I am a T2 who has only beein using insulin 1.5 years. But my whole idea is that I never want to correct. I want to do things well enough that I never have to correct. And I have to accept that I am not perfect, so sometimes I will not correctly count my carbs, dose my insulin or in fact life will just thrown me a curve ball. I reserve corrections for when I have a blood sugar of "epic" proportion and I have some significant confidence that my existing insulin on board won't fix it.
This happens sometimes after a meal, but I usually wait til 3 hours after my last dose to be sure that my insulin on board won't take care of it. My most common use of a correction dose is in the morning if I wake high. In that case, I am just running on basal and the situation is clear. Then I just add it into my breakfast bolus and do as others have suggested pre-bolus, perhaps 30-45 minutes before I eat.
I am lucky to have good control, so my endo actually suggests that I not correct after meals and that instead if I am high before the next meal I simply add a correction into my next meal bolus. This is a good safe practice when you are starting out and still have beta cell function, particularly if you just have a mild high. Learn from things. If you are routinely high after a meal, you want to improve your counting and bolusing, not regularly correct.
This is something I’m planning on talking to my CDE about, as well.
She’s told me not to bolus unless it’s with food - in other words, i will calculate for a correction at mealtime as well as for the meal’s carbs, but if I’m high between meals I’ve been instructed not to correct and if I’m having a snack and have IOB, I’m only supposed to bolus for the carbs.
Overall, this seems to work for me but I am also taking a lot more basal insulin than you are (16u) - so even when I’ve had a spike around 180 2-hrs after a meal, it tends to drop into range pretty quickly and I’m extremely confident (afraid?) that any more insulin would send me very low.
Right now, if I’m high I try to get active - even just moving around the house or a quick walk with the dog - which seems to work pretty well and avoids the risk of taking too much insulin.
LOL @ walking the dog! I had surgery (umbilical hernia...4" scar!) in October and was on the DL, no running for 4 (well, 3 1/2..) weeks and no lifting/ crunches for 8 weeks. Right before "lights out" the OR nurse said "walk, you'll heal faster" so I started out the day after, walking the creature around the block going "please don't poop, I won't be able to pick it up!".
That being said, w/ CGM, testing and experience and wild craziness, I will correct without eating. I think I eat a lot during the day 1) to get more veggies, as I feel better running and 2) it's easier to keep BG pretty flat if I've got insulin and food on board a lot of the time? Then I lay off after 2-3PM, work out when I get home and settle in for the evening. I don't run up to 180 very often these days. I am pretty dull, in that I eat the same thing for lunch a lot of the time during the week, but I am doing ok w/ BG and running goals most of the time.
I think one has to decide how high he/she is going to turn up the intensity level on their insulin therapy. My goal is to keep my BG between 70mg/dL and 140mg/dL 90% of the time on any given day. The only way I can do this is to correct after meals and make food selections that do not spike my BG over 140 for long periods of time.
My pump adds correction insulin based on BG and active insulin every time a new bolus is given (sometimes I even correct the correction) and I watch my CGM and make small post meal corrections based on history and what I think my BG is going to do in the next hour or two.
My total correction insulin (30 day) average's about 3-4% of my TDD and if it runs more the 10% then something out of the ordinary has happened that day.
It has taken me over 20 years to settle into a plain that works for me, and I have no real interest in pushing for better results. I have many good days with flat blood sugars and then there is the occasional blowup when the "Bete's" sticks it's tongue out at me.
Yeah, its just so hard to get a handle on at first. They are not serving food here this weekend, so I actually went grocery shopping and can do some more precise counting. For example-- Woke up today at 84. Dosed basal 4u of lantus and 4u bolus 20 minutes before breakfast. Ate 60g carbs with breakfast-- two hours later 138. Not bad, maybe a little room for improvement. Before lunch started feeling a little twitchy and tested at 64. ate 60g carbs for lunch and took 4u again--We'll see what happens. According to your linear math theory-- that would put me at 118 2 hours after... plus or minus a few for different fat and fiber contents, right? We'll see what happens, it just doesn't seem to work out that predictably for me yet.
I'm obviously going to have to start figuring out how to work some snacks into the routine. I really don't understand why I'd be in the 60s before meals when on such a tiny basal dose and clearly not overdoing the boluses.
A small change in your activity level can have a huge impact on your basal requirements... this can even be several small tasks that just burn off a little extra BG between meals...there will always be some inconsistency when using lantus..one day your body may absorb 85% and the next day only 60%.
