Hey there I am Christel from Diabetes Strong and today we're going to talk about what is active
insulin on board or IOB and how to calculate it IOB active insulin on board is it refers to
how much of your rapid-acting insulin is left in your system so your rapid-acting insulin
is your Humalog your Novolog your Fiasp and it's those types of insulin that we use to
quickly lower our blood sugars for example if we eat or if we want to do corrections
that type of insulin the way that it works is that when you inject it so you inject it in fatty
tissue when you inject it it will generally enter the bloodstream in about 10 to 15 minutes but
won't really start to work yet it will be at its peak so be working the best after about an hour
hour and a half and it will last in your system for three to five hours it's a wide range because
it depends very much on the person I usually assume four hours because that seems to be fairly
accurate for me for most people I know and it's just it's the easiest for calculating knowing
your IOB is really important for two things it's important for dosing and it's important for
knowing if you have too much insulin on board for a given activity so let's talk about dosing first
so a lot of us when we are diagnosed are told not to stack insulin stacking insulin means taking a lot
of doses relatively close to each other for example within that four hour time frame that
insulin generally lasts the thing is if you know your IOB stacking is not necessarily an
issue because you'll know when you're over stacking so it can be a great tool again
in assessing should I add more insulin or should I not the other thing I mentioned was for activity
one of the things that I think is most overlooked when we talk about diabetes management is IOB
simply because if you go low during an activity such as let's say go for a walk or go exercise
if you go low it's because you have too much IOB that's the only reason why you're going low if
you had the adequate the right amount of IOB for you for that given activity you wouldn't go low
so that being said if you understand how much IOB is right for you for different types of activities
you can significantly reduce the amount of low blood sugars that you have
there are different ways to finding out what your IOB is at any given time
if you use an insulin pump on their screen it will tell you your IOB so simply say IOB
active insulin on board it will be right there on your screen what you need to be aware of though
is your pump will only calculate IOB from your corrections and your mealtime boluses that means
none of all of that rapid-acting insulin that's actually dripping in as
basal insulin is included in that I'll tell you how to calculate it in a second but something to
be aware of if you use multiple daily injections MDI like I do there are a few different ways
to keep track of IOB one could be if you're here in the US there's such a thing as a smart pen it's
called an In-Pen INPEN it's the one I currently use that would automatically that will automatically
keep track of your IOB as all your doses are bluetooth to an app if you don't have that
there are some different apps available the US
does not have any FDA approved apps however I have been using one for years called RapidCalc
r-a-p-i-d c-a-l-c I will add a link to a video, I did on that specific app
down in the description field so those are sort of the the way you can use technology to
keep track of IOB if you're in Europe there are some different apps as well I believe MySugr
can also keep track of IOB and there are some meters that can as well but if you don't have
access to any of that technology you will have to calculate your IOB yourself same thing as I
said if you're on an insulin pump and you actually want to know what your true IOB is or your IOB for
your basal you need to calculate it yourself so let me show you how to do that but it's actually
fairly simple okay let's calculate your IOB so first let's assume that you're on a pump so that
means we're calculating your baseline IOB let's just assume one unit an hour just because that's
easiest so we assume again an insulin duration of four hours that means you get one unit every hour
okay so what we assume then is that this will leave your body sort of at the same pace so
that means all the insulin that you got within the last hour we assumed 100 percent of that is left
what you got the hour before we assume 75 percent of that is left we got before two hours before would be 50 percent
left and then when you got before that would be 25 percent left okay so basically just multiply them all
and if you run those numbers what you'll see is that your IOB is 2.5 at any given time again
assuming that you get one unit an hour I mean we can even put in the one for the hour before but
you would have 0 percent left of that so to still be 2.5 most people don't have the same basal rate going
24/7. If they're an insulin pump let's say let's just choose a number let's say instead
that you're doing two units here instead of one run the numbers again you'd see that your IOB
would be three okay so that's how you do that assuming again a four hour insulin duration time
if you are on MDI multiple daily injections like I am it's a little different because you don't
need to do you know all the calculations you just need to look at the individual
individual doses so let's say let's make an example where we say we take four unit
two hours ago for lunch okay so that means that now we assume that 50 percent of that is left
that means your IOB is two
why can this be helpful? Well this can be helpful let's say that again you ate two hours
ago and you're 200 milligrams per deciliter, so just over ten millimole per liter
then you need to think about well those two units you have left well though
well those two units reduce your glucose down into the level that you want you wanted to
a lot of people probably would so this is would be one of the situations where you want to think
about what is your IOB and not do any unnecessary stacking because then you might end up going low
but this calculation it's the same one that the pumps do it's the same one that the smart pens do
in order to calculate your IOB this is just if you want to do it manually
as you see that's actually a fairly simple calculation most of us would rather not have to
do that manually or you know it's one thing is you need to keep track of all your doses in the last
four hours sometimes we do end up taking more than one or two and it's just doing math but so I
would recommend that if you do not have an insulin pump if you do not have a smart pen to invest in
something like for example RapidCalc that I mentioned before or another tool but back to
why is IOB important again I do really think it's one of the most overlooked components of
diabetes management because your IOB is literally the reason why you will go low during a certain
activity if you have too much IOB same thing it'd be why you go high for another let's say that you
like to do resistance training resistance training can actually make blood sugars go
up during the activity come down later so it's so important that you have enough IOB
on board during so that you don't see a sharp increase but you don't see a sharp decline after
same thing with aerobic activity that will for a lot of people make blood sugars drop so if you
have too much IOB you will drop too much so it's a critical component to managing your diabetes
levels I hope this video made sense to you I hope it was helpful thank you so much for watching