Type 1 diabetics rates and ratios.

Type 1 diabetics are infiltrated with a constant stream of numbers, calculations, rates and ratios, the baseline, fundamental systems which help us manage our diabetes. They are brilliant, until they are not.

The thing about ratio calculations, pump algorithms, and basal rates, is they are just that, a fixed principal which does not account for life outside of normal. Your insulin to carb ratio, does not tailor your dose based on whether you have been stressed, or sleep deprived, or experienced a change in climate, or have been on a walk or a run, or to the gym, a few of the upwards of 40 factors outside of carbohydrates which impact your bodies.

insulin and your body.

So when you rely on the equation and nothing else, you will be left wondering why what worked yesterday did not work today, even though nothing “really changed,” when something as small as a change in temperature or a stressful conversation at work could impact the way in which your body responds to insulin.

We must be adapting the result of the equations we are using, by applying the context of our circumstances and situation to come to a more well rounded and better informed decision, rather than just relying on the ratio itself.

This adaptive approach to Type 1 diabetes management is a major focus inside our Elevate membership, where we teach members how to interpret trends, patterns and real-life variables beyond carbohydrates alone.

decision adapting diabetes managment.

Let me provide you with some examples of when context matters and how you can adapt your decision to accommodate.

You are waking up 2 hours earlier to catch a flight, it's the luteal phase of your hormonal cycle and you are someone who finds flying slightly stressful.

The fact you are waking up 2 hours earlier may mean you experience a more profound effect of foot to floor syndrome and your cortisol spike may be more apparent, therefore you might need to increase your foot to floor thresholds. You also have to account for the fact that you are feeling overall more stressed due to the nerves of flying, plus you are in your luteal phase, a time where many women experience increased insulin resistance and changing glucose patterns.

We discuss this in more detail in our guide to hormonal cycle changes and Type 1 diabetes management. Your normal rates are unlikely to work, even if you have secondary luteal rates in place, they may not be enough with the added stress from flying. You would likely be looking at needing extra basal and bolus for this sort of situation as well as longer pre bolus times, extra hydration would be really beneficial.

You are about to have lunch and then go on a nice long walk with a friend after and grab a coffee, its the weekend and you are having a relaxed day, you also went to the gym in the morning and did some upper body strength training for 1 hour.

factors at play for insulin sensitivity.

There is a lot of factors at play here to increase your insulin sensitivity, you are likely coming into your post workout sensitivity surge, which following strength training can kick in anywhere from 2-6 hours post workout, you are also going to be walking after you eat, two huge variables which will mean you use insulin really effectively. For the bolus for both lunch time and the coffee you have, you will likely need to manually reduce the total dose by a percentage which you will be able to specify through tracking data and experience. You may also require reduced pre bolus times. This is going to help you avoid any incoming hypos from the boost in sensitivity you will experience.

You went to the gym to do some cardio before work, but you are heading into 2 hours of meetings back to back where you intend to be seated for the duration. The nature of the meetings are slightly stressful but something you are well accustomed to.

pinpoint your baseline.

In this situation, you have a couple of opposing factors, one which will benefit bloods and the other which will make it slightly more difficult to balance. When you are articulating the way that you need to adapt your decision for this sort of situation, pinpoint your baseline, inclusive of your hormonal cycle phase and think about how this may additionally impact things, then you want to plus and minus for the incoming variables - how much would you deduct your bolus and rates by for the morning under normal circumstances, that's your new outcome, but now apply the changes you would make to combat the elongated periods of sitting and stress, it will bring you somewhere in the middle since the two factors check and balance one another, however usually one is more impactful than the other, so it's not always just back to middle ground, hence the plus and minus adaptations from the start point.

influential factors you may not realise impact your insulin sensitivity.

Some influential factors you may not realise impact your insulin sensitivity include sunburn, certain medications like steroids and antihistamines, caffeine (even in the absence of milk and sugar), dawn phenomenon, foot to floor syndrome, humidity, hot or cold water and many more.

Digestion speed, meal composition and glucose absorption patterns can also dramatically alter insulin timing and response, even when carbohydrate amounts stay the same.

Understanding digestion profiles and bolus timing can help make these responses far more predictable. When you are in a situation where these factors are present, start paying attention to th way in which your blood sugars respond to help guide your knowledge into how to adjust your approach and rates.

good to great t1d’s management.

This is what can take you from having good to great management, because it is the skill that arms you to be well managed in all conditions and circumstances, since you are not relying on a single theory or principal, you are using that to make a start but adjusting for your own personal bodies response to everything that is going on it your life, and if we really think about it, when are circumstances ever perfect? It is rare and it does not happen often.

trust your experience as a diabetic.

You will build up knowledge over time about how all of these factors impact you, trust your experience as a diabetic to help grow your confidence in making the shifts, the worst case scenario is not quite getting the shift right first time, in which case you can use your data to adapt and get it right next time.

Build Confidence Applying Nuance to Type 1 Diabetes Management

Inside Elevate, we help members learn how to adapt insulin, food timing, exercise strategies and glucose management decisions to real-life situations, rather than relying purely on fixed ratios and algorithms.

Great Type 1 diabetes management is not about perfection. It is about learning how your body responds under different conditions and building the confidence to adapt accordingly.

Ratios, rates and algorithms are valuable tools, but they cannot think critically for you. Your lived experience, awareness and ability to apply context is what turns information into better decision-making.

We cannot control every variable, but we can use logic, reflection and data to improve our decisions over time.