Adult Type One and I:C Ratios

Hey Everyone, I was diagnosed when I was 24 now 32 and I am just starting to learn more about this condition. I was misdiagnosed with type 2 and put on the wrong meds and I decided to get a second opinion at the time. Long story short, after having a baby in 2022 I feel like my body has changed. I am having to re-learn everything and the most challenging, especially after breastfeeding is finding the correct IC ratios. I know it’ll never be perfect but I am working towards getting my numbers under control. So I kinda want to start from scratch and wanted to know if anyone else experienced this (starting over trying to learn with their IC rations are) and what they did to get back on track without suffering from so many lows of course. I would like to try and start over safely. I am currently using OP5 and Dexcom G6 Sensor.

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@KayD Welcome to the group! There are several of us here that were mis-dx’d T2, then correctly as T1’s. I got my T2 dx at 58, put on oral meds with increasing dosage over the next 8 years until they stopped working completely, at that point my PCP said you may be one of these T1 LADAs and referred me to an Endo where I got correctly dx’d . It’s not the most common, but not rare either. You’re on CGM (G6) which is good, though Dexcom will push you to the G7 eventually. You’re on the O5 and hopefully that’s working relatively well for you (some people it works well for, others not so much). If it’s working for you then your numbers should be good, but your mention of trying to get better control makes me think possibly it’s not working that well. You’ll have to give us a bit more info on your numbers to aid you further. Normally, I’d launch into recommending you have your basal rate set correctly, but as I recall O5 takes your TDD (daily dose for basal and bolus) and uses a black box algorithm to determine where it will start and then continues to modify it as needed. As I haven’t used the O5, you’ll be better served by others here using the O5. I laud your efforts to get control as best possible; if you decide to try another system, let us know as someone here will have experience with whatever system your considering (example: I’m using G6, Dash pods, and DIY Loop). For now, I’m sure you’ll get a response from someone with O5 experience…

Hi @Tlholz ! Thanks for getting back to me, to answer your question my fasting BG is anywhere between 99 - 150 I usually don’t go over these numbers, and then I tend to stay anywhere between 180 - 250 after meals depending on what I eat but my diet is pretty much the same every day unless I eat out of course. OP5 does an amazing job of keeping me in range overnight but I am having an issue with how the pump responds to my highs. I tend to bottom out if I bolus, and then the pump decides to correct me every 5 min 20 min into my meal. (right now my IC ratio is 1:10 in the morning and 1:12 the rest of the day) and b/c of the pump correcting me so often this has caused me to scale back and not try and give myself too much insulin to avoid the sudden drops. I want my pump to be aggressive but not to the point where I am saving myself from a low every day it gets exhausting. My endo did make a change in my ISF recently it was at 100 and she changed it to 90 because she is always saying she never sees the “lows” I’m mentioning but that’s because I’m always preventing them by correcting them before I get below 90. The only thing I do notice is that I’m dropping while the pump is trying to bring me back to my target which is set to 130. I could understand if I was making a gradual drop but two arrows down with more than 2u of IOB and I’m in the low 200s is still just as scary when it’s dropping 30 points at a time.

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Hi @KayD and welcome to the forum! I’m on Omnipod5 too, after a few years on Tandem and several on Minimed. I find Omnipod’s algorithm works better for me than Tandem’s, but if course that varies.
Is not unusual for user set basal rates and/or carb ratios to change now and then - not that we are doing anything wrong but simply because our body’s needs change over time: it may be hormonal, or due to stress, different activity levels, or simply changes due to age. If I’m having patterns of highs or lows around the same time every day and can’t attribute them to the anything I have or haven’t done, it may be time to tweak my basal/s. And if I get a consistent response after eating at certain times then I’ll look at my carb ratio. I’ve found that small changes can make a big difference so I go in 0.1 unit increments and allow 3-4 days for the changes to settle in. (When I first first first started pumping in the mid-90s I was having some issues and decided to change a basal rate. I forgot if I :arrow_down: or :arrow_up: it by a full unit - but boy was that a mistake! Thankfully I was able to handle things on my own but that was a lesson learned!)
Changes may be needed for certain times of the day but not others; or to one or the other, or both.If you’re not familiar or comfortable with making your own adjustments, work with your doctor until you are.
With the Omnipod5 user set basal rates only come into play if you’re in manual mode - but they may need to be adjusted now and then as our needs change, so keep that in mind if you have issues with your numbers when in that mode.
I highly recommend you check out the book Think Like a Pancreas by Gary Scheiner. He has Type1 diabetes and works in the field so has a unique personal perspective that is particularly helpful. I was diagnosed in 1963 and read it for the first time 3 or 4 years ago, and was surprised how much I learned! And I found it to be a fun read.


