Hey everyone…new to the Omnipod and I’m just on my 4th Podd. So I’m wondering about what others do for correction boluses. When do you consider giving yourself one? Just looking for some feedback.
I have a feeling I’m being to picky as my Doc and I argue all the time over what my normal range should be…she set me up for between 120-140 for 2-3 hrs after eating and I keep shooting for 90-100 since I keep asking what a normal person would be after eating and she kindly reminds me that I’m not like a normal person…but hey I think its a goal and even it I hit it only 1/2 the times I’ll be better than if I didn’t at all !!
Just wondering when you’d consider a correction and when you maybe let it ride out…Example the other day It was between 2-3 hrs after and I had a 148 so I did a correction…and I went below 70 later for a bit but I’m still trying to figure out how this works yet. Good new is that I’m insulin sensitive and If I can get an accurate carb count I’ve been able to get some great control to this point with the podd. Appreciate suggestions on what you might do and when Thanks~Schumtz!
For me a correction has a significant effect only after about an hour. If I expect that without correction my BG will return to the target range within an hour then I do not correct.
I have the same problem. I guess that we really don’t level off until longer than 2-3 hours, but of course we don’t want to wait for that. I will let the PDM tell me what my correction should be and then I just quesstimate down from there. If it says I need 1 unit, I’ll dose a half, for instance. Not technical at all, I realize.
Another option is to try an extended bolus anytime you are having fat and or protein. That technique requires some playing around with also. Good luck.
I try to avoid the need to correct highs. This means that my BG goes out-of-range more often on the low side. Lows are so easy and fast to correct. Correcting highs is a pain.
I have lots of lows, Helmut, trying to control highs, of course. Do you wonder about negative side effects from lows? They can feel so mind numbing I am afraid they are causing damage.
Caleb is programmed to be corrected over 130, with a typical target of 115. Although this varies throughout the day and I am always making judgments to override that based upon what he ate, the amount of the bolus he last had (the bigger the bolus, the bigger the tail of insulin), his current, prior and planned activity, time of day, what happened the day before, etc.
It sounds like you are getting a good feel for things and will be able to tailor your settings to your specific needs and sensitivity.
Happy 4th Pod! Yesterday was Caleb’s 3 year Podiversary - I think that’s probably about 400 Pods for him!
The truth is…we can kill ourselves trying to get our bg to “Normail” levels…and I have made the decision that time is too precious to spend it correcting 9 out of 10 times. I will correct if my 2 hours post meal is over 200, very liberal yes, but also seems that if I correct to anything lower I will be too low in another 2 hrs. I may be the anti christ taking this position, however, my most recent A1C was 6.5 and that is not too bad. Would love to be back in the 5.0 range but, realisitically, i would rather not be diabetic also. I actually had a stroke back in 2005, doctors say they dont know why it happened, but I feel like it was the result of my trying to keep my blood sugars around 120, my A1C at the time was 5.8. the final word, dont kill hyourself trying. Its not worth it. See my book at "supportersofsurvivors.com’.
Elaine, I spent a day googling for studies about negative side effects from lows. Very little came up. Negative side effects from lows seem to be confined to secondary effects like passing out and hurting oneself during the fall. My lows are not severe. Thanks to my DexCom 7+ I see the lows coming and rarely dip below 50. I don’t reach the point of being incapacitated. During my research I found plenty of studies that document negative side effects of highs. I correct a low when based on the DexCom 7+ readout I expect to dip below 70.
Helmut -
Good note, however, please remember not all diabetics can AFFORD a Dexcom or any form of CGM, (expense of over $800)unfortunately. My insurance company wojuld NOT cover one for the longest time, then, after a battery of letters from me, my wife, my endo, and others they finally realized that a CGM is a way to avoid (possibly) complications in the long run. I was finally on the Dexcom 7 and found the readings COULD be as much as 100 points off. That is when I dropped it and started just testing again. Latley I have been looking at the “Freestyle Navigator”, I have heard some good reviews there, and I have a friend here who is on it and loves it so far.
Steve, I agree that CGMs are finicky. Developing a good calibration routine is the hardest part. The results that I get with my DexCom 7+ are so accurate that I no longer test between calibrations. I am glad that your insurance began covering CGMs. My insurance does not incur any additional cost as a result of covering my DexCom 7+. My BG strip usage went down from 12/day to 4/day. This saves $8/day which offsets the cost for the DexCom 7+. In terms of accuracy I have heard only good things about the Navigator. The reaction of your body to the sensor plays an important role. I am always amazed to read posts about the MM CGMS. Some users deem the MM CMGS absolutely useless and others swear by it. The spread in accuracy seems to be the smallest with the Navigator. I would not be surprised if in a couple of years CGMs will be as accurate as BG strips and self-calibrating.
