Life on a Sliding Scale: The Ups and Downs of Diabetic Math

A Working Pancreas Is the Mathematician Most People Take for Granted

Diabetes isn’t just about watching what you eat; it’s doing math equations the moment you get out of bed, before every meal, before long or intense physical activity, before sex, before driving or operating heavy machinery, before a performance, more often when you’re sick, more often in extreme weather conditions, more often when you drink alcohol, more often when you travel across time zones, and checking your answers two hours or so after. Then there’s more math to correct your mistakes and make sure you’re good before bed time and sometimes the damn disease wakes you up in the middle of the night to do some extra credit work.

I failed my statewide exam in high school… twice… and barely passed the math for elementary school teachers course in college, but when it comes to diabetes math, seven times out of 10, I’ve got this. Let’s imagine I wake up with my blood sugars in range. Ideally 80-140 is where I’m functioning at my absolute best, but I try not to get too upset if I don’t exactly hit the mark. I want to decide what to eat for breakfast.

[15 grams of carbs is equal to one carb count]

For every carb count I need 6 units of insulin. So if it’s 30 grams I do 2 x 6 = 12 units of insulin. If my current blood sugar is higher than my normal range, I add 1 or 2 more units of insulin. If my current blood sugar is lower than my normal range, then I would subtract 1 or 2 units of insulin from the 12. This is the basic diabetic math formula.

[carb count × number of units of insulin you need per carb count + or – a few units based on your current blood sugar]

Carb count gets harder to figure out when you’re staring at a piece of fruit or a restaurant menu with no nutrition facts to guide you. But there are apps like Glooko (my personal favorite) and Google has for the most part gotten pretty good at answering, how many carbs are in X. When in doubt, I think about my current blood sugar, how much I’m going to eat and the effect that particular food group has on my blood sugars. I document patterns of impact from sauces and marinades to animal protein (which can cause insulin resistance in excess) vs. plant protein and caffeinated beverages and learn what amount of insulin works best to navigate the no-nutrition-facts-available situations.

The Impact of Exercise on Blood Sugars

Performances and workouts tend to spike my adrenaline and blood sugars while longer walks tend to lower them. Before I start moving, I’ve got to be 70-80 for a high intensity day and in the high 100s for low intensity day and checking and correcting with more sugar or insulin during and after physical activity. Post-exercise, if I’m at 300 mg/dL, I need 5 units of insulin to get me back in range within the next half hour and I watch it closely in case there are delayed effects of the exercise. If I am at 50 mg/dL I need about 20 grams of carbs to get me back to my normal range. Any lower than 50 and I’ll need about 45 grams of carbs or to use my emergency glucagon pen injected into a muscle, not my stomach (where I inject my insulin) to bring me back to normal. The scale is constantly sliding when I’m moving.

Long-Acting Insulin

These insulin needs will be different for everyone. I’ve spent 14 years and counting figuring out what math works for me. I take a fast-acting insulin with meals or to correct a high blood sugar and a long-acting insulin which helps regulate sugars throughout the day and night. I take 16 units of my long-acting insulin if my current blood sugar is over 100 mg/dL or 14 units if my sugar is under 100 mg/dL every morning.

Traveling Abroad With Type 1 Diabetes

If I am traveling overseas I take half the dose of long-acting insulin in the morning EST and half the dose at morning time at my destination so my body can stabilize. I do this for the first three days of my trip and then return to the full dose at the local morning time and repeat, on my return trip. The adjustment is tiring, but necessary to avoid a blood sugar rollercoaster.

The Impact of Alcohol on Blood Sugars

Alcohol is tricky and often requires more frequent checking and adjusting of insulin. Blood sugars can spike or drop dramatically several hours after consuming alcohol, depending on the type of alcohol and quantity. I tend to avoid mixed drinks altogether, because the impact is unpredictable. So more than about watching what you eat, diabetes is about moderation and listening to your body’s needs. If I’m right 60 to 70 percent of the time, I can avoid complications and continue to live a full life.

Since I live on a sliding scale, I have to make sure my provider and my health insurance are on the same page about the minimum amount of insulin pens, needles, test strips and lancets I need to live on. This tends to be the most complicated math and can result in the most dangerous human errors as I have made 18 calls between my provider and health insurance to get it right, so I’ve broken it down into an easier chart. Keep in mind, my ratio of carb count to insulin is 1:6. I typically eat 2 to 4 carb counts per meal. That’s 12 to 24 fast-acting units times three meals a day + the possibility of dessert or needing to correct a high blood sugar so I need of an minimum allowance of up to 75 units of insulin daily. That doesn’t leave much room for error… or dessert. I take 14-16 units of long-acting insulin once daily.

Diabetes Supplies Needs for 90 Days

Luckily the more complicated math is only done once a year.

My A1C (the three-month average blood sugar reading) is at 5.6. I’m in range more often than not. I’d say my math teachers would be pretty proud of me.