IC (Carb ratio in g / U ) determination

What is the IC value?

It says how much insulin we need for our carbs. For example, IC = 8 g / U
means, for 8 g Carb, 1 Unit of insulin is required
Unfortunately, it is not one fixed number we can count on (count with):
* can vary between times of day => measure at all meals /use circadian pattern
See AndroidAPS Users / Files / ..circadian … Duesterhoff.xls:
https://www.facebook.com/groups/AndroidAPSUsers/permalink/286963892325750
6/

* can also vary between days e.g. when hormones play into it => Autosense

Sandra Carral
IC is only active when COB > 0

Rough estimate for your IC:

a) Autotune
Autotune gives one „average“ IC. It’s „reliability“ is seen controversial, to a large part probably
because: : it makes calculations based on data (carbs and insulin dosing data). So, if if you don’t
enter complete / correct data, then you’ll get suggestions you probably don’t want to take.
Inaccurate/inconsistent input = less useful output.

b) Via TDD
You can get your daily average IC if you (1) count up the g carbs in 24 hrs and (2) divide it by the
amount of 24 hr bolus insulin. Problem with the latter: Because your Loop modulates basal rates all
the time, you must first look up the TDD (total daily insulin given, in AAPS you see that at the bottom
of the /AKT/ screen,(next to HOME, or in statistics). Then substract the "real" 24hr basal need as in
your profile, from the TDD).

IC (g/U) = C (daily g carb) / ( TDD - 24h Basal as in Profile).

Adult example: TDD = 37U; Profile Basal = 16U; daily carbs 200g
=> IC = 200 g / (37U-16U) = 200 / 21 g/U ~ 9,5 g/U
I would eliminate days with extreme sports, infection. from that evaluation. Later you will
modify insulin for such scenarios extra (via profile switches), hence avoid "averaging" that
into your factor determination upfront already
Determination at meal time
Still, it is worth determining the IC that is valid at each major mealtime

On a day without preceding major activity, stress, infection, and before the meal a relative
steady glucose in the normal range (and cob=0): Shut closed loop off. Eat well defined
smaller meal (20 .. 45 g of carbs) and use your suspected IC to determine the amount
of insulin for this meal. Watch for 3 hours.

 If your glucose levels about where you started, the IC can be used.
 If curve goes too low (eat some carbs and) try again with a higher IC value. See
example in picture below.
 If curve remains too high, the IC was too weak and needs to be lowered.

The IC should get you through the first 2-3 hours of a meal. Challenges can arise after the
2nd hour when meal bolusses „wear out“ and Fat/Protein contribute. See (in German)
https://de.loopercommunity.org/t/mahlzeitenmanagement-spaetphase-ecarbs-fpes/5000
People who eat very carb-rich diets must give some consideration to the fact that the
capacity of their body, how much carb it can absorb per hour, is limited (in adults often to
30g/hour). So only a portion oft he meal might be servable via a meal bolus given at the
beginning.

aus Studie https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454102/

CR was determined with the following simulation. Each subject receives 50 g of CHO,
starting from his basal level. The optimal insulin bolus is determined so that (1) glucose
concentration, measured 3 hours after the meal, is between 85% and 110% of the basal; (2)
the minimum glucose concentration is above 90 mg/dl; and (3) the maximum glucose
concentration is between 40 and 80 mg/dl above the basal level. CR is then calculated as the
ratio between the amount of ingested CHO and the optimal insulin bolus:

CR=ingestedCHO / optimalbolus
Nb – wie in meiner summary II.-2, es wird an 3 Punkten geschaut ob Bolus (IC) „passt“ (3)
seems a bit hard to reach, especially w/o EatingSoonTT or pre-bolus /BH

Carb Ratios from: http://seemycgm.com/2017/10/29/fine-tuning-settings/

Now that you have basals, ISF, and DIA all set-up…here’s where it gets really tempting to
close loop and move on. And, truthfully, it’s not that hard to test carb ratios on a closed loop
vs an open loop if you’ve solidly tested all these other factors.

A good carb ratio will bring your BGs back to the starting point of the meal within
about 3 hours or so.
A bad carb ratio will leave you higher or lower than the starting point of the meal.

For example, these are two examples of carb ratios being too strong. In this first example,
there’s 2.27 units of IOB and BGs are at 103 and headed down at a pretty good clip at about 2
hours after the meal. If the next meal hadn’t been eaten then, low treatment certainly
would’ve been needed.

This graph shows too aggressive of a carb ratio. Three hours after the meal, there’s nearly
0.50 units IOB, BG is well below where the meal started, and definitely more carbs are
needed now for treatimng the low that results from too much insulin given because rthe IC
was too aggressive (numerically too low).
If you are finding that a correct carb ratio is yielding good BGs 3 hours later, but you aren’t
happy with the peak BGs during the meal…then it may be time to explore increasing or
adding prebolusing time to your meal or implementing “eating soon” targets an hour before
meals to help control the post-meal BG spike.

Artificially strengthening carb ratios to help control post-meal BG spike will likely yield
lows 2-3 hours after a meal.

(in deutsch dazu. https://de.loopercommunity.org/uploads/short-

url/mKpNMGdaIMIRyihP9BXXf8vCGqU.pdf

Eine andere Strategie gegen hohe BZ schon ca. in der ersten Stunde nach der Mahlzeit ist der
„Spritz-Ess-Abstand“ (SEA). Das kann aber gefährlich sein, wenn man nicht eisern
diszipliniert rechnet und vor allem Zeiten einhält. Beispiel:
https://de.loopercommunity.org/uploads/short-url/l6RgRGCAODKXxY826knBDXobu40.pdf
Caution when tuning IC in/for Hybrid Closed Loop

… especially if including bigger meals > 60 g carbs

You must take into account that during the major activity of a meal bolus, probably only
about 60g of carbs are digested (absorbed). See /Files: Meal Management I + II.

Ideally IC should be „tuned“ following this suggestion („main phase, hit 3x green X )

Circadian pattern Example

Relation to CRR

CRR = ISF/IC (mg/dl)/g

The carb rise ratio (also called CSF, carb sensitivity factor) is actually quite easy
to determine (maybe easier than the IC, which requires 3 hours with underlying
stable glucose and correct basal rate):
Drink sweet beverage with x g of carbs, and watch how much (mg/dl) glucose
rises.

=> ISF (mg/dl drop per U) / CRR (mg/dl rise per g carb) = IC (g carb / U)

(Likewise of course in the mmol world)