Seems like I should know this by now-- if you check two hours after meal you've bolus dosed for and find you are above your target range-- say, 180 for example-- do you administer a correction dose at that time? Or just learn from it for future reference? I haven't really figured out this concept yet.
I do unless there is still enough insulin on board to cover it. I don't know if you're on a pump or MDI, but on a pump it's easy to keep track of the IOB so you don't stack. But even with MDI you just have to do the math. I really believe what's important isn't what highs we spike to but how much time we spend there. So I always correct.
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I'm on MDI-- novolog and lantus. Even when I go higher than I'd like after a meal I seem to come back down to a decent level (say, less than 120) relatively quickly-- so I'm a little afraid to add more insulin. I haven't had any post meal readings over 180 in a couple weeks, but 170 or so is common, and disappointing for me.
Well, if you come down quickly, it's really a choice. Even an hour or two spent over 140 can really add up if it happens regularly. The key is to figure out your ISF - how much one unit of insulin lowers your blood sugar. That way you can bolus a correction without having to worry. But it is harder on MDI. Not only do you have to do the math but you have to stick with whole numbers.
Do you pre-bolus? If you are coming down to a reasonable number, consider taking your insulin 15, 20 or so minutes before you eat so it has a chance to get a kick start.
I would also correct if I were high 2 hours after a meal.
I've tried dosing a little earlier-- been experimenting around 15 minutes before eating here currently. It really doesn't seem to make much difference that I can tell. I am hardly taking any basal dose-- only 4u of lantus once daily-- apparently my pancreas still works enough to provide most of the basal needs... which I think just makes managing the bolus doses a little more complicated maybe? My ISF seems to vary enough on a daily basis that I just can't seem to get it pinned down quite-- doesn't help that I'm eating in cafeteria every day so my carb counting really involves a lot of estimation at this point yet
If you're high (170-180+) at the 2 hour check, but normal 1-2 hours later, then I think the bolus amount is correct. But the timing to match food and insulin is off.
You could change how/what you eat to slow down the food converting to glucose. Things that help slow it down is adding fiber, protein and/or fats. Sometimes I may eat 1/2 - 2/3 of my meal, wait 15-30 min and then finish the rest, usually a piece of fruit. By then, my bolus is starting to peak.
When trying to pin down your ISF, try tracking it by different times a day. Mine, for example is 1:40 during the day but 1:60 at night.
As far as the basal, a question is where your numbers are at during those "in between times" like waking, before bed and most important perhaps before meals. If you are starting your meal at say 120 or 130 it makes it more likely to spike to 170 or 180 after. Two approaches to use if that is frequent is either that you actually do need more basal (depending on your waking numbers too). Another is to add a correction into your mealtime bolus. I do this all the time if I'm over target prior to the meal.
I tend to be more worried about being too low than too high during the 'in between times' like waking, pre-meal, etc. Usually 70-85 even with just the baby dose of lantus, sometimes lower. I am really wondering if I should actually be taking any lantus at all right now, because all indications are that I don't seem to need it right now. some sort of a honeymoon period I guess.
i wouldn't do a correction if I were you, if you did indeed correct at that 180, say enough to bring you down 60 - 70 points to 120 - 110, then that 120 a few hours later would or could be 60 - 50 and with your fasting levels pretty low and basal needs so small...I'd agree that you probably would benefit from timing your insulin a bit better. I wait at least 15 minutes, depending on what my numbers are, prior to eating. It also depends on what you eat.
Yeah, the honeymoon period can be tricky.
I try to evaluate it situationally, I revisit what I ate and, if I missed some carbs, I might correct, if the recalc is a big miss, I'll bolus for what I missed too, which I don't think is in the manuals and is probably horribly dangerous but I figure it will help get it down? That being said, I usually will test inside of two hours and have a CGM so it's not exactly a suprise either and I will sort of start fiddling with it if it's hitting 120-130?
this is a guy who was JUST diagnosed in April, very insulin sensitive, not on a pump, on a very small dose of basal and still making some insulin, honeymooning...so, correcting is very different then what you mentioned.
