Last night after eating my dinner I was still hungry so I decided to snack a little bit. So for the snacks I ate I did not bolus. When I took my BG after this I was around 275. I am trying to figure out what is the best way to do a correction. What I did was go to easy carb menu and put in zero carbs and let my pump figure out how much insulin I needed. This didn't work so well. When I got up and checked my BG three hours later it was only down to 227. What would have been the best way to handle this situation?
I am on a Ping Pump and my IC at night is 1:15 ratio. I have only been on a pump for 5 weeks. Learning curve is kicking my butt.
Sometimes when my BG runs up after food, I'll toss some carbs into the correction, figuring that the reason it ran high in the first place is that I guessed wrong about how many carbs were in the food in the first place? This is, of course, ****EXTREMEMY**** dangerous?
Any time I have a bloodsugar over 250, my correction factor does not work especially if I had eaten a lot of food. I was 245 after dinner last night, correction bolus of 2 units and two hours later I was 249, so another 2 units, was 205 an hour later, pump suggested .6 units, whoops woke up with a 40, soooooooooooo, it is not an exact science and every day is different but I should of done about 3 units upfront. Need more insulin when bloodsugars are high, but not too much more, grrrrrr.
The “ezbg” feature of your Ping will allow you to figure a correction bolus without having to go through the steps of entering a 0 carb bolus. If your pump isn’t making a calculation that works, you may have to experiment with changing your ISF (insulin sensitivity factor) setting. My son’s was way off initially and it took a number of experiements to dial it in better. His initial setting was set such that he was gettting almost three times as much insulin as he actually needs. He had a couple of super quick drops to really low numbers as we adjusted, but after a couple of adjustments, we got to an ISF setting that works well for him. Also, we use a different factor at night than what we use during the day. An overcorrection at night is more worrisome for me than possibly overcorrecting when he’s awake.
With some trial and error, you’ll figure it out. Good luck!
Another factor is how much of the snack had not yet hit your BG when you tested at 275. So BG was likely still going up, You didn't say what the snack was, or the time between snack and BG check. The pump didn't know you had eaten the food w/o a bolus. If you were at a 'steady' 275, then the correction amount may have been correct.
I would have considered what bolus would have been taken for the snack, and if significantly higher than what the correction suggested, then would likely bumped up the correction a bit, especially if less than 2 hours since the snack.
Out of curiosity, why did you choose not to bolus for the snack? The thing my son loves best about his pump is that if he eats more than what he bolused for at a meal or has dessert or a snack after he’s already bolused, it’s painless to just top off his insulin a bit to cover it vs. having to take another shot when he was on MDI. As a rapidly growing and active young teen, the extra eating and extra bolusing happens frequently and the pump makes it much easier for him to eat what he needs. In fact, though he gained back a portion of the weight he lost before he was diagnosed within a few months of starting shots, it wasn’t until he got on his pump that he got back up to a healthy weight for him.
The learning curve will never end, once you figure out your factors...they will change! Good for you for knowing your ratio and correction factor. But like others have said, sometimes they just don't work. I also need more insulin than my pump suggests if my bg is extremely high. I suspect it's because the pump can't possibly know what is causing the high so it is just using the factors it does know. Luckily we can override that! To answer your question about what would I do to handle the situation Uniboy, I would have corrected and checked not three hours later but 1 hour later.
Going low scares me. When I go low I tend to overcorrect. So last night I didn't want to over correct knowing I was going to bed. I thought about staying up a while longer but was afraid I would continue to eat and make it worse instead of better. When I got up this morning I was at 126. So maybe I didn't do so bad after all. I am my worst enemy cause I want better control but I also tend to like high carb snacks.
I guess I need to say it was multiple snacks. It came up to about 60 carbs I guess. I had forgotten some of the stuff I ate when I wrote this earlier. I think the 275 BG was about an hour after the last snack.
I think part of it I was having an attitude problem with myself and I just wanted to feel normal again for just a little while. Then when I took my BG I came back to reality real quick.
So if your son is eating something every couple of hours he gives himself a bolus & checks BG each time?
Usually I will take a correction bolus with a needle instead of the pump but the other way is to eat some more carbs and let the pump figure out the correction. It seems to chase down the high better.
I think you're entitled to have an attitude problem every once in a while - it's a big adjustment. As you figured out, though, pretending everything is the way it used to be will come back and bite you most of the time. So, as you're doing, learn from it, don't beat yourself up about it and move on.
