Hi, I have been reading a lot about corrections after a big meal with a bolus lately…so I have question re this matter as I have not really been doing this.
When I am higher than what I should be lets say around 140 before bed, I do not bolus and wake up withing the target below 108 in the morning.
Also when I am at 200 after a meal I do not bolus as after my BGL reaches a particular high, it starts dropping anyway to maybe not the ideal below 108 but it does drop to around 130-140 area before my next meal, especially if I do not have a snack in between.
So my question is…should I be bolusing? Or leave things as they are…
Could be any number of things…are you 200mg/dl 1 hr after meal, 2 hrs after meal? and what insulin are you on…via pump or shots? Could be that your insulin is not covering the spike in blood sugars right after meals (maybe higher in CHO) and once it kicks in, it brings you down…may benefit from faster acting insulin or one that peaks quicker (even differences betweeen Humulog and Novolog) could be that basals (shots or pump) need adjusting and I:C ratios need adjusting after that to get tighter control all day. How long have you had T1? Could be your basals and I:C are low but, your pancreas is still bringing highs down? Goal would be to get BGs less variable and in tighter range to minimize stress to pancreas (if still honeymooning) and get your HgA1c down to gain benefits of tight control. Would suggest talking w/ your doctor or diabetes educator…keep documenting your numbers. Good luck and hope these suggestions help:)
Thats what I use also…and often, it takes until the 3hr to really bring it down…unless I am taking a lot of background insulin. I have thought about switching to Apidra, but tried it and seems I must have some immune reaction to it because it is not consistant in its effects on my blood sugar. You may wish to try it…and given the experience of others on this site…I may try it again…I had a sample vial and maybe it was less potent. Given the onset curves…Apidra would bring you down quicker w/ likely less insulin than either Novolog or Humulog. I am currently trying low CHO to minimize the amount of insulin I have to take for meals and less carbs has resulted in flater blood sugar curves (meaning 70-90mg/dl through and after meal) which is truly amazing for me:) I have left my basals alone and they are about 0.7/kg (so slightly higher than most). PS: I like Novolog (NovoRapid) better than Humulog…onset is quicker…made that switch a long time ago. Also of note is the number of amino acid changes (from normal insulin) to make the different types of analogues (may effect immune response to the insulin): NovoRapid.
First of all, if you’re satisfied with the fact that your BG drops anyway, leave it alone. If you want to get closer to your ideal of 108, then give it a try.
If I’m within 50 points of my pre-meal BG two hours after eating, I don’t bolus. Otherwise, yes and drink a glass or two of water.
At bed time I don’t bolus if I’m under 140 without also eating something.
As Patricia suggests, there are a lot of factors at play including the time that’s passed since you last bolus, the type of insulin, what you have eaten . . . Keep records and keep trying stuff. For instance, you may know you’re going to come down anyway, but if you want to come down even further, bolus, especially if it will be 3 or so hours before your next meal. If you’re going to eat sooner, might as well wait. Just remember that if you do bolus between meals to bring down a high, you’re going to have to calculate or guesstimate your “insulin on board” when you bolus for you next meal.
I haven’t done the ‘revenge bolus.’ I don’t think that’s a technique that would work for me. If you try it, I’d recommend doing it the first time when someone is going to be around.
If time and space allows, a nice brisk 20-minute walk can bring down a blood sugar that’s only 20-40 points higher than you’d like (you’ll have to try and test–your mileage may vary)–and then you don’t have to worry about calculating for any insulin left in your system before your next bolus/mealtime shot (rainbow goddess, did you like how I wrote that to apply to MDI or pumping?!)
I don’t immediately correct for highs after meals because I’ve gone low from too much insulin on board. I keep testing & if I’m still high for several hours, then I correct. Also I drink a lot of water & take a long walk, or run up & down the stairs, much to the amusement of my husband.
If I was at 130-140 before eating. I’d correct to bring it down, in addition to the bolus for that meal. Without being a fanatic about it, I correct to stay within target range.
