On my last visit to my Endo she changed my ISF from 75 to 60. Since this has been changed it seems like when I do a correction it takes longer for me to come down than it did when I was at 75. Now when I do a correction if the the meter says 1 unit I will bump it up to 2.5 units to get my BG back down in normal range. Should I go up or down on the ISF to make it work better?
Uniboy
Just for clarification: an ISF of 75 means that one unit will reduce your current blood glucose by 75 mg/dl? The new ISF of 60 means that one unit will decrease your BG by 60 mg/dl? If this is what you meant. Are you aware that this change by your endo will already increase your dosage for corrections?
BG above target: (BG - target) / ISF = dosage for correction
Example with current BG of 260 mg/dl and target of 110 mg/dl
ISF 75: (260 - 110) / 75 = 2 units of insulin
ISF 60: (260 - 110) / 60 = 2.5 units of insulin
Very likely you meant the Carbs per Insulin unit to calculate the dosage for the carbs!?
Your ISF is one of those things that will change periodically, so you can always adjust it according to your calculations and what works for you. Your adjustments should be made based off the data that you keep from BG tests, your total daily insulin, etc.
If you're unsure of how to calculate this you could always give your endo a call and explain that your new ISF isn't working well for you.
Thanks for the info. IC ratio isn’t working anymore either. Guess I am getting out of the honeymoon phase. I probably need to reset the whole pump.
Even if you meant the Carbs per Insulin the recommendation of your endo still should lead to more insulin units:
Carbs to eat / carbs per unit of insulin = dosage
Example with 100g of carbs to eat:
75: 100 / 75 = 1.33
60: 100 / 60 = 1.66
How do you calculate?
Yowza. You are basically overriding the whole thing. Normally your pump will use your ISF to properly calculate a correction. Holger showed you the calculation. In the example you gave for a correction to drop you 60 mg/dl, your pump calculated a bolus of 1 unit. You then overrode it to 2.5 units corresponding to an ISF of 24. An ISF at that level would suggest a fair amount of insulin resistance.
I'd like to suggest that we all must have a resonable expectation of how fast a correction will work. A correction will work primarily over a period of 2-3 hours, you may experience only fraction of it's affect at one hour. You may not be giving the correction enough time.
Also, we need to remember that we generally correct for a high blood sugar and often the higher the blood sugar the more difficult the correction. When our blood sugar is really high (> 250 mg/dl) it starts to induce insulin resistance. So we may require additional correction bolus to adjust for that. You should not adjust your ISF to do this.
And finally, it is always good to know how everything works on your pump and how to properly adjust the settings even if you have a good medical team. You no doubt have a manual, but the book "Pumping Insulin" by Walsh is also invaluable and describes how to properly use testing and your logs to estimate your ICR and ISF.
When I have been using the pump to do the correction my BG has been staying the same. I don't really understand whats going on. Now when I bolus for a meal my bg keeps going above 200. To keep this from happening I have started doubling what the pump suggests. I know how to change the settings on the pump but my endo didn't like the changes I was making. She thinks I'm being to aggresssive. Every morning I get up and my BG is 200 or more. The day starts off doing corrections. Yesterday morning I gave myself 3 units of insulin and then cranked up the basal rate by 70% and three hours later I was finely back down to normal and leveled off in the 70's.
I check my BG alot while I'm doing this. Good thing I like Roller Coasters.
I agree with everyone else, Uniboy and do find it a bit scary that you are just randomly increasing doses without really understanding what the dosing system is. I highly encourage you to read Pumping Insulin first and get some clarity as to how the dosing works, and then, since it sounds like you are high a lot, to start from scratch and reevaluate your doses, starting with your basal, then going to your I:C ratio and ISF. It sounds like you have a good Endo who can sit down and work on this with you, but bottom line is, on a daily basis we are the ones living with our diabetes and need to be comfortable with having the knowledge and understanding to tweak doses based on patterns we see.
Actually my endo is the one who made all the changes on my pump after I had it set up accept for the early morning basal. This is why I am constantly doing corrections. She didn't like the fact that I had two lows in two months; one in the 50's that was caused by exercise and one in the 60's where I probably misjudged the carb count.
There are mornings I have woken up in the 300 range. I agree with you that this isn't the best way to handle this by wild ■■■ guessing. When I bump up the basal rate for 2 hours at 200% to bring down my BG I am checking BG every hour to make sure I don't come crashing down.
I have read Think Like A Pancreas and Pumping Insulin and was using the guidelines in these two books to set up the pump. The books are worthless if my endo is going to change my pump settings. Before she made the changes my control was fairly good with very few highs and very few lows.
I am really starting to hate the so called medical professionals. When I ask her where she wants my numbers at she want even give me a straight answer and tells me she is more worried about the lows. Right now I have just as many lows as I did last time I saw her; so I guess she will want to raise my basal and IC ratio again. I might as well go back to MDI if she doesn't want the pump set up the way it should be.
Thanks for listening Uniboy
Perhaps you could get your endo to agree to have you work with a diabetes educator on getting your pump settings right. Having another person involved my use an innocent bystander as buffer between you and your endo (who really sounds like a control freak). If your endo can "trust" another professional, your chances of getting any other professional to be a little more rational seems pretty high.
I'm getting real close to looking for another endo. I'm not sure it's worth the effort do to all the comments on here I see about endo problems. I have only been going to an endo since last august.
I don't think she has any diabetes educator in her office.
Next time I go to her and she tells me she doesn't like the lows I'm having; I'm going to tell her they are not really lows that it is the fault of the inacurate blood meter I have. LOL
She was upset about two lows in two months??? She'd probably send me to the ER (and I don't think I have an excessive amount of lows, but it's a lot more than that!).
Yes I only had two lows and 48% were above 140. Now do you understand why I'm cranking up basal rates and going above what is recommended on the pump. She was telling me with numbers like this I should still have a good A1C.
I wonder if she was diabetic where would she want her numbers at?
Maybe if you say where you're generally from, someone can recommend the name of an endo group.