#964 Defining Diabetes: Carb Ratio

July 28, 2023Scott Benner

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define Carb Ratio.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 964 of the Juicebox Podcast. We haven't done this in a while

today's episode of The Juicebox Podcast is with me and Jenny Smith, and it is a another in the defining diabetes series. This episode brings the defining diabetes series to 50 episodes. This whole thing started years ago when I decided that I wanted to define each term that you would use daily with diabetes. The defining diabetes series began on episode 236 With Bolus and it's been going on for years. Today, we're going to be discussing insulin to carb ratio or carb ratio. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. You can use my offer code juice box at checkout at cozy earth.com to save 40% off of your entire order and get a free year's supply of vitamin D and five free travel packs with your first order at drink ag one.com Ford slash Juicebox.

Podcast so this episode of The Juicebox Podcast is sponsored by the Omni pod five, and the Omni pod dash. It's sponsored by Omni pod, but they have two different kinds of Omni buds, they got dash and they got five. You're like us, Scott, it seems like a lot, but it's not, you know where you can go to make sense of it all. Omni pod.com forward slash juice box. While you're there, you can learn all about the Omni pod five, which is an algorithm based insulin pump, or the Omni pod dash, which doesn't have an algorithm, but it's still tubeless and delightful. My daughter has been wearing it on the pod every day since she was four years old, and she just turned 19 This week on the pod has been nothing but a friend in this journey. And I think you would really enjoy it. Head over to my link. Now to learn all about Omni pod, scroll down, take a look around you're gonna see pictures descriptions, here's a little button, check my coverage if you want to check your insurance coverage and get started. Or here's another button. I'd like a free trial of on the pod who take the pod for a test drive. But look for those purple buttons when you get there. Read all about on the pod. But really, here's what you need to know. It's a tubeless insulin pump. You can swim with it bathe with it, your activities will not get in the way. Right? They play in soccer, there's no tubing, you're walking through the kitchen, nothing to get caught on like a drawer or something like that. But man not having to disconnect for bathing and swimming. It's a big deal. I don't think people think about it. But it's summertime right now. And it's just terrific. All those other two pumps you disconnect to get in the water and how many times have you forgotten to put it back on. And then no insulin, high blood sugars, and all the rest. That's not going to happen with on the pod because you don't have to take it off to be active Omni pod.com forward slash juice box, check out the algorithm based pump that works with the Dexcom G six, that's called Omni pod five, or you get the Omni pod dash. Whether you want an algorithm or not, you're gonna get the best damn insulin pump my daughter has ever used, and that I've ever seen Omni pod.com forward slash juicebox. Jenny, we have not done one of these in quite some time. But I am being told by the powers that be which means Isabel in the Facebook group, that we are lacking a defining diabetes episode for carb ratio. And she really thinks it's necessary. Oh, so we miss how did we miss that? Oh, no, I feel like it's my fault. I can tell you that much.

Jennifer Smith, CDE 4:07
Well, we came up with the list and we'd sort of put them together in order to gather. So I missed it.

Scott Benner 4:16
It's also your fault. Perfect. It's also my fault. All right. Yeah. Well, I like that better. It makes me much more comfortable.

Jennifer Smith, CDE 4:22
No one is perfect, Scott.

Scott Benner 4:24
Thank you. I appreciate this. So you're gonna hear some people call it carb ratio, you're gonna hear some people call it insulin to carb ratio, right? There's no other names.

Jennifer Smith, CDE 4:34
Insulin to carb ratio ICR IC insulin to carb. They might do it reverse carb to insulin. But yeah, insulin and carb as a ratio to cover food.

Scott Benner 4:48
Yes, Jenny. There are people who love this podcast and love you. And I don't think you're even aware of this but that I'm gonna get you to say carb so many times is really going to delight them because of Your accent? You don't even know that do

Jennifer Smith, CDE 5:02
you? Do you? I say it weird.

Scott Benner 5:04
I mean, not to you. But I'm so excited about

Jennifer Smith, CDE 5:10
saying I didn't know that I said it. Interestingly, comparative.

Scott Benner 5:15
Interestingly, that's a lovely way to put it. You say? We'll say it again. carb. Yeah. I think it happens more in a sense, you kind of go carob it's like that. It's interesting, right?

