Adjusting Insulin Pumps For Keto: A Comprehensive Guide

Adjusting insulin when using an insulin pump requires careful monitoring and adjustments to prevent high or low blood sugar levels. When starting a keto diet, it is crucial to lower insulin doses to avoid low blood sugar. This is because keto diets are low-carb, high-fat, and protein-rich, which affects blood glucose levels and insulin requirements.

People with type 1 diabetes on keto may need to adjust their insulin-to-carbohydrate ratio and basal rate. They should closely monitor blood sugar levels and ketone levels to prevent diabetic ketoacidosis, a serious condition. Type 1 diabetics should not stop insulin completely but can benefit from smoother blood sugar control on keto.

For type 2 diabetes, insulin doses, particularly long-acting insulin, may need to be reduced by 30-50% when starting keto. Mealtime insulin may be reduced more than basal insulin. Close monitoring and working with a healthcare professional is essential to safely adjust insulin therapy on a keto diet.

Adjusting insulin doses based on blood sugar patterns

Understanding Blood Sugar Patterns:

• When using an insulin pump, monitor your blood sugar levels consistently to identify patterns. Look for fluctuations that occur at specific times of the day and adjust your insulin doses accordingly.
• Keep a record of your blood sugar levels to identify these patterns. This will help you make more informed adjustments.

Adjusting Insulin Doses:

• If you experience high blood sugar levels for three consecutive days at the same time of day, increase your insulin dose. Consult with your healthcare professional to determine the appropriate amount of increase.
• Conversely, if you have low blood sugar levels for two consecutive days at the same time of day, decrease your insulin dose. Again, seek guidance from your healthcare team on the extent of the decrease.
• The insulin-to-carbohydrate ratio (I:C) is crucial. It determines how much insulin your body needs to process a certain amount of carbohydrates. Work with your dietitian to calculate your specific I:C ratio and adjust your insulin doses accordingly.
• The blood sugar levels checked 2 to 4 hours after a meal indicate how well the bolus for that meal worked. If your pre-meal blood sugar levels are within the target range, the bolus doses are appropriate.
• For high blood sugar levels checked 2 to 4 hours after a bolus, adjust your basal insulin amount accordingly. For example, if your child's blood sugar is high three days in a row before breakfast, increase the basal insulin amount four hours before breakfast.
• Similarly, for low blood sugar levels checked 2 to 4 hours after a bolus, adjust your basal insulin dose. If your child's blood sugar is low two days in a row before breakfast, decrease the basal insulin dose four hours before breakfast.
• Remember that the goal is to prevent the problem with blood sugar levels rather than correcting it afterward. Work closely with your healthcare team to fine-tune your insulin doses and maintain stable blood sugar levels.

Other Considerations:

• When starting a ketogenic diet, insulin therapy usually requires adjustment, and close monitoring is essential.
• The ketogenic diet's high-fat content can slow down digestion, so consider delaying the bolus or using an "extended" bolus to prevent post-meal lows followed by delayed highs.
• Large amounts of fat in a meal can also increase insulin resistance for the next 8 to 12 hours, requiring more basal insulin to maintain stable glucose levels.
• Always consult your doctor or healthcare team before making any changes to your insulin doses or starting a new diet. They can provide personalized advice and ensure your safety.

Understanding the insulin-to-carbohydrate ratio (I:C)

The I:C ratio is expressed as 1 unit of insulin to X grams of carbohydrates (e.g., 1:10 or 1:15). For instance, an I:C ratio of 1:15 means that one unit of fast-acting insulin is required for every 15 grams of carbohydrates consumed. This ratio helps individuals with diabetes calculate the amount of insulin needed to "cover" the carbohydrates they eat or drink.

To calculate the I:C ratio, the “Rule of 500” is commonly applied. This involves dividing 500 by the total daily dose of insulin (basal plus bolus). For example, if your total daily dose is 60 units, your I:C ratio would be 1:15. This calculation serves as a starting point, and further adjustments may be necessary based on individual factors.

It's important to note that the I:C ratio is not static and can change over time. It depends on various factors, including lifestyle, diet, weight, age, and health goals. Therefore, it's crucial to work closely with a healthcare professional or a dietitian to determine and adjust the I:C ratio as needed. They can help establish a pattern of blood sugar levels and make the necessary adjustments to prevent persistent high or low blood sugar levels.

Additionally, when starting a keto diet, it's important to consider the effects of dietary fat. While fat does not turn into glucose, large amounts can cause insulin resistance for up to 12 hours afterward. In such cases, a temporary basal increase may be required to offset this effect and keep glucose levels stable.

Basal rate adjustments

When starting a keto diet, insulin therapy usually requires adjustment, and patients should be closely monitored.

• Timing and Frequency: Basal rate adjustments should be made based on consistent patterns in blood sugar levels. For instance, if blood sugar levels are high three days in a row before breakfast, you should increase the basal insulin amount four hours before breakfast. Similarly, if blood sugar levels are low two days in a row before dinner, you should increase the insulin-to-carbohydrate ratio (I:C) specifically for dinner.
• I:C Ratio: The I:C ratio is the amount of carbohydrates (in grams) that one unit of rapid-acting insulin makes available to the body cells. Adjusting the I:C ratio can help manage blood sugar levels. For example, if your child's I:C is 1:10, decreasing the ratio to 1:9 for a specific meal can help manage high blood sugar levels before that meal.
• Blood Sugar Checks: Blood sugar levels checked more than four hours after a bolus can indicate how well the basal rate was working in the previous hours. Therefore, it is important to monitor blood sugar levels regularly and make adjustments as needed.
• Collaboration with Healthcare Professionals: It is important to work closely with your healthcare team when making basal rate adjustments. They can provide guidance and advice based on your existing insulin doses and help you determine appropriate basal rates and boluses.
• Gradual Adjustments: When adjusting basal rates, it is often recommended to start with small changes and gradually increase or decrease the basal amount as needed. For example, if your child's basal insulin amount is 0.4 units/hour, you may set the basal rate to 0.45 units/hour and monitor the impact on blood sugar levels before making further adjustments.
• Mealtime Insulin: While basal rate adjustments are important, it is also crucial to consider mealtime insulin doses. In some cases, you may need to reduce mealtime insulin doses or even discontinue them completely, especially if blood sugar levels continue to drop.
• Individual Variability: It is important to recognize that basal rate adjustments may vary from person to person. Factors such as weight loss and adherence to the ketogenic diet can impact the necessary insulin adjustments, so it is essential to closely monitor and adjust insulin dosages accordingly.