Hi @KayD you can test I:c by starting at your normal blood sugar, eating a small snack with a known carb count, and watching your CGM for 4 hours. A good I:c will bring your bs back to the start at 4 hours. Remember that activity is really important so try to do what you normally do to test I:c and also that if you are even slightly more active, I:c can change by a lot (for me -normal activity I’m 1 unit to 12 grams, heavy activity I’m 1 unit to 100 grams carbs)

You cannot test I:c if your pump is in auto or your basal rate is not right. Basal testing takes a bit of trial and error and involves skipping meals.

My opinion is to force op5 into manual mode, get your programmed basal rate as close to perfect as practical, and then test and adjust I:c. Then back to auto. If you are uncomfortable making changes you can ask your Endo for a help, I’ve used CDE help even after 20 years of T1. Good luck.

Absolutely. Is 2u. what you gave to correct for the 200? Or was that an overbolus for a meal?

I have not used pumps, I do MDI and a glucometer. But I have found my experience as far as correcting for highs, and dropping significantly and quickly with insulin on board, to be very similar to what you describe.

My strategy, which I’ve been trying to get better at for several years now since I’ve been diagnosed in 2020, is to be pretty conservative with boluses and especially corrections. I really hate preventing and correcting for lows, and to do so frequently really is exhausting, not to mention taxing on one’s body (even more so than highs, at least for me). No, I don’t want to be high either.

But, say, if I’m realizing that fairly consistently 2u. is too much for a 200 reading (which it definitely is for me), next time I’ll do a lower correction based on how many carbs I needed to eat to correct for that over-correction. If I needed to eat 15 carbs later on to correct, for ex., then I would take 1.5u. less for a future correction of 200.

I also take into account how active I’m planning to be–if I’m not just going to be sitting, then I need even less correction. For me, a 200, not knowing any priors or planned activity, I would either not correct at all if I knew I still had insulin on board because even four hours after eating it can come down, it’s just that the carbs seem to have only momentarily “run passed” the insulin. Or, if I suspect I have no or little insulin on board, I might do 0.25-0.5u. Half a unit would be the max. My target range is like yours, in that I try to shoot for landing back around 120, sometimes 110 or 130, depending (not that I’m super successful at being so precise!), just because I do need that cushion for any margin of error.

Anyway, consistent drops really just mean, in all probability, that you bolused too much and/or corrected too much, so just keep ratcheting those things down. If you’re still going pretty high frequently, but needing less insulin ultimately, (which seems contradictory, but hey, it’s diabetes!), the issue may be timing–you could try shooting in the insulin longer before you eat to let it get more in your system (say five or 10 minutes earlier, depending, or more, if you’re pretty high to begin with).

Anyway maybe none of that helped given all your experience already. I wish you the best and congrats on your new addition!