Thanks, Helmut. I still feel my lows so I can usually just enjoy the chance to indulge in juice or candy and not worry about falling and hurting myself…yet.
I sure hope you’re right, CGM’s could change the face of diabetes care for sure! And I am keeping faith. I will be ordering a Navigator soon, just have to get the “necessity” sheets signed by my edo and I wil be oood to go…I beilieve the first truly accurate CGM will lead to the first external artificial pancreas…looking forward to that! Keep in touch, Helmut!
Good luck with the Navigator. Keep me posted.
Thanks Lorraine…Wish Caleb a belated Happy Pod-Day for me! 400 vs 4…He’s way out in front so tell him to keep leading the way and I’ll follow. Glad that I don’t think I’m crazy for correcting over 140 and your right it’s just a matter of getting used to how this works! Just did an extend bolus over lunch with 50 carbs, started at 109 and was at 77 2 hrs later so might have overestimated the carbs but a handful of trail-mix and all is good!
I’m not on the Omnipod yet but the doctor has it in and I have an appointment for the 19th for training. Training seems a little silly at this point since I’ve been on a pump for the last 10 years but rules are rules.
Anyway even though I am not on the pod yet I do have to do corrections with my current pump. I usually try to wait 3 hours before correcting because I always go down in the 3rd hour. What frustrates me is that if I bolus before a meal I end up dropping too low and if I wait until I’m eating or after a meal I seem to go too high. I’ve got to the point where I dont think there is an answer and now I bolus a minute or two before eating and hold off on corrections until 3 hours later.
I haven’t read all the comments, but wanted to point out something that is often left unsaid in these kinds of conversations.
The interactions between basal and bolus insulin are much more complex than I think most diabetics realize. A good endocrinologist will understand the relationship and interactions in general but will still need to “experiment” with each patient to understand the specifics of that patient’s case.
If you’re corrections are sending you low, it could be the obvious: that your correction factor is out of whack. But, it could also mean that your “insulin active time” is not set properly. Furthermore, it could really mean that your basal rate is too high, or your I/C ratio is too low. Most likely, it’s a combination of several of those factors. The bottom line is that it takes a lot of knowledge and experimentation to discover what needs to be changed; the endocrine system is just not simple!
What I’m trying to say is, a) a target range of only 10 points is, in my opinion, unrealistic and maybe even counter-productive, and b) if you don’t trust your endo doc enough to trust what he/she suggests then you should either examine your attitude toward him/her or maybe consider changing doctors. The diabetic patient/doctor relationship has be be one of trust; if you don’t trust your doc, figure out why that is and correct whatever it is. That’s my advice.
Anngelia, I observe the same BG pattern. I can only chose between going too high early on or too low later. For a given food choice there are only 2 variables that I can play with: the timing of the bolus and the amount. For example, I bolus 15 minutes ahead of my breakfast and see my BG drop by about 10 ml/dl before my BG starts going up. I cannot bolus any earlier without risking to go too low before the breakfast kicks in. If I bolus enough so that my BG does not exceed 120 ml/dl then I will go low a couple of hours later. I only know of 2 ways not to go low later:
- Bolus less and go high early.
- Eat a little snack after 2 hours.
I practice 2).
Helmut, see what I wrote a few minutes ago. There are a bunch of variables, not just 2: insulin active time, I/C ration, basal rate, and correction factor. They all interact in complex ways to impact your BG.
Eric…Appreciate you comments. Is a goal that is only 10 pts unrealistic, maybe to you but not to me. I’d rather have that goal and hit 30-40% of the time than have a goal that’s easy to hit. It’s like shooting at a target with a bulls eye and I’m aiming for the smallest dot…does it mean I’ll hit it every time…absolutely not but doesn’t mean I’m gonna keep shooting for it. Even the best baseball players end up being out 7 out 10 times at the plate but they keep trying!
I also didn’t say I don’t trust my doc, but at the same time I challenge the things she may suggest or we discuss and figure out if that is something I’m comfortable with or not. Same reason why people get second opinions I guess. But I do agree with you that it is a lot of experimentation and it’s different for everyone just wanted to know what others do and how so I can take some of that and apply to what I do…I’ve only been on a pump for a week so I know very little compared to most. Thanks for the reply I do appreciate it even thought I don’t agree with it.
Schmutz,
To be within 10 pts means SD=5 or better. This is not realistic for a true T1. Consider yourself an overachiever with SD < 20. I am trying hard, but not too hard, and see SD=25. Right now I am able to stay below 100 for 66% of the time. My goal is 80%. If you only account for a narrow range where your BG is for 30-40% of the time this means that anything outside counts the same. 200 is the same as 120. I prefer to be more inclusive.