Something you might experiment with is timing of your bolus. While 15-20 minutes before eating is the usual guideline for rapid acting, some do better with different timing. It depends on how fast food is digested. Some people digest quickly, others have slow digestion. My endo had me checking at 1, 2 & 3 hours to see where my spikes happened & when the drop took place. From this, I messed around with timing for weeks to figure it out.
I used to bolus to bring 200+ numbers down. I am very uncomfortable being above 200. 5 units of Humalog did not do the trick (I was too impatient). I went to 10, 15 and sometimes 20 units. Half an hour later I had to drink tons of orange juice to stay afloat. Now I know that in most situations 2-3 units would have been fine. If you were looking for a bad example, you found it.
But see, you’ve learned, so that’s a good example!
Besides the risk of continuing or repeat hypoglycemia, having so much extra insulin floating around in one’s body can lead to weight gain (from taking in excess calories to treat the low) and overtreating to a rebound high, all of which neither a type 1s nor a type 2 is likely to desire.
It’s important to determine your correction ratio(s), which, yes, may change over time, in response to hormones, weight gain, etc. For example, I take 1 unit of rapid-acting to drop 30 points in the morning; 1 unit of rapid-acting to drop 50 points at other times of day or night.
This also corresponds, somewhat to how I treat a low at certain times of the day: 4 grams of glucose tab can raise me a full 20 points in the morning, but I may need 8 grams to raise me 20 points in the afternoon. YMMV!
Kelly, you are so right about weight gain. I had a hard time losing weight because I could not lower my regular dose and I considered the extra insulin for corrections not as optional either. Since I started using a CGM two months ago I lost 5 pounds without trying. I am thrilled.
If I’m under 140 before bed, I know I will wake up in range (70-100) the next morning, so I leave it alone. If I’m below 170, I might take half the suggested bolus. If I’m higher, I stay up until I know it’s not some sort of pump problem I need to take care of and watch my Navigator CGM for half an hour or so to see if the bolus starts to budge the blood sugar or not.
After a meal, if I know I calculated correctly, I try not to bolus until 2 hours have passed. The insulin is still working at that point.
Otherwise, yes, I bolus to correct highs, but with one eye on what’s happening in my day (how soon is the next meal?).
397 was really bad. A once in a lifetime event. I will tell 2 stories to explain:
I had gotten into the pattern of using more than 10 strips a day. I get 300 strips per month from my insurance. I tried to make do with 8 or 9 strips per day until I was caught up. Thus I skipped tests when I knew what the bg would be (so I thought). On that day I had not eaten within 2 hours before lunch. In my mind I was dangerously close to a low. I made it until lunch and had a Caesar’s salad and a milk shake. I had the exact same food many times before and expected to be about 100 when I returned from my lunch time walk. My next measurement came in at 397. I was puzzled and swore never to guess my bg again. It must have been one of these days were my bg stays high even when eating little or nothing.
When I got my CGM I was asked to test twice for the calibration. I thought that this was nonsense and I was tempted to just input the same value twice. But then I reconsidered and tested twice. Surprise, surprise! The two values were not close at all. I was horrified. I always believed in the bg meter values and used them to dose my insulin. Was my meter bad? I had another meter. It turned out to be as bad. I started complaining on the forums and searching for a more accurate bg meter. I was surprised to find out that the industry standard is +/- 20%. Then I learned something new after using bg meters for 25 years: I had to wash my fingers. When I was dx’ed urine strips were all there was. I tried to use urine to test whether in a restaurant they really served me diet coke and not regular. But the urine strips did not react to the sugar in regular soda. I tested urine strips against sugar water, cake … The only thing that I every saw them react to was glucose in my urine. I must have learned this lesson too well. It never dawned on me that bg strips could pick up anything other than the glucose in my blood. This is not so. bg strips pick up sugar from Caesar’s salad dressing. Bottom line: I don’t know whether I ever was 397.
Been there too…glad you have CGM now:) Look forward to more accurate and user friendly devices that may come in the next few years…when I am a post-doc and have REAL insurance:)
Yes, I do bolus usually between 2 to 5 units, if I am high. It depends on my sugar level. If I have had a meal at a restaurant or take out then I will need to bolus before the meal and then again 1.5 hours later. I do not bolus before bedtime since my sugars usually drop while I’m asleep.