It can be tempting to take an extra bolus for corrections, but don’t forget to check how much insulin in board (IOB) is left from a previous bolus, and even with the Omnipod5’s micro adjustments, bringing numbers down may take longer than we like sometimes. I find it’s generally best to let the system program corrections, unless there’s is something like a problem with the site.
Several months after starting on the Omnipod5 I found some Juicebox podcasts that were very helpful:

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@KayD Welcome Kayla to the JDRF TypeOneNation Community Forum. You ask if anyone has had to start over and learn again [I:Cr] how to manage their T1D - (I heavily rephrased your question) . I for one have had to relearn my management technique during my seven decades using insulin injection/infusion to stay alive; usually the needed method change was brought about by scientific discovery. Carb ratios [I:Cr] was one of the big revolutions in treatment methods we developed [under Dr. Bill Black] in the mis 1970s when we created the formula now used for bolus calculations in most insulin pumps.

The method outlined by @Joe is the most effective and it is made very convenient by use of your G6. IMO, carb ratios using this method are more accurate if first basal rates programmed in your infusion pump are set as accurately as possible.

And NO, you will never “be perfect” as long as you are human and not a robotic machine. Go easy on yourself and don’t let one day, or a few days, of way-off numbers discourage you; look at the bigger picture - how you are feeling, if you can do things you want to do - especially enjoying your new baby, and celebrating life.

Know that it is highly unlikely that your I:Cr at 7:00 AM will be the same as it is at Noon or at 6:00 PM. And, that the ISF [insulin sensitivity factor / correction ratio] is one of the more critical factors needed for automated/assisted dosing calculations in pumps such as OmniPod5.

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Hi! Thanks for responding I keep hearing about this book think it’s a sign to buy and read it so I’m going to read it! Thank you!

Hi @joe! okay, thanks a lot I will try this! I started on the dash and mastered my rates on that so I could capture that data from there and test it out.

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hi @BKN480 ! thanks so much, it’s good to know I am not the only one. So after my pregnancy, i cut my insulin in half but it was still too aggressive, (I was on the omnipod dash at the time) so I would bolus 4 units for my rice, chicken, and veggies and by the time my husband and i got to the park I would bottom out with 2 plus unit still on board. I am factoring in my attempted walk in the park but i always felt like 4u for a balanced meal was too much

hi @Dennis thanks for your comment and the history behind it, it’s so interesting. I feel fine most days and have even gone back to working out every other day, seems to me the only issue IS my blood sugar lol. I am finding myself wanting to buckle down and just get to a place where I can trust that the amount of insulin I take will cover the carbs without so many lows/highs because I’m also getting over my fears of that (lows), it’s been quite the journey. I am just now starting to trust the 15: 15 rule and I’ve been diagnosed for about 9 years now. How I managed diabetes 4 years ago I can’t tell you. I wasn’t afraid of highs or lows b/c i didn’t really understand it, but as of late I am researching and trusting trying to learn how to trust my body beyond what the doctor is telling me. I got tired of hearing oh let’s just increase your insulin, going low, and then recovering from lows only for the dr to tell me i’m still high.

I’ve never been penang so I hope you won’t mind my asking, but I freshener reading that insulin needs can increase greatly during pregnancy. Was that the case for you, and did you go back to what you were doing before you got pregnant?
It sounds like you’re going to have to continue with trial and error to find what works now - hang in there, and most important congratulations on your little bundle of joy!!

Thank you! no worries thats why we are all here! &. yes by end of my pregnancy i was 1:2 and went back up to 1:6 - 1:8 shortly after giving birth for all meals and that was too much insulin so i am just trying to figure this whole thing over again. The doctors bumped me up to 1:10 but i started having those lows where i eat and bottom out an 45min - 1lr later, so here i am at 1:12. I have no lows but i am still running high and my dr recently suggested that i take my insulin after i eat because it hits my system faster than my food is digesting it.

Yeah it’s weird how much needs can change. It sounds like a major shift, needing to cut your dose in half, but honestly I’m not surprised at all given my own experiences, ven only being at it a few years (and no pregnancies, just other issues like illness and increasing exercise). Main thing is, if my body seems to be telling me I need less/more consistently, no matter how “illogical” it seems, I just try to listen and follow orders… :slight_smile: :slight_smile: