Negative Correction Factor?

I recently experienced a couple of low BG–56 and 47. The 47 deserves a YIKES! I felt pretty creepy. Both of these happened when I waited too long to eat. I was going to go ahead and eat thinking that my OmniPod system would do a negative correction and let me bolus for the meal. NOPE!!! How have you handled this situation? My granddaughter’s diabetic educator explained how to do a negative bolus calculation (subtracting 15g of carbs from the total grams of carbs for her meal). She, however, is on injections and not a pump.

Most pumps won’t let you bolus at <60… too dangerous.

My Minimed Paradigm 722 pump gives me a warning that I should wait until my BG is above 70 before bolusing. But that’s just that - a warning. I can go ahead and give it the number of carbs I’m going to eat and it calculates the correct bolus after compensating for the low BG reading.

I wish that I had that option. The way the OmniPod is set up…I had to do that 15/15 thing 3 times to get my BG high enough to eat and bolus. I hated it. I was hungry!!!

John is correct. I have the MM722+CGMS and I can eat with a bg of 50 and bolus for whatever I am going to eat. The bolus will automatically deduct for my bg of 50 and NOT give me the normal dose. I just let my pump do all the math for me.

Ok…so the lack of that capability sucks!!! You’d think that you should have the option to over-ride the denial.

I’m going to get flak for this…MMs are like Linux (you control everything) and Omnipods are like Macs (Apple controls everything) :-(.

Uh oh…I’ve had extremely good luck with the OmniPod. It’s my first pump experience. I chose it over the One Touch Ping because I have a very affectionate Bichon who would have gotten tangled up in the tubing. She’s all over me!! My loyalty is to myself and whatever works best for me.

You can set the threshold on the Omnipod for negative corrections. I believe the default is 70. i have mine set at 60. You can set it as low as 50. Settings -> System setup -> bolus/basal calcs -> Ratios/factors -> Min BG for calcs. No Linux required.

Duh…totally forgot about that. That would have resolved all but that pesky 47 that I had the other evening. I like that humor. My BG was as high as 397 and that low of 47 all in one wretched day!! I’ve been taking better care of my newly diagnosed granddaughter than I have myself. Forgot to bolus and then waited too long to eat all in the same day. Thank goodness I really watch those carbs or I don’t know how high it might have been…good thing we skipped that pizza.

Well I am pretty sure you COULD override it on an Animas pump, but common sense tells me not to… since wearing a CGM I know that I often drop into the 50’s from a bolus from a “normal” BG shortly after I start eating, if I was already low and I bolused, even if I ate immediately that could just be a big disaster waiting to happen.

If I am low before a meal and I ‘feel’ fine I will eat and just bolus after… IMO that’s safer than just assuming everything will be fine.

Can you not bolus only for the carbs consumed?

That’s pretty good John. No flak from me. I kinda like the analogy, and I also like Linux, but I like Mac’s too. Maybe I’m just too easy. Makes life simple for me tho.

The idea of eating and bolusing immediately afterward sounds like a great idea. My problem was that my brain was trying to work on pilot light mode…flame on was definitely not happening. I’m pretty aware of going low…but I’ve been involved with my granddaughter (aged 14) who recently was diagnosed–type 1; and have been a little neglectful of myself. The 47 BG was pretty scary!!

Janice - What I usually do in that situation is let the PDM calculate the bolus but then put it in extend mode - 0% up front with a 30 min. duration in most cases. Works like a charm!

Tony R and Sarah…I’m going to try both of your ideas…but as I’m typing my reply, I realize that neither of your responses/solutions address the LOW. You’re both simply delaying the bolus. I’m leaning toward the extend bolus solution that Tony suggests…but do you subtract at least 15g of carbs from the suggested bolus? If not, why wouldn’t you wind up low again?

I don’t have Caleb’s PDM with me right now, but you can definitely have your settings established to allow for a reverse correction to reduce the insulin dose to compensate for the low, and I think you can also set the low number as low as 50 to allow for insulin administration. If you want to bolus right away, I think (I may be wrong) that you can manually change the BG number to the 50 or whatever your lower limit is, to allow the PDM to administer the correction. You will have an added BG in your stats, but still able to give the correction.

The reverse correction for Caleb hasn’t worked too well - I have found it to be a little too conservative, thus resulting in highs. So I have that option turned off and I typically subtract an amount of carbs from what he is eating. For Caleb, 4-6 carbs translates to about 25-30 BG points.

Thanks guys…lots of advice to consider. The lowest that I have been is that 47 since starting the OmniPod. I was very confused and therefore need the easiest most straight forward solution. Probably setting the PDM to 50 (still above my low). Then if I can get it together…turn the PDM off then back on and manually enter 50 for BG to calculate bolus for meal. I should be fine. I think.