Flat amount of insulin every meal regardless of what the meal is… is that normal?

That’s fairly normal to start. Especially in a new diagnosis, your body is still likely making some insulin, and the counter-regulation mechanisms haven’t completely deteriorated yet.

You’ll eventually move to carb estimation (“counting” is a misnomer) and titrating doses based on carbohydrate content.

At some point, you may even move beyond that to just looking at a plate of food and thinking “3.4 units” or “9.3 units” or whatever. Or you may start trying to account for fat and protein in addition to carbs.

Or, depending on how quickly insulin and automated delivery technology improve, you might wind up forgetting everything that was taught because your pump just takes care of it.

Yes, you should have your insulin:carb ratio figured out and be dosing appropriately for the carbs in your meal. You should definitely be challenging that. If they aren't helping you adjust, then you need a new doctor. You should be seeing an endocrinologist and I highly suggest a dietician or nutritionist at some point.

This does sound like the kind of advice you get on day 1 of diagnosis but then gets adjusted very quickly as your honeymoon period settles down. When I was diagnosed I had to take like 2u a day as a 'boost' but very soon switched to 'proper' dosing.

Obviously if a fixed 2u is working for you, then great, but I suspect you'll be getting highs and lows when the meal carbs doesn't match and should speak to your doctor about this as they probably just missed the follow-up advice.

Edit: for reference it used to be that insulin doses and carb intake were 'fixed' - e.g. your breakfast must always be 20g carbs and 1u insulin, dinner is 40g carbs and 2u etc - but that approach was already being phased out in many places by the late 80s/early 90s so unlikely the case here, unless you have very

Did anyone else approach it this way at the start?

I did, though I'm a Type II.

The end result was, I was eventually taken off of fast acting, because it was overkill for me. And my long acting dosage hasn't been moved in over a year.

How much should I challenge this at next checkup?

You probably want to ask for an actual explanation from your doctor.

Am I crazy for thinking this is weird? I generally trust doctors and the medical fields but I can’t get my head around the logic here…

You're not crazy.

I suspect this is so they can build a model for how you handle food and insulin. I'm assuming they're asking you to document everything you eat, so they can correlate that with your CGM data.

Getting practice in with jabbing yourself is probably a nice bonus, but there are some d

I was taught the basics of carb counting and adjusting insulin ratios while I was still in the ICU with DKA following the initial diagnosis.

I suppose things might be different if it's caught earlier and you don't have 4 days for the DSN and nutritionist to bring you up to speed?

How much should I challenge this at next checkup?

I think it would be insane to continue taking too little insulin if you know that it's going to result in a BG of 12 mmol/l every time.

Am I crazy for thinking this is weird?

I think that a lot of doctors use very outdated, inappropriate methods - you frequently hear about people using a sliding scale, or suffering prolonged hyperglycaemia because they need to contact their endocrinologist for permission to take an appropriate amount of insulin.

I've only had diabetes for a year but they got me started on counting carbs pretty fast.

For the first weeks they had me do the somthing kind of similar as you. A set dose depending on my blood sugar before eating that didn't take the food into consideration. We gradually increased and dialed in my basal until I was back in range. That took maybe two/three weeks to figure out, then we went on to work out my insulin-carb ratio and how to calculate dosage for different foods.

Don't you end up running low if you eat something low carb? I would definitely push for starting to count carbs at your next appointment!

I started off (years ago) on a flat amount every meal, then over the years moved to a sliding scale depending on blood sugars before meal and anticipated carbs from the meal

Now years later my sugars and weight are so under control I am pretty much back to a flat amount and talking with my Dr about possibly scaling back to 2 shots a day instead of three

Doesn’t sound normal to me. I got a sliding scale to start with for the first week or so, which did give me the same dose for foods each day, but also added correction doses. If I was at 200mg/dL I’d have taken more insulin than when at 100mg/dL before a meal.

Then it went to carb counting, starting out with a 1:20 insulin to carb ratio. I ended up at roughly 1:7 after some trial and error. That all happened within the first month.

I’m surprised you didn’t even get a sliding scale, let alone start carb counting

The VA did that to me when I first started insulin about 5 years ago. I was horribly out of control, and they had me giving 25 units for every meal. Yes, 25 units. Then I caught COVID and my appetite went away. One night for dinner I was having a piece of chicken pot pie. I had no appetite, so I had a smaller piece, and I randomly reduced the amount of insulin I took to about 20 units. I didn't even finish the half slice of chicken pot pie, and around 2:00 in the morning my wife ended up having to give me two glucose injections because the finger stick meter was reading LO. That is, I was below the registerable range on the meter.

Totally normal, its what I did for the first fifteen years of being a diabetic

I got sent away from the hospital with similar instructions. (Though my doses were higher and they told me to take more before breakfast.) Absolutely no regard for what I might be eating or doing, or provision for eating anything other than 3 set meals. They did say not to take any insulin if my blood sugar was under 5 / 90 before a meal. I was also instructed NEVER to use insulin until I started eating.

That is really not an adequate longterm plan whatsoever, but to get started? I guess it's easy and not overwhelming for someone who's new to the whole thing.

Hopefully you can see an endo soon who can get you on a better treatment track!

(I could not--never got referred and was stuck with a GP who really wasn't up to much. But, I managed to figure it out on my own with the help of onlin

Oddly enough I’m trending towards flat amount lately. I know what my carb counts are and everything but I tend to eat hard to estimate foods without measuring so I just get full at a certain number.

HOWEVER this assumes a certain percentage of carbs and if I’m having a lower or higher carb meal I absolutely need to adjust the bolus for it.

I have always taken a pre set amount of insulin. I monitor levels with cgm.

My dad does this going on 7 years and his sugar is crap, yet he refuses to discuss it with his Dr. You can always ask your Dr what the theory behind this approach is how long this treatment will last.

I would definitely ask for an endocrinology referral. A lot of PCPs are behind on diabetes education and management.

generally 20-25 with all meals fast acting and 50 long term with evening meal, if things go tits up, then it might be additional doses during the day

You didn’t mention your age but the later in life you are diagnosed the more slow progressing type 1 is, typically. If your glucose is similar after giving the same amount of insulin despite different meals you may have some amount of functioning beta cell mass that is picking up the slack. Evidence suggests the harder you work these cells the quicker they fatigue and die off. Ask your doctor if you can start titrating your insulin bolus to your meals. Whenever giving insulin, especially when increasing your dosages, always have glucose on hand

Mine is on a sliding scale. Sugar- 160 do 6 units 200 do 8 units and so on.

This didn't work well after multiple years. I have had a insulin Pump and sensor that puts it all on autopilot.

I change sensor and port weekly and fill resevaur every couple of days

I use less than half of what I was injecting with the pump

Goid luck

Idk what's standard practice nowadays so I'm not sure what's normal, but you're clearly interested and engaged so I you should definitely be learning more now. I highly recommend "Sugar Surfing" by Stephen Ponder for a great general education, but before you open that book you'll need to learn to count carbs. Here's a video to start you off learning how to count carbs. There are loads of videos. My advice is to stick to the ones that count grams rather than anything like points or COH, because grams work no matter what your insulin to carb ratio is. COH or points end up in decimals immediately, it just gets confusing.