates for breakfast. ​​ Therefore, my Novolog dose will be 45/6 = 7.5 units.

  • My CGM reading of 304 mg/dL is significantly higher than my target of 120 mg/dL. ​​ I will take an additional amount of Novolog with the aim of reducing that 304 to 120. ​​ Based on my reduced insulin sensitivity factor (ISF) estimate, I will add (304-120)/75 ​​ = 2.45 units of Novolog.

  • My total Novolog dose is 7.5 + 2.45 = 9.95 units. ​​ Since my syringe can deliver only multiples of 0.5 units, I will take 9.5 units of Novolog and hope for better. ​​ (Perhaps I should round upwards, because 9.95 is so close to 10.) ​​ 

  • I took this dose (9.5 units) at 7:08 AM.

 

 

Mid-morning:

  • At 10:15 AM my CGM reading was 367. ​​ Why? ​​ The insulin seems to have had no effect. ​​ Did I actually take it or not? ​​ I double-checked by syringe’s top end dial, which shows that I did take 9.5 units, alright. ​​ But it’s like I didn’t take any at all.

  • I will try to estimate my new CR and ISF, based on using 6.78 units out of that 9.5 unit dose. In the calculations, I see that the 367 reading is not far from the predicted reading. ​​ 

  • The new estimates are CR=5.9 and ISF=74. ​​ (Yes, I will explain the calculation at some point.) ​​ This informs me that the rise is to be expected before things (hopefully) head back down. ​​ I will not inject any insulin and will wait until noon-time instead. ​​  ​​​​ 

  • The remaining 2.72 units could drive my blood glucose down to 367 – (2.72 * 74) = 165.

  • Contrast this with my observation from yesterday – too-low CR and ISF estimates, to be nudged upward. ​​ The take-home lesson is that these ratios vary! ​​ It is my hope that “staying on top of them” is better than sticking to single CR and ISF values (for dose calculations) over time. ​​ By “staying on top of them”, I mean that I use hindsight to calculate them in order to calculate the next dose.

 

I observe that the CR and ISF effective values are lower when the CGM readings are higher. ​​ Perhaps with good data some non-linear function could be estimated, or, neural network could be trained, to take this non-linearity into account. ​​ 

 

Noon Novolog Dose

  • Time: ​​ 12:00 PM.  ​​​​ CGM reading is 278. ​​ Based on 9.5 units of insulin, 45 grams of carbohydrate, the predicted CGM reading was 157, close to the hoped-for above 165, but these did not happen. ​​ The calculated CR was 4.97 and the calculated ISF was 67.9. ​​ I’ll use 5.5 and 70, expecting that these may increase from the morning into the afternoon.

  • I plan to have a lunch comprising 53 grams of carbohydrates (based on food package labels). ​​ Thus I should take 53/5.5 = 9.64 units of Novolog.

  • My CGM reading was 278 (milligram%/liter), significantly higher than my target ​​ 120 mg/dL, so I will take an additional amount Novolog with the aim of reducing that 278 to 120. ​​ My insulin sensitivity factor (ISF) is 70, so I will add (278-120)/70 ​​ = 2.26 units of Novolog.

  • My total Novolog dose is 9.64 + 2.26 = 11.9 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 11.5 units of Novolog. ​​ 

  • I took this dose at 12:000 PM.

  • I will wait until about 12:25 PM to begin eating, in order to reduce the CGM reading further and hopefully enhance my ISF.

Mid Afternoon

  • CGM reading was 103 at 3 PM. ​​ Accordingly I had a snack of about 8 grams of carbohydrate (popcorn).

Dinnertime Novolog Dose

  • Time: ​​ 5:05 PM. ​​ My CGM reading is 170, after above-mentioned popcorn snack. ​​ New estimates for CR and ISF are 6.3 and 76. ​​ .I plan to have a dinner comprising 69 grams of carbohydrates (based on food package labels). ​​ Thus I should take 69/6.3 ​​ = 10.95 units of Novolog.

  • My ​​ CGM reading was 170 (milligram%/liter), higher than my evening target of 150 mg/dL, so I will take a small amount of additional Novolog with the aim of reducing that 170 to 150. ​​ mg/dL. ​​ I will add (170-150) / 76 ​​ = 0.26 units of Novolog.

  • My total Novolog dose is 10.95 + 0.26 = 11.21 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 11 units of Novolog. ​​ (I almost always round downwards to the nearest multiple of 0.5 units.)

  • I took this dose at 5:15 PM.

 

Bedtime Novolog Dose:

  • Time: ​​ 9:50 PM. ​​ I will use 6.7 and and 78 as the respective CR and ISF. ​​ Why? ​​ Because my actual CGM reading (103) ​​ at 0 PM is lower than predicted based on consuming 9.84 units of Novolog. ​​ The remaining units (1.16) ​​ will bring me still lower. ​​ 

  • I will consume additional grams of carbohydrate to avoid going too low.

