If my niece is too high after a meal, she will either be going higher or she will not return to the proper level, so two hours postprandial, when we check to see either/or (will she need more insulin or carbs?), yes, I will correct, even if the pump does not allow it. For instance, two hours after, if she is 250, I will give her enough insulin to knock her down to where I want her to be at the two hour mark. If at school, I will give enough to knock her down to 200; if at home, I may give enough to knock her down to 160. Depends. We always correct highs if there is no insulin on board, whenever. Overnight, she has a different correction factor, so she gets less insulin to correct but we do correct. If she is 130ish, sometimes I just give a small temp basal for an hour and that will take care of it.
thanks a lot everyone, for all your great input
If it’s around 170 I usually exercise. any higher than that and I’ll bolus. For example, the other day I went up to 165, took and intense bike ride around the block, and was able to drop it 60 points in about a half hour, as opposed to waiting two hours for novolog to do the same thing.
You have to bolus carefully, as I see you suspect already. First thing to be aware of is that you may want to bolus if you use Humalog or Novolog, but if you are using R (which is fairly unlikely these days, but possible) it could complicate things. Since R, the original kind o insulin, takes effect slowly and also keeps working too long. That would lead to disappointment at the start while waiting for it to reduce bg, and a low some hours later.
That being said, you need to decide how much a single unit of insulin will drop your bg level. Not really difficult to figure out if you dose for each meal, just divide the grams of carb by the units of insulin you take. That gives you the carb/insulin ratio, which is likey close enough to the desired bg drop/unit of insulin to get you started. Just play it conservative until you get real results, don’t want to go low if it doesn’t happen as expected.
Now, another thing 130-140 is definitely too high before a meal for long term treatment. I’d suggest a small bolus at that level or higher. I just looked farther down and found you take Novorapid by shot. Syringes limit you to maybe 1/2 unit, (by guesstimate) more or less. If you don’t need that much you’re best to not take a shot.
Night times are a rather different story though.
I thought I had replied to this thread, but don’t see my response. At any rate I had mentioned I had a very high Correction Factor based on my TDD, 1 unit to lower me 112 points and so had never felt comfortable to try it. So today I was 223 two hours after breakfast (no clue why) so decided to give it a go and injected one unit at that point. Later when I went to Using Insulin and read about “unused bolus” I realized that I had 1.5 units unused so maybe didn’t need to do it at all?? Anyway, I tested and two hours just now after that extra one unit I am down to 117. I’ve always been so conservative (read frightened) about insulin since I screwed up and had a scary low in April so I’ve never had much chance to think about stacking of insulin. Now it is an hour to my lunchtime (3:15) and I am a little concerned about that extra unit I took at `12:15 (I know small numbers, but I am sensitive!) I guess I will just test before lunch and if I am not low by then I’ll bolus for my lunch as usual, because there is only an hour before the rest of that insulin all leaves. If I’m low or even borderline low I may go a unit less. Make sense?
Someone posted a blog post recently… about contaminants on fingers.
To aid in their point, I tested two fingers at the same time… one clean, one contaminated by rainier cherry juice (not even enough to be sticky, I just ran my finger tip over the cherry flesh and let it dry) and there was a whopping 450pt difference in my readings. I expected some difference… but I wasn’t prepared for the 583 that stared back at me! I’d have flipped out if I hadn’t known why it was so high…
I have just found out that my morning bolus’s are not cooperating with me. I end up with a high blood sugar about three hours later. bleh. I usually go high for like 10 minutes then go lower. I think I need to change my I/C in the morning.
I have found that I have different insulin sensitivities during the day. I am type 1 with insulin resistance (double diabetic). From 8am to 8pm 1 unit will reduce my BG 12 points. From 8pm to 1am it is 20, from 1am-5am it is 30 and from 5am-8am it is 20. I know there are additional variations but it is too difficult to determine them. With all this in mind I can better determine how much I will drop when I do a correction bolus. Before I knew that my sensitivities varied that much I had many lows in the late evening or during the night with too much insulin.
