Tight controllers: Do you correct below 100?

Just had a 97, juiced to correct it. Got me thinking that I generally correct in the 90s if convenient.

Seems rather meaningless, given all that I've learned scientifically about diabetes.

The only reason I do is it helps with the spike after eating, if I start lower.

How about the rest of my OCD maniacal tight control brethren?

I don't. My pump target is 5.5 mmol/L (99 mg/dl) +/- 0. At night, I correct to 6.0 (108), because if I go to bed lower than that I frequently have middle-of-the-night lows. Overall, I think correcting to lower than the chances of going low would just be too great.

So when you say 'juiced to correct it', I'm guessing you mean did a small bolus, and did not 'drink apple juice' !!. (based on later comment that you want to start lower pre-meal).

If I'm at 97, I would generally NOT correct. But the answer is really 'it depends'.
If I'm going to be driving, or active, I might correct with a small snack. If it's before a meal, I might 'pre-bolus', as you stated, to get a bit lower before meal, but would subtract that bolus amount from meal bolus. Would depend on how long until the meal, and what direction the CGMS says I'm going.

This is a perfect demonstration of the value of CGMS. If all you know is the single BG value at time X, you don't have the advantage of estimating what it might be in 20-30 minutes, without a correction.

From reading this site, I think a CGMS changes a lot of the way people manage diabetes. I read about people doing corrections for in-range numbers, or correcting with extra and then snacking before a low hits, or doing X depending on Y. I can't do any of that without a CGM, or without testing 20 times a day (which I don't have enough strips to do).

I've been known to take .05 unit at 99 but that's just noise either way. I prefer to start eating in the 90s as I have a tendency to go low at 1-2 hours if I'm in the 70s or even in the low 80s.

I hope so, too! Hoping the Dexcom/Vibe comes out soon! Though I'll have to pay for it out of pocket, so it partly depends on if I can afford it ...

A bit too OCD for me, I'm afraid. I have to be 110 or higher.

Let's say my ideal target is 80. I sincerly doubt, given everything else that affects my BG, that I could dose with the kind of resolution needed to bring myself from the 90s into the low 80s, then stay there. Heck, if I walked to the nearest coffee shop I could probably get enough of a workout in to bring my BG down into the low 80s.

If I'm in the 90's, I'd probably be more concerned about crashing under most circumstances.

I have to tell you, even as a Bernstein follower I would never correct a 97 mg/dl. When I first read this, I thought you were asking whether you should treat a 97 mg/dl as a low. I think a good philosophy is to do the absolute minimum required to attain your health goals. And correcting a 97 doesn't make sense for a number of reasons

First, according to your profile, your A1c is 6.3%, you should be proud of that. But it corresponds to an average blood sugar of 135 mg/dl. If you are really doing well with your control regime and dealing with meals, that is your approximate fasting blood sugar. Performing hourly corrections to levels that are 40 mg/dl below your normal fasting doesn't make sense. If you want to improve your fasting blood sugars then do some basal testing.

Second. Meals. An average blood sugar of 97 mg/dl corresponds to an A1c of 5%. If you are having trouble with meals, that suggests some modification of your meal bolus regime. I really doubt that correcting a 97 mg/dl before a meal is actually any different, what really makes a difference is timing and profile. I would suggest that you adjust your timing of your meal bolus and see if that helps. If your meal really leaves you high at 3-5 hours then your ICR is likely off. If you just have a high at 1-2 hours and then go back to a normal fasting at 3-5 hours, then it really is all about timing.

Third. You may actually think you are getting a correction bolus, but it is being overridden. The Omnipod has two settings, a target and a correction threshold. If your blood sugar is already below correction threshold, you should not get any bolus delivered. If you mess with your threshold and correction threshold and set them to like 80 mg/dl and 85 mg/dl, and your endo finds out they will most likely give you a serious thrashing.

Fourth. Change the important things first and worry about the details when you have the important things taken care of. My A1c is in the 5s and I only correct when I am above 140 mg/dl. I want to never have to test and correct. Remember my philosophy. The two most important insulin regime things are getting your basal settings properly established and then to eat and count an appropriate diet and bolus the right amount at the right timing/profile for the meal.

Please don't take this personally, I just don't think almost anyone here should be testing and correcting a reading under 100 mg/dl. You can be OCD, many of us are, but spend your finite amount OCD energy on the things that are really important.