Managing high blood sugar levels

When starting a keto diet, it is important to adjust your insulin doses to avoid high blood sugar levels. Here are some detailed instructions and guidelines to help manage high blood sugar levels when using an insulin pump:

• Monitor blood sugar levels regularly: Keep a close eye on your blood sugar levels, especially when starting a keto diet. Check for patterns in blood sugar levels that fall outside your target range and adjust your insulin doses accordingly.
• Adjust insulin doses based on patterns: If you experience high blood sugar levels for three consecutive days at the same time of day, increase your insulin dose. Work with your healthcare professional to determine the appropriate adjustment.
• Understand the impact of dietary fat: When following a keto diet, consider the effects of dietary fat. Large amounts of fat can cause insulin resistance for the next 8-12 hours, requiring more basal insulin to maintain stable glucose levels. You may need to raise your basal rate temporarily.
• Consider the insulin-to-carbohydrate ratio (I:C): The I:C ratio determines how much rapid-acting insulin your body needs to cover a certain amount of carbohydrate intake. Consult with your dietitian to determine your specific I:C ratio and adjust it based on your blood sugar levels.
• Adjust basal rates: Check your blood sugar levels more than four hours after a bolus to understand how well your basal rate is working. Adjust your basal insulin amount accordingly to maintain stable blood sugar levels.
• Seek professional guidance: Consult with your healthcare team, including your doctor, dietitian, and other specialists, to determine the best course of action for managing your blood sugar levels. They can provide personalised advice and support throughout your keto journey.
• Be cautious with insulin reduction: When reducing insulin doses, it is generally safer to decrease doses by a larger amount rather than a smaller amount. This is because taking too much insulin can lead to dangerously low blood sugar levels, while slightly high blood sugar levels for short periods are usually less harmful.
• Monitor ketone levels: If you are following a keto diet, monitor your ketone levels regularly. Ketosis is a normal state that occurs when the body burns fat for energy. However, people with type 1 diabetes are at risk of developing ketoacidosis, a dangerous complication. Stay within a safe ketone level range to avoid potential health risks.
• Maintain open communication: Communicate frequently with your healthcare team throughout your keto journey. They can guide you in adjusting your insulin doses and provide valuable advice based on your individual needs and experiences.

Managing low blood sugar levels

• Understanding Low Blood Sugar: Low blood sugar, also known as hypoglycemia, is a common side effect of insulin therapy. It occurs when blood glucose levels drop below the normal range. Symptoms of low blood sugar include dizziness, sweating, hunger, confusion, and in severe cases, seizures or loss of consciousness.
• Frequent Blood Sugar Monitoring: When starting a keto diet, it is crucial to monitor your blood sugar levels frequently. This is because a keto diet can lead to fluctuations in blood sugar levels, and you want to be able to adjust your insulin doses accordingly. Check your blood sugar levels before and after meals, and at regular intervals throughout the day.
• Adjusting Insulin Doses: If you experience low blood sugar levels for two consecutive days at the same time of day, you should decrease your insulin dose. This is known as a basal rate adjustment. Work with your healthcare team to determine the appropriate reduction in insulin units per hour.
• Mealtime Insulin and Carbohydrate Intake: When on a keto diet, the amount of insulin you take before meals (bolus) and your carbohydrate intake become even more important. You may need to adjust your insulin-to-carbohydrate ratio (I:C) to prevent low blood sugar levels. Consult a dietitian to determine the appropriate I:C ratio for your specific needs.
• Managing Ketosis: A keto diet aims to induce a state of ketosis, where the body burns fat for energy instead of carbohydrates. However, people with type 1 diabetes need to be cautious as ketosis can progress to dangerous ketoacidosis if not properly managed. Monitor your ketone levels regularly, especially if you feel unwell, are fasting, or have been exercising.
• Communication with Healthcare Team: It is essential to maintain open communication with your healthcare team, including your doctor, diabetes educator, and dietitian. They can guide you in adjusting your insulin doses, meal plans, and exercise routines to prevent low blood sugar levels.
• Emergency Preparedness: Always be prepared for the possibility of low blood sugar emergencies. Keep fast-acting carbohydrates, such as glucose tablets or juice boxes, with you at all times. Educate your family and friends about the signs of low blood sugar and how to assist you in an emergency.
• Fine-Tuning and Patience: Adjusting to a keto diet with an insulin pump takes time and fine-tuning. Be patient with yourself and the process. Keep a logbook or use a diabetes management app to record your blood sugar levels, insulin doses, meals, and physical activity. This will help you identify patterns and make more informed adjustments.

Remember, managing low blood sugar levels is a delicate balance, and it may take some time to find the right approach for your individual needs. Always work closely with your healthcare team to ensure your safety and well-being throughout this process.

Frequently asked questions