Sugar Surfing Lesson 14: Dosing on the Deltas

  Perhaps the most counterintuitive aspect of Sugar Surfing™ is the act of dosing rapid insulin when blood sugars are still in range. Static diabetes self-care limits us to only inject rapid-acting insulin when blood sugars are well outside of our assigned target range. Dosing insulin between meals when the sugar level is in range is largely forbidden and does not make sense when all you have is a single blood sugar value to base that decision upon. One exception might be when additional carbohydrate containing snacks are being eaten between meals.

Static diabetes management means insulin doses are based on predetermined formulas, algorithms or arbitrary sliding scales. Specifically, mealtime insulin doses are based on a single blood sugar measurement and a carbohydrate estimate of the food to be eaten. The timing of the insulin dose and the meal may not be done in any particular order. All that matters are that both are done.

 

The larger situation under which the blood sugar is measured is also not considered. Static diabetes management poorly addresses changing, real world conditions. Sugar Surfers learn to appreciate that life situations are not easily reduced to mathematical formulas or dosing ratios. In contrast, dynamic diabetes self-care depends on balancing the objective (things which are relatively easy to measure or quantify) and the subjective (intangibles like stress, illness, slowly digested foods, even the intensity of physical activity). Timing also becomes a vital element of self-care and has been discussed in prior lessons.