I usually get home from work at about 5:00 and am quickly and enthusiastically greeted by our small mixed-breed dog, Panda. Panda’s insistence on me petting her and scratching her belly usually draws the attention of my kids, who then join in on the scratch-fest. At this point, Leslie will usually give me her summary of the day’s high and low points – how she scored on a test, the unfairness of one her teachers over some incident, her friend’s upcoming sleepover, and, often, whether or not she had a “high” or “low” during the day. In this case, she tells me of her after-lunch low blood sugar.
I won’t go into the details, but preparing our dinner meal includes the same necessity of knowing how many carbohydrates are in everything we eat. Carol meticulously records on a sheet of paper all the ingredients that go into each and every dish that is put on the table and next to Leslie’s seat at the dinner table rests our digital scale for her to weigh some of the items placed on her plate.
Before eating, Leslie is required to check her blood sugar. This is her sixth glucose check of the day.
After eating, we help Leslie count the carbohydrates she consumed and she then takes the required insulin. Once again, the amount of insulin required for each gram of carbohydrate consumed has changed. Recall that there was a ratio of 5:1 at breakfast and 10:1 at lunch. The dinner and evening ratio is 15:1.
In physiological terms, this means that one unit of insulin facilitates the removal and use of 5 carbohydrate grams from her blood in the morning. That same unit will remove 10 grams during the day and up to 15 grams at night. If we didn’t change the ratios during the day, then Leslie’s blood sugars would be all over the map – from dangerously low to unacceptably high.