I have heard or read it is bad to very quickly correct a high BG level.
I was 220 after dinner at a restaurant so I gave myself 2 units of insulin. 90 mins later I was 85.
Is that bad to have such a quick drop? Or is it better to gradually come down to 85 over maybe 4 hours or something.
Whether its right or wrong I try to correct highs as quickly as possible. I do wear a CGM so I can see if I am trending downward quickly so I am not really concerned with hypos. I think I hit the 50s maybe twice a month.
I don’t think that drop in that amount of time is excessive. As long as it isn’t the precursor to a low!
When in DKA, they lower BGs more slowly, because there are a lot of biochemical abnormalities that take time to correct, but a 220 after a meal doesn’t involve anything but a lot of glucose coming into your system, but not ketones, if you’ve taken insulin.
One thing I will caution you about, though, is stacking insulin. That means taking more when what you took before dinner still hasn’t finished its job. That can be a recipe for a bad low, and when I was on shots, I used to do that all the time, with predictable results. Now that I have the pump, it advises me as to how much insulin I have on board, and won’t let me stack insulin, unless I override it, which I usually don’t. It means that my highs (of which I have very few nowadays, because I’m doing low-carb) take longer to come down, but they come down safely.
The fast-acting insulins are the neutron bomb of bg corrections :-). I’m all for corrections right up until they become an over-correction.
If you had tried to use, say, good old Regular insulin for such a correction it would have taken like 4 hours to happen, and I don’t think you really wanted to wait that long.
Others here will tell you that 220 is stratospherically high but IMHO it isn’t. Just a matter of perspectives.
One risk, is that “insulin already on board” (e.g. the bolus for the meal that hadn’t yet kicked in at the time you measured 220) would have kicked in at the same time as the correction and caused a double-neutron-bomb hypo. That’s what me and a lot of others worry about, inconsistent absorption.
All that said, perhaps you wouldn’t have reached 220 if you had bolused for the meal, more in advance of the meal.
Depends on what your correction factor is, that sounds like more of a sliding scale based approach which I’ve never used even though the CDE who I talked to when I went on insulin to start tried to get me to do.
I don’t know, I have read conflicting arguements about how dropping too quickly is bad. I have always been of the opinion, the closer to the normal range the better. I have had both a doctor and an endo tell me that a person with non-d can get up to the 160 ish range for a short time. And I figure thats for the same reason as us - their liver is dumping glucose, and the insulin hasn’t kicked in yet. Then it drops them down to the 90-80 range over the course of the next 30 minutes to an hour. To me, thats the same as me going from 200, down to 120, but my insulin is slower acting, so I don’t see it as being that quick.
We all have different correction factors. Mine is one unit to drop 45 points, so if I was at 220 I would take closer to 2.5 units,subtracting of course, the Insulin still on board from a previous bolus. Sliding scale dosing and corrections are pretty old school and not very precise.
It would depend on how long after dinner it was that high. I usually wait about 2 hours before making any decisions for a correction. Then test again about 2 hours to see if more is needed. If I go to hard or quick to correction I would go low real quick. Then the fun begins.
Very rarely do I get restaurant meals right when they involve a lot of food. I seem to either overdose and then go low. Or I underdose and go high. Or I seem to do OK in the short-run and then go sky high later because of the the absolute quantity of the food taking longer to digest and the probably high-fat content taking longer to digest.
I do have a couple of fast-food meals that I can do great on, but they’re relatively healthy choices and not super high-carb. My most reliable fast food meal is at Wendy’s: a small chili, a side salad with a spicy ranch dressing, and a diet coke. I dose for 24 carbs, either all at once if my BG is normal, and a dual wave if my BG is somewhat low before eating. That’s not a ton of food, but it’s great for me on my workdays.
Like most everyone, I like to have fast corrections but in reality, they don’t work well for me. So I do my best to stop those high numbers from happening. If I take enough insulin to bring down a high quickly, then there is no doubt that I’ll go low later unless I snack a lot. For me there is no doubt that I have noticeable insulin action for 4 hours after a bolus, so I can’t take huge doses without repercussions. It also takes me so much more insulin to bring down a high than it does to prevent one.
I don’t worry about the speed of bring down highs. I think that for people who have been chronically high, there is the belief that bringing the average BG down too quickly can impact the eyes. I don’t think that applies to random post-meal highs.
I want to second Natalie’s advice on stacking. I think this is the only time it’s really bad to ‘correct too fast’. Before you correct a high, make sure you take into account any insulin you already have in your system that maybe just hasn’t peaked yet, or which you are still in the tail-end of.
We do correct at hour 2, which is one and a half hours prior to the end of her duration but that is because we use Apidra, where most of the bolus is gone by hour 2. To avoid a crash we correct to a higher target (where endo wants her blood sugar to be two hours after eating). Her two hour postprandial target is 150. This has proven to be safe. Cgms is not always right on so if I were you I would do a fingerstick 1.5 to 2 hours after the correction and then check insulin on board. You can then always cover some or all of the IOB. We do this all the time, as well, though no endo would sanction this. Just be on top of it.
There’s no one-size fits all answer to this. Here are some of my thoughts:
-If I don’t bolus (like if I have a steak and salad or something), I don’t typically force myself to check until my next meal.
-If I have something that requires only 1 or 2 units (the majority of my meals), I check after 2 hours unless I feel funny (either hypo symptoms or unusually groggy/fuzzy)
-If I have something that requires 3+ units, I check at 1 hour and 2 hours. If it’s b/w 150 and 200 at 1 hour, I wait another hour before correcting (I once corrected a 170 1 hour out right before class and had a nasty hypo right in the middle of the class). If it’s 200+, I instantly correct, although if I have significant IOB I try to be conservative.
-Highs fall into 2 general categories: (1) I ate a small amount of carbs and simply took too little insulin by mistake (in which case I correct more aggressively because there’s less harm from stacking); or (2) I ate a ton of carbs, took a bunch of insulin, and I’m not sure it has kicked in yet (in which case I’m more conservative)
I also find that Apidra lasts about 3 1/2 hours, Jason. But I don’t like to wait to correct. If you take into account the insulin on board (either with a pump or just doing the math yourself on MDI) you can make sure you don’t overcorrect and go low.
I guess my biggest issue is, I generally get the most variance from my dinner meal. I don’t like the idea of trying to correct before I go to sleep, unless I know for sure I won’t be going low. The other thing is, I feel like its hard to estimate the glycemic load, or how many carbs has been processed. I have found many times that I will check at 2 1/2 hours and be at 150, then at 3 1/2 hours I’ve dropped 60 points. Other times, I may stay at 150 or, even go higher. I guess I like to just wait till the 3 hour mark to make a correction.
Thast just the way I do it. i haven’t been at it very long, and am sure at some point I will be slightly more aggressive with corrections. My last A1c was 6.1, and believe it will better this time, so it seems to be working so far.