I'm looking at my copy of Think Like a Pancreas by Gary Scheiner. He advocates using the 1500/1800 rule to calculate the insulin sensitivity factor or ISF. Take the average amount of total daily insulin, basal + bolus (novolog + lantus), and divide it into 1500 and 1800. This will yield a range of ISF.
For example, if the average total daily dose is 30, then calculate 1500/30 = 50 and 1800/30= 60. That means that 1 unit of insulin should bring down your blood glucose by 50 to 60 mg/dl. In this case, use 50 to be aggressive and 60 to be conservative.
As others have note above, it's important to consider how much insulin is still working and subtract it from the calculated correction dose. Novolog takes about four hours to complete its work. At two hours post-shot, you'll have about 1/2 the meal dose left to work.
So, if, for example you take 6 units to cover your meal and you check two hours after your insulin dose, then there are 3 units still left to work. Let's say your two hour BG = 200 and your target BG is 100. Then here's the math: (200-100)/50 = 2. Since there are 3 units still left to work, then no correction is needed at this point.
There is as much art as science to this, so the best thing is to take note of the numbers and write down what happens to your BG. Live and learn. Your diabetes will vary, of course from any textbook examples.
AS MegaMinx observed, playing with the timing of the bolus before eating may be all you really need. Knowing how to calculate a correction dose, however, is a useful skill to know.
I agree that your diabetes may vary from the textbook examples. I find the formulas both Gary Scheiner and John Walsh use to be only guidelines, they don't work exactly for everyone. For example, using my own 25 units (average) a day it would come out between 60 and 72. My night ISF is, in fact, 60, but my day ISF is only 40. I think the best way to figure out any of these numbers, whether ISF, I:C ratio or basal rate is trial and error/trial and error.
I would still think of it as sort of linear math though, even w/ really small amounts of food? I don't recall his diet strategy which might affect the size of the doses. When I was on MDI, I was always "splitting" doses in between the lines to get all sorts of different approaches, etc. I figure if he's a sailor, he's probably pretty handy with math and, if he's not, he has a calculator on his phone? I have different approaches for different sorts of meals?
these factors, rates, etc...aren't designed really for those going through a honeymoon phase...i did not do any corrections for a while after Dx and while honeymooning because I was still producing some insulin and I would eventually, like abellseaman did, drop down. abellseaman, please be careful with this and these suggestions and discuss with your endo. When I did start correcting, it was only with meals..then, eventually corrected for anything above 140, it took a while. Also, remember 1/2 doses, 1/2 doses you can do for both basal and bolus with a syringe.
Thanks everyone for the advice. So far I've only used the pens so half doses haven't been an option yet. But definitely something I might look into-- have some serious doubts about the precision of doses this small with the pens. I had a previous discussion on here on that topic.
I'm just looking hard and trying to spot all the patterns-- seems to be anything but consistent. Hoping to get CGM asap-- I think that'd help a lot to understand the patterns.
I just hope for the best after meals that my blood sugars will come down on their own, which they mostly do if my basal rate is accurate. If they don't come down, I can correct it later. I only administer a correction dose at mealtime.
I would correct if I was high 2 hours after a meal (unless I was trending down at a good clip--CGM saves me yes) If I didn't have a sensor in i woulb be very cautious and check again in 30 min
Another is to add a correction into your mealtime bolus. I do this all the time if I'm over target prior to the meal.
So do I.. and I add the correction in 30 minutes prior to the meal, along with the Planned meal bolus if I know exactly what I am going to eat ( when at home). I may correct a out of range 2 hour post prandial.. It depends on how high ( is it over 150 but not yet to 180 and I plan on exercising, still have IOB :no correction needed.) The over 180 spikes are rare , but I will correct at two hours if that is the case, exercise or not)
God Bless,
Brunetta