Jennifer Smith, CDE 5:26
Yeah, it kind of goes along with the Midwest. Oh,

Scott Benner 5:31
yes. Oh, yeah. 100%. Yeah, but trust me, this is going to tickle people I'm gonna get, I'm gonna get notes about this. Here's what the noodle say, Thank you for having Jenny say carp.

Jennifer Smith, CDE 5:42
That's really fun. I never, I guess I didn't realize people, I probably made the way that I speak,

Scott Benner 5:48
I probably didn't tell you when that happens, but I'll start sending those notes to you. Oh, that would be lovely. So I'll tell you what I'm going to do. I never do this. But I'm gonna go to Integrated diabetes services. Right. And there's a whole thing there from Gary about insulin to carb ratios made easy. So he's got it all broken down. We're not going to dig all through it, we're just going to, we're going to tell you what it is. So I'm gonna give it to you from my head, and then you'll give it to me from you remember how we do this, and then you'll give it to me the right way. So insulin to carb ratio is just a measurement, it's how much insulin you need. One unit covers how many carbs? So Arden's carb ratio is what people would consider strong or aggressive, right? So her insulin to carb ratio right now is one unit for five and a half carbs. Okay, which I think people would think like, wow, that sounds like a lot. But it's the amount that we know she needs. And other people might be like, Oh, my God, I use one unit for every 20 carbs or 40, you might be a kid getting one unit for 100 carbs, I have no idea. But that's all a carb ratio is is it's it's that measurement that you tell your pump, when you're setting up your settings near pump, or the amount you use when you're drawing up insulin in MDI. I don't know that there's another way to explain it is there?

Jennifer Smith, CDE 7:08
No, I didn't have to say very much. So I don't think people are gonna be able to hear me say car, but I know.

Scott Benner 7:17
I'll lead you down another road. So we get back to it.

Jennifer Smith, CDE 7:20
But no, you described it very, very well, essentially, you figure out how much one unit of insulin covers a certain amount of carbohydrate that you eat. And with some evaluation around your meals, you may find that a certain amount of insulin at a certain time of day covers a certain amount of carbohydrate, a little differently.

Scott Benner 7:43
And so like it when you leave the doctor's office, they're going to just give you an insulin to carb ratio. They're gonna say, here's where we're going to start with this. Now Jenny and I have actually done an episode about that. It's episode 821. It's called the math behind setting insulin to carb ratio. It's a catchy title. That was a while ago, wasn't it? That was at the beginning of this year. Does it feel like a long time ago to you seven?

Jennifer Smith, CDE 8:10
It feels like it was a while ago. Yeah,

Scott Benner 8:11
we made it about seven months ago. So. So there, so there is an episode, it's about 20 minutes long. And it explains to you how to set your insulin to carb ratio give you a good starting place. And it tells talks about the math, so you know how to do it yourself. But what I'm being told by Isabel is they're just a lot of people who just don't know what it means to begin with. So yeah, so she just wanted to have a defining diabetes episode for it.

Jennifer Smith, CDE 8:38
Well, and that's really interesting. I wonder, I wonder how many of those people were diagnosed maybe, with the questions that came in how many were diagnosed, maybe as an adult, and were given a set amount of insulin to just take at a mealtime, almost what's referred to as an old scale, or an old sliding scale, kind of concept of, don't worry about how much you eat. Just take three units of insulin with each mealtime. And that's what's going to cover it. And so maybe they've never really been moved into the concept of counting up, how much you're eating and taking a certain amount of insulin to match what you want to eat. Rather than being told you just have to eat about the same amount all the time

Scott Benner 9:27
my mind jumps to, excuse me, my mind jumps to I wonder how many people's doctors keep cranking up their insulin to carb ratio as they get older or gain weight or something like that, and don't reevaluate their Basal. And how many people's insulin to carb ratios are probably wrong. We're more aggressive than they need to be if they're basil was right. That's the thing. I really wonder about it. Yeah. I think that this is I think diabetes is a good example of people wanting to be set it and forget it. It's not Your your situations change. Like you know Arden's a great example at college, there's one quality of food at home, there's a different quality, she needs more insulin in college than she does. At home, she needs more basil at college, her carb ratio stronger at college than it is at home. But that's happening to people all over the place. And doctors, generally speaking, ignore your basil. Like, I know, that's not everybody, but a lot of people's basil does not get considered again. So as you start needing more insulin, I think they start putting it into your correction factor. And they start putting it into your carb ratio sometimes.