I correct if I am over 120 two hours after eating. My target is 90 and 120 is 30 points above that target. I run a very tight ship but I still have some highs and lows and even pumping does not totally solve that problem. My exercise varies a lot and the kindfs of food I eat does too. That certainly has a lot to do with my highs and lows. I stay between 70 and 130 almost 90% of the time so I should not complain. Those years 1945-1985 were dismal because I did not know I was supposed to eat low carb, I was told repeatedly that I only needed tp avoid sugar. We live and we learn!
Hi Richard, amazing experience that you must have had. Meanwhile I admire you running this tight ship and that would be my aim as well. As I am still new to diabetes compared to yourself, can you tell me if you had some tests done on how many units do drop your BG for the times that you have mentioned, or is this due to the experience that you have build up with logging all your food vs insulin requirements?
I have been logging much info every day for about 20 years. That info combined with trial and error gave me the ratios and insulin sensivity levels I have been using. It took me months to get them just right. My ratios change periodically due to seasonal changes . There are so many variables to consider when using tight control. It requires much patience!!!
Read up on postprandials - ie testing 2 hours after a meal.
If your sugars are going high after a meal, but then they eventually come down, that might be a sign that your long/short acting insulins are out of whack - maybe you’re not taking enough for your meals, and too much for background insulin so it balances out in the end…
Before making any changes in your insulin, gather lots of information! Start by doing some fasting tests. Check your sugars every hour or 2 without eating or taking short-acting insulin. If you notice that your sugars are dropping or rising on more than one consecutive day, talk with your doctor about adjusting your long acting insulin.
My physician tells me to go to bed with a blood sugar at or about 150 to prevent nighttime hypoglycemia and if it is under that I need to eat something with protein and fat. Does your endo have you using a sliding scale based on your blood sugar to add or subtract from your bolus? If not, ask why not? If you are not familiar with what a sliding scale is, check your sugar and say it is within your range (mine is under 120 before meals), you take a bolus based on your carb. count. If say the sugar is 180 my dr. has me add .5 units up to 150 then another unit for sugars 150-200, so I would add 1.5 units to the bolus I should be taking for the carb count. It sounds confusing, but it is a great way to keep yourself within “normals”.
I have never understood why doctors recommend using sliding scales. A sliding scale gives an approximate number of units needed whereas carb counting is much more precise and dictates the exact number of units of insulin needed for meals and snacks. My control was greatly improved by carb counting. No doctor ever had me use a sliding scale. Determining our insulin sensitivities is also very important and helps determine proper insulin dosages.
Very true, Richard. The sliding scale for me works in addition to carb counting. If my sugar is above 120 before a meal, I use the scale to get the sugar where it should be prior to eating. I use Apidra and can bolus 10-30 minutes before meals to lower my reading. Then when I eat, I just bolus using my carb ratio. If I am out at a restaurant, I do it all at the same time. Sliding scales are for some people and not for others. As a woman with hormones still happening, it has been a blessing to have.
As a pumper, I’m glad to be off of a sliding scale though. I was on one for my first ten years when I was on MDI and I definitely see its value over set dosages (which I find crazy), but, in practice, a sliding scale is pretty imprecise. It was better when I added carb counting PLUS a scale, but still… If I’m 150, I need less insulin than I do at 199, which would still fall in the same range on a typical sliding scale. With a pump, however, because you can do such tiny changes, I’m able to correct to a specific value - like 100 - rather than a broader target range. So I much prefer it. I would take a different amount for 155 than I would for 150. Same theory, much more intricate.
Animas calls it CarbSmart where you input the amount of your carbs and blood sugar then it decides how much you need like the Bolus Wizard on Minimed. Most of the time, I eat at home, but on very rare occasions when we actually get to eat somewhere other thanWendy’s or DQ, my numbers sometimes get a little out of whack due to the way the foods are served and how long it takes a chef to prepare your meal. At home, I know we eat at 5:30 or 6 depending on activities and can check levels at 5 and sit down and eat with my guys, husband and son.
this is a great idea…you might be correct
Hello nilufer:
This would be the IDEAL situation to try our a CGM and see what it said specifically! Given your numbers I wouldn;t touch it, but 130-140 would not be worth mentioning… IMHE.
…If it AINT broke don;t fix it…
thx vm for all your feedback, which I found extremely useful. I have read like 20 books about diabetes by now, but nothing makes you really wiser than people with the experience 