  • Also, I will set a bottle of orange juice by my bedside in the case that my CGM readings go still lower than 120. ​​  ​​​​ 

 

November 4

 

Today my initial CGM reading was satisfyingly low. ​​ However it rose quite unexpectedly during the morning. ​​ I used a lower carbohydrate ratio and insulin sensitivity factor during the rest of the day. ​​ This was a day of a surprising fall off of the plan and then getting back on with revised parameters.

 

Morning Novolog and Lantus Dose:

  • My CGM reading is 109. ​​ It stayed flat during the night, but did drift downward. ​​ Therefore I will decrease my Lantus dose to 12.5 units.

  • I will use CR=6 and ISF=75 based on yesterday’s calculations. ​​ I plan to consume 45 grams of carbohydrates at breakfast, so I will take 45/6 = 7.5 units of Novolog. ​​ I will add (109-120)/75 = -0.04 units. ​​ (Really, this is a subtraction.)

  • The total dose is 7.5 – 0.04 = 7.46. ​​ I round this down to 7, but wonder if it should be 7.5. ​​ 

 

Mid-morning:

  • At 10 my CGM reading is 380. ​​ This is a surprise. ​​ It effectively means that my CR and ISF estimates were too high. ​​ They should have been something like 4.4 and 63. ​​ 

  • Hopefully the insulin still on board will reduce this level.

 

Noon Novolog Dose

  • My CGM reading is still around 380. ​​ It did not decrease noticeably despite the unused insulin on board. ​​ It is as if my body did not respond much to the insulin dose. ​​ This does happen from time to time, and I have not been able to predict such occasions, except in times of high stress or illness.

  • I will hope that my CR can be 5.5 for the afternoon, up from the 4.4 of the morning. ​​ Likewise, I will hope for ISF=70.

  • I plan to have a lunch comprising 53 grams of carbohydrates (based on food package labels). ​​ Thus I should take 53/5.5 = 9.64 units of Novolog.

  • My CGM reading was 380 (milligram%/liter), significantly higher than my target of 120 mg/dL, so I will take an additional amount Novolog with the aim of reducing that 380 to 120. ​​ I hope that my insulin sensitivity factor (ISF) is 70, so I will add (380-120)/70 ​​ = 3.71 units of Novolog.

  • My total Novolog dose is 9.64 + 3.71 = 13.35 units. ​​ My syringe can deliver only multiples of 0.5 units, so I will take 13 units of Novolog. ​​ 

  • I took this dose at 12:000 PM.

  • I will wait until about 12:25 to begin eating, in order to reduce the CGM reading further and hopefully enhance my ISF.

Mid Afternoon

  • CGM reading 220 at 2 PM. ​​ Hopefully will head lower

 

Dinnertime Novolog Dose

  • CGM reading 167 at 5 PM;

  • this is as expected per the CR=5.5 and ISF=70 values. ​​ I will use these for calculting the Novolog dose.

  • Novolog dose: ​​ I plan to consume 54 grams of carbohydrates, so I will take 54/5.5 = 9.8 units. ​​ 

  • My CGM reading is 167, slightly above the evening target, 150. ​​ Therefore, I will add (167-150)/70 = 0.24 units.

  • The total Novolog dose is 9.8 + 0.24 = 10.04 units. ​​ I will take 10 units.

 

 

Bedtime Novolog Dose:

  • At 7 PM the CGM reading was 80, so I consumed 3 gm (popcorn) + 6 gm (orange juice) = 9 grams carbohydrate.

  • At 9:11 PM the CGM reading was 171, falling slightly. ​​ I re-estimate the CR and ISF as 6.8 and 78, based on the now-higher insulin effectiveness. ​​ At this time, 9.19 units of the Novolog has been consumed, based on a 5-hour activity period for Novolog [3]. ​​ 

  • At 10 PM, 5 hours after the last Novolog dose the CGM reading is 242. ​​ This is higher than the target value, 150. ​​ Accordingly, I will take (242-150)/78 = 1.17 units of Novolog to bring the CGM level to 150,.

 

November 5

 

Morning Lantus Dose

  • Overnight my (continuous glucose) meter (CGM) readings ranged from 240 at 10 PM, down to 90 at 3 AM. ​​ After 3 AM there was no change. ​​ I had taken 1 unit of Novolog, so the apparent insulin sensitivity factor (ISF) is (240-90)/1 = 150. ​​ I do not believe that I can apply this value during the day, however. ​​ Although the CGM reading was ‘flat’ after 3 AM, I will retain my Lantus at 12.5, hoping to avoid too-low readings overnight.

Morning Novolog Dose

  • I will use CR=6 and ISF=90. ​​ (Higher ISF based on discounted overnight apparent ISF=150.) ​​ I plan to consume 45 grams of carbohydrates at breakfast, so I will take 45/6 = 7.5 units of Novolog. ​​ I will add (169-120)/75 = 0.65 units.

  • The total dose is 7.5 + 0.65 = 8.15 ​​ I round this down to 8. ​​ 

 

Noon Novolog Dose

 

Dinnertime Novolog Dose

 

Bedtime Novolog Dose

 

 

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