Jennifer Smith, CDE 10:37
Yeah, I think the car ratio is the one that's the heaviest in terms of first adjustment. I always actually consider the correction factor or as like the forgotten, like stepchild and corner kind of, like, I have some people that I end up working with initially. They're like, I don't know, what does that do? Or I don't know, that hasn't been changed since I started on a pump 15 years ago. And I'm like, it makes me kind of cringe that nothing's been evaluated.

Scott Benner 11:10
So correction factor. One you live insulin moves your blood sugar, how far right? Correct. When Arden was a few years into diabetes, I started thinking like, I can't move these high blood sugars. Like I couldn't figure out why. And i Nobody told me like I had to dig through it. It was before I'm with Scott from the podcast, and like, so I was like looking through it. And I realized that Ardens correction factor was one moved it they had it set at 301 unit moves or 300 points. Well, that was not even close to being true. And even back then it was more like one to 100 today, today. It's like 143, maybe, you know, and so, but that's also things that we reassess. So you need to know what these things are, so that you know what they do so that you know that you need to look at them when you're having issues. Correct. Yeah. Okay.

Jennifer Smith, CDE 12:06
And I think that's a good point to make. As you said before, this isn't a set it, I figured it out, and okay, now I've got it for the rest of my life, it's not that way at all. You may have lifestyle change, you may have growth in your child or your teenager, you may have something significant that shifts for you as an adult. And so once you have it set and figured it out, once you start seeing it, something isn't working, and I haven't changed any other variables, then you need to reassess, well, gosh, maybe my one unit per 10 grams of carbs isn't working anymore. I'm now always low after lunchtime, yeah. Reevaluate.

Scott Benner 12:47
I just thought of something I never occurred to me before, I'm just gonna say it here, before we end, you buy a brand new car, and they tell you it gets 30 miles to the gallon. And you drive it away, as you drive it away, you think, Oh, they told me to use premium fuel, but I don't want to spend all that money on that I'm going to use regular, now you're gonna get less gas mileage, then the air filter starts to get dirty, and you're gonna get a little more lowering of your gas mileage, and then the tire start wearing unevenly and your gas mileage lower it literally, diabetes does the same exact thing. You know, like, if you moved to an area that's at a different elevation, your car will get different gas mileage. If you move to a higher elevation place, you don't need as much insulin most of the time, like so. They're, they're all these little things. We call them variables when we're talking about them, but they're, they're all these little unseen forces that change how much insulin you need that and they're everywhere, and you're not thinking about them. So reassessing your insulin to carb ratio. And your other settings is really important. So yes, okay. Well, there we go. i Because I said to her, I'm like you want us to describe what a carb ratio is? And she said, Yeah, I'm like, I think that's going to be like a 45 second episode. Are you sure we need that? And she's like, You should see how many people don't know we need somewhere to be able to send them and I said, Okay, fair enough. I'll make Kelly do it. Awesome.

Jennifer Smith, CDE 14:11
I think that was, I don't know. 10 minutes. 11 minutes wasn't bad. It was bad. No, it was purposeful. So yeah,

Scott Benner 14:18
yeah. Right in right now. All right. Thank you. Sure. I might have ruined all your fun by telling Jenny she says curb. Thanks so much to Jennifer Smith. Hey, Jenny works at integrated diabetes.com If you're interested in hiring her I also want to thank Omni pod makers of the Omni pod dash and Omni pod five and remind you to head right now to my link Omni pod.com forward slash juicebox I can't say enough good things about Omni pod. I hope you go check it out. The entire defining diabetes series is in your podcast player. If you want to see a list of the episodes go to juicebox podcast.com up top in the menu, click on defining diabetes. And there's a list. That same list is available in the featured tab of the private Facebook group Juicebox Podcast, type one diabetes. I hope you're following the Facebook groups. There's a private group with 40,000 members, great conversations all day long about diabetes. And there's a public page Juicebox Podcast, give them a follow. You're gonna find them incredibly helpful. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.