Yes, my son tests his BG whenever he eats. The only exception is if he has eaten really recently. For instance, if he finishes dinner, helps clean up the table, then decides to have dessert or a glass of milk, he won't retest at that point as he knows the test wouldn't be giving him information he needs to act upon. Generally, he boluses for every carb he eats unless he's having a small snack to bring himself up a little before going to bed, or if he's deliberately raising his BG in anticipation of an athletic event. Through experimenting, he's learned where his BG needs to be for various types of exercise so he can make it through safely.
There are a few books I would highly recommend you read. Think Like a Pancreas by Gary Scheiner and Pumping Insulin by John Walsh. Also, if you exercise or play sports, I would highly recommend The Diabetic Athlete's Handbook by Sheri Colberg. All three are excellent resources and will give you a good framework from which to learn and ask questions.
If you were recently diagnosed, you'll be amazed at how quickly most of the overwhelming stuff becomes second nature - until, that is, something new comes up and throws you for a loop!
The only way to know is to experiment with it. If you're new to this, I would recommend asking your endo or your CDE for help and advice. It took us a few months to get comfortable with making changes and experimenting on our own. At the beginning, I never thought I could possibly feel comfortable making adjustments since so much was at stake, but it didn't take long before we got comfortable.
When you do a correction, make note of what happens. You may already know this, but your ISF is how many points 1 unit of insulin drops your blood sugar. So, if your ISF is set at 50, that means the pump thinks 1 unit of insulin drops you 50 points and uses that as the basis for calculating how much insulin you need to get you to your target blood sugar. If you're dropping really fast and going low, you would increase your ISF number (so you'd be getting less insulin); if you're not getting back down where you need to be, you probably need to lower the number (so you'd be getting more insulin) - I hope that makes sense? I would advise raising or lowering in small increments - maybe 10% or so at a time? With all of this, whether adjusting basal rates, ISF, or insulin:carb ratios, I always make small adjustments and evaluate the results rather than making big changes and overdoing it one way or the other.
Also, when we were trying to dial in my son's ISF, I only used the data I gathered from pure corrections - that is, not corrections we did along with a meal. If you're correcting AND bolusing for food, wherever you end up later could have been caused in part by overcounting or undercounting carbs or the content of the food, so that data isn't that useful for adjusting your ISF.
If I would have checked an hour later I still wouldn't be sure what to do. The only reason I got up and checked it three hours later was to make sure there wasn't some other problem.
Sounds like I got years of fun & frustration ahead of me.
Thanks; It does make since now. Mine is set at 80 and I am now pretty sure that isn't write. I have no problem making changes. My endo actually encourages it. When I change ISF will it impact the IC ratio?
Theoretically, no. Your ISF is used in calculating how much insulin you need to get your blood sugar to your target. Your I:C ratio is used to calculate how much insulin you need to cover any carbs you eat. When your Ping calculates your bolus (using EZCarb), it takes your current BG into account and adds to or subtracts from your bolus depending on whether you were above or below your target.
For example, if your target is 100, and you are at 180 at mealtime, and you eat 60 carbs, and you have no bolus insulin on board from a recent snack, your ping would say:
Carb: 4.00 (using your 1:15 I:C ratio) BG: 1.00 (using your ISF of 80)
IOB: 0.00
Total: 5.00
One thing I think is a little confusing is that IOB number. It subtracts and IOB from the amount of insulin it tells you to take. If you have IOB from a correction, I think that makes sense. If your IOB is from a previous meal (as in your case last night), your pump might tell you not to take more insulin - that isn't correct.
One caveat, though - if your ISF has been set such that you're not getting enough insulin to get your blood sugar to target, it might appear that your I:C ratio is working well when it's not. For instance, in the example above, if your I:C ratio should really be 50 instead of 80, and you've been getting to target when you correct in combination with a meal, it could be that both ratios are off.
Adjust one factor at a time and adjust in small increments and you'll get it figured out. As I said in the previous post, I would adjust your ISF based on pure corrections (no food bolus), so you don't muddy the waters with your food intake and bolusing. Your pump only uses the ISF to calculate corrections.
I hope that all makes sense! I have it clear in my head, but writing it down is harder.
This morning I ate breakfast without giving myself a bolus. I was reading pumping insulin last night and from what I understand I should wait for three hours before I give myself a correction and then check my BG every hour until it returns to normal. This should take about five hours if I have the ISF set write and I should not go low. I did change my ISF to 72 last night. I ate 69 carbs this morning. Little nervous about how much my BG is going to go up before I give the correction.
Thanks for the info on The Diabetic Athlete's Handbook; because trying to exercise with D is being a big challenge.
Thanks for all the help you have been giving me. Every day I see that being on a pump clearly has a lot of advantages. I am now starting to like it where I hated it at first.
