Do mdi users take shots between meals


#1

Was wondering if anyone gives extra insulin shots between meals when you think BS is getting too high? I do very rarely. This mid-morning my BS was higher than I expected, so I took 1 unit of Novolog. That seems logical, but I know my DR. would go nuts about it. Any thoughts?


#2

Absolutely I do. No different from giving a correction with a pump. If your doctor objects, your doctor needs a refresher course.


#3

I take between meal shots all the time. If you are running high, would’nt you want to corrrct it as soon as possible? Why sit there with high blood sugar for two hours waiting for the next meal?


#4

I do all the time. Sometimes due eating more than realized or due to stress or dawn phenomenon worse than usual. Agree with above that if doctor has a fit then maybe he needs refresher course.


#5

Yes after fine tuning this approach using trial and error and a CGM I have no hesitation about taking fast acting insulin between meals. I use a CGM to watch my BG trend during those hours after a meal. If it’s trending high, it’s easy to knock the BG back down into range with a “correction bolus” if I catch it soon enough. I should note that I always have fast glucose in my pocket (either sugary candy or glucose tablets) and if I am going to be active between meals I always have a jug of Powerade close by. Those are just in case I inadvertently over-correct between meals, so I can avoid or treat a low BG. Several of the books often recommended on this site discuss how to use a correction bolus in detail.


#6

Before I went on the pump, I’d always have insulin in between meals. If I felt high, I’d check. I always check before having any extra insulin or having anything for a low. Or if I’m hungry because I didn’t have enough to eat. I don’t have an amount that a typically eat for breakfast or lunch. So if at 2pm I decide I want something, I’ll go check my blood sugar and then have whatever amount of insulin is required to cover the number of carbohydrates I’m having. I’ve done that while on vial and syringe and still do on the pump.


#7

Before pumping, I certainly did. Just need to be careful to not stack, which applies to pumping also but most current pumps give you what you already have on board.


#8

It’s the same as a pump. If you would take a correction with a pump, do it with MDI. The only difference is that the pump gives you smaller doses, like fractional units.

By the way, if you are going to do it with MDI, get a 1/2 unit pen or 1/2 unit syringes. I can give you the NDC #'s for those if you need them.


#9

Thanks for all the good replies. I started on Dexcom in late March, and I guess I’ve been too coerced by my Endo. Obviously each of us spends more time thinking about our own situations than our Doctor does.


#10

Yes, we make corrections if necessary and BG is out of bounds. Fortunately this is rather rare for us… most days are fairly stable between 70 - 120.

I think it’s more a case of… some doctors are more concerned about THEIR situation than ours (not getting sued for advice potentially leading to a serious low, should someone way overdo a correction).


#11

I absolutely agree!


#12

Sometimes something that I’ve eaten doesn’t digest the way I anticipated and if I am running a bit high 3 hours post-meal I will take a correction dose of insulin to bring it back into range. As someone else mentioned, you want to avoid insulin stacking so you don’t tank your blood sugar unexpectedly. I suggest looking at the pharmacological profile of your particular insulin so you understand its onset, peak effect duration, and half life to better understand how to dose between meals if needed.


#13

Of course.

You need to account for how much active insulin is still in your body. (Insulin on board)

You need a correction factor. Amount of insulin to take for the amount your BG is over target.

An insulin pump does these calculations automatically based on setup values and some practicle trial and error adjustments.


#14

As a rule, endos are strongly low-averse. When I was on MDI (in its various forms for 30 years), I ran up against the thing of being chastised for A1Cs too far below 7 because they’re trained to see that as evidence that you’re having a lot of hypos. And they’re not necessarily wrong–it’s an average, after all. But that attitude should really not prevail for patients using CGMs, even the ones not using a pump.

So I guess the question is whether your endo is confident that you know what you’re dealing with, and that the CGM is helping you stay in range more of the time. Because time-in-range is a much better measure of how you’re doing than A1C, and with the Dexcom reports you’ve got a graphical display of time-in-range and more data about any excursions you do see. And like everyone says, corrections are a perfectly normal part of MDI anyway–that’s what your Correction Factor is for, after all.


#15

of course. I did that for many years.


#16

Assuming you’re not experiencing regular hypo events, show your endo your cgm data and explain that you’re paying close attention. If that’s not enough to convince him/her that injecting whenever and as often as you need to is prudent, it’s time for a new endo (I know that can be easier said than done depending on your situation…).

I always tell people “I’m MDI, emphasis on the M.”


#17

Yes, I do. I swap back to MDI, Lantus+Humalog, from the Omnipod and my prescription is for the Kwikpen because of that. I do correction boluses just like I would from a pump, but rounded up to the nearest IU of course.


#18

If you’d prefer to round to the nearest half unit, both the Humalog Junior Kwikpen (which is prefilled) and the Luxura pen (which takes Humalog and other cartridges) dose in half units. (I hope I got that right. I’m in Canada and some pens are different.)


#19

Fast acting insulin lasts 3-4 hours, so you want to make sure you are past that before you make corrections. I have a spreadsheet that I used to calculate how much insulin was left so I know how much I need to correct with. My pump now takes that into consideration when I bolus. The short answer is, yes but do it smartly.


#20

When I was on MDI I took an injection whenever I needed it.