I was reading some of the training material in dexcom's thecgmsresourcecenter.com website. I came across a powerpoint which had case studies using the dexcom. They mentioned a scenario where after bolusing, the dexcom alerted to a sharp rise and they recommended taking a correction bolus prior to even the first hour.

I'm confused- I thought we weren't supposed to stack boluses? I actually tried this on Friday and it worked, but it was a total SWAG. Can anyone help me figure out a little bit better way of guesitmating how much to bolus based on the trend and rate of rise?

Here's their scenario:

"Let’s take a look at how John started his day

On waking, his BG was 72

He ate breakfast at 8:00 AM and took 4U of H (60g/15=4)

At 9:20 AM the “high alert” alarm (set at 180) went off

He did a fingerstick to confirm his BG level and reviewed the 1- and 3-hour glucose trend graphs

Best answer—meal bolus should maintain glucose values within 50 mg/dL of pre-meal value. Glucose up 100+ points – correction ratio 1:50. One question you might ask is, given that the correction factor is 1:50 and that 2 or 3 units of Novalog would drop the blood glucose 100-150 points, if John is only 182 mg/dL, shouldn’t this amount of insulin cause hypoglycemia? The BIG difference in this situation is that we have TREND information showing the trend is going up and has a high ROC (rising steeply). Helps make the decision to take more insulin to address rapid rise and reduce time spent in hyperglycemia."

I'm wondering if there is a safe guideline to correcting if you've *obviously* underbolsed and you don't feel like spending the next 4+ hours high...

Thanks!