Situationally, I would take a whiff of insulin if it were like 4:00 AM and the 97 on the CGM was going up from like the 70s or 80s, to get a head start on breakfast or whatever.

I don't (can't) try for tight control since my son is only 6 and actually needs to have higher BG levels right now (not to mention the annoying habit his pituitary has of releasing growth hormone all the time), but it seems to me that the best strategy is to strive for numbers that are physiologic — and from that standpoint, I don't think it's beneficial to dose numbers in the 90s simply as a matter of course. Your pancreas, were it functional, would not increase output if you were stable at that level on the amount being released/circulating already, unless it had reason to anticipate a rise (meaning, because you were eating something that was going to bump your glucose levels up shortly). And even then, it wouldn't really turn on the insulin faucet too much until you started to near the standard upper level of 150-180. Tight is one thing, but there's such a thing as too tight. It's no good maintaining an a1c in the 5s or low 6s if the flip side is that you increase your risk of catastrophic lows.

Just a note on the Omnipod. You will know if a dose is being delivered or not. Since Dave is the thread stater, I assume he's worked through all the settings to allow him to correct a 97 to whatever target he desires.

I only correct anything above 130.

Spot-on, Jen!

I have a G4, and this has substantially changed my behavior.

I light to tell people that the CGM is like have sight restored. I mean that with no exaggeration.

If I didn't have a CGM, I would never administer any insulin below 100. And, like you, I'd probably snack to bump it up before bed to avoid lows.

No offense taken at all, Brian.

One thing I think get's lost in many discussions is T1 vs. T2. I'm an unusual T2 because I voluntarily went on insulin, and (miraculously!) got approved for a CGM and pump.

I don't need these technologies to live, like a T1 does (or at least, insulin). However, I can not achieve my goals (normal, non-diabetic blood sugar) without these tools -- insulin, CGM, and pump.

Okay, so that said, some of the aspects of T2 make this a bit different than for T1s, particularly in the "resolution" of insulin. Because of insulin resistance, I have a much higher "resolution" (i.e. the amount of correction I can deliver in terms of reduced mg/dl is much tinier than T1s without IR). For example, my correction factor is 10 -- that is, 1U of insulin drops my BG 10 mg/dl.

Because of this, I can correct a 97 with 0.25U, then keep an eye on it. Or, temp basal +0.5U/hr, and then again watch it.

Also, I've found since I got these technologies that, below 150-170, the CF is pretty constant and reliable. If I wait the 3.5 hours insulin is active in me, I'll get nearly exactly the drop expected. This has led me to do some tentative experimentation a the fringes, like what we're discussing here.

The other big "experiment" has been correcting based just on the CGM (highs, that is) in some cases. Posted another discussion about that one.

Lots of good feedback. Thanks tons, friends!

I think I've got a bit obsessive since I got the pump and CGM. The latter is a double-edged sword... Great that you know what your blood sugar's doing. At the same time nagging that you know what your BG's doing.

I've gotten to where I just don't like seeing numbers over 100 during fasting. As a T2, my BG comes down much more gradually in response to insulin, so it's harder to achieve the sub-6 a1c's. But that's where I really, really, really want to be.

The encouraging flip side is I rarely have lows, only one serious one ever. I suppose after being so out of control, feeling like absolute cow dung, beginning signs of peripheral neuropathy, and on and on, it's just so awesome to see my BG down at normal, flat, not even spiking to 140 after eating, etc. etc.

I've been working hard since I got this gear to figure it all out, bolus timing, extended boluses, etc., to achieve what's stated in the above paragraph.

Also, having a CGM gives me some comfort regarding serious hypos. Also, since I've go all the numbers figured out and working, it's all working very predictably.

That is, until I get sick. Then I'm a walking bottle of corn syrup, and no matter what I do, BG's all over the place and stubborn, until I get well.

so, you're giving yourself insulin to correct a PERFECT blood sugar of 90. whatever! this stuff is becoming simply insane!

I like breakfast. If my BG is going up and hits 90, 100 isn't far behind so I might as well get a head start on it...

I'm assuming you have a GCMS

I don't think I have ever did a correction at 100 but if my SG was 120 with two up arrows I would be

considering a small adjustment soon depending on what i think was causing the up tick.