It might be "leftover" insulin kind of lurking around from the prior meal? The "tail" on those graph things runs out for a few hours after the "peak" and, w/ a relatively small dose, a little bit might go a long way? Also, w/ a recent dx, you may still be brewing your own up and having some honeymoon dosing. My honeymoon was over a LONG time ago so I don't recall it and was probably only testing 4-6 times/ day anyway as it was 1984! I snack on a lot of cheese and nuts that have some protein and fat and seem to help keep my BG ok although it's sort of easy to eat a lot of nuts pretty quickly and turn into enough carbs to warrant bolusing?
Wow-- same exact meal at the same exact time, with the same exact preprandial BG and same exact bolus dose as yesterday. The perfect experiment. Yesterday shot me up to 135-160 postprandial (tested several times). Today 68-77 postprandial. I just don't get it. I'm trying so hard to find consistency, and it just appears that there is none. I did go on a leisurely walk after lunch today-- but I exercise much more vigorously than that most days and don't believe it really made that big of a difference. Please tell me it gets easier once this "honeymoon" is over.
Your leisurely walk could indeed make a difference. I used to walk about 12 blocks each way and then stroll around a large market to shop and went low every time.
I think it gets somewhat easier after the honeymoon (I was LADA so had a different experience), but there are still times things seem inconsistent. There are so many variables to deal with so sometimes you can figure out why something happens, but sometimes it is without rhyme or reason.
So my short answer is it gets "easier" but never "easy".
It’s not just the honeymoon. If I eat more than about 20 carbs and my BG is at 120 2 hours later, I will probably end up going low if I don’t have a small snack. I’m very sensitive to insulin and I have measurable action 4 hours out.
I know that the honeymoon adds many confusing variables, but even once you’re completely insulin dependent it’s still hard to get everything to balance out and be consistent day to day.
Do you find that when you eat less carb and bolus less that you don't have as large of a spike, followed by a crash afterward? I've been trying to eat 60 grams of carb with each meal-- which is a lot higher than I think a lot of you are, but considerably lower still than the ADA reccomends--- I definitely think I may be willing to try a different strategy though.
Actually, when I eat more carbs and bolus more...my body seems to like it better. The amount of insulin I take and the carbs I eat don't really seem to make much difference, I can spike on something low carb - grams if I don't get the insulin dose correct, etc.. for me...I just have to wait after I bolus to eat.
BTW, I just switched from novolog to humalog and the change is incredible. Some people do well with all fast actings, some notice no changes, some prefer one over the other. I haven't had one high or spike with humalog, I actually have had to lower my insulin (i've had two significant lows) because it seems to really work fast for me and I seem to need less. I LOVE IT!
Yes, I think many of us have learned to eat less carbs and bolus less to avoid spikes. Also there is something called the "law of small numbers" that means that the less carbs you eat and the less insulin you take the less chance of making mistakes and if you do make mistakes, the result is less severe. Many people have excellent results longterm on true low carb, following Dr. Bernstein's "Diabetes Solution". Others of us eat a more moderate version, like myself - I try and keep it under 100 a day.
Humalog was what I was originally prescribed actually, but they never filled it because my insurance wouldn't cover it, so it got switched to novolog-- wonder if it might make any difference for me as well. I think I can probably get my insurance to cover it but the doctors office would have to call and get it preauthorized I think
maybe wait a bit and see if the novolog helps...sometimes it helps too to eat protein first..let the insulin get going, then try your carbs last. Low carb too, if that's in your plan. You're doing great! My honeymoon was very very tricky too. It will change often and you just need to kinda go with it. Don't worry too much about a spike right now...remember, some CDE's say 180 2 hours ppl is a goal. We tend to like nothing above 140..but you're still new and your body is trying to adjust, still spitting out insulin. As I said, I did not do corrections for a while and started with just doing corrections with meals. It just takes a lot of trial and error. Many people swear by novolog too..so maybe hang tight for a bit. Are you seeing a CDE, do you have a follow up with your endo? Have you checked your BG's one hour after meals, are you checking 2 hours after you start the meal or when you finish the meal. I was told many different theories on this..I check two hours after I finish because sometimes it takes me a long to finish a meal.
I have met with two different CDEs. I've only met with the one where I live once, the first one was several meetings immediately after initial diagnosis (I was away from home). So far I haven't been to an Endo yet, as I live in Homer, AK and the only place in AK with Endos is Anchorage-- and I haven't made it up there yet (it's about 250 miles away) But my family doctor's daughter is a T1 so I think he probably knows a lot more about it than most. My goal is to check two hours after I start eating-- but in reality with these classes / conferences I'm at all month its hard to be precise, at least during the week. Often anywhere from 1:30 to 2:10.
I just filled out the pre-auth request for dexcom cgm. I really think that would help a lot. Hope I don't get too much of a runaround with the insurance. I can just see them forcing me to collapse a few times before they agree to cover it...
