Hi!So this is my first month on insulin and I’m testing hard to figure it all out. I will read “Think like a pancreas” which probably answers this question but I didn’t have time to get to that.
I managed to survive my first month on 40-50 grams carbs per day and low insulin doses and I see great results already. But I had a social event yesterday and I snapped I took 2 units Humalog and had a beautiful piece of cheesecake(it was totally worth it:) I was 190 after 1 hour and figured 2 units didn’t do the job. I added 1 more unit then and managed to drop to 149 by 2 hours and 120 by 3. I figured with 2 units I would run around with 190 for next 3 hours.
Question: was this a right way to correct?When is the time to make a correction- is it 1 hour post-meal or anytime I’m high?Is it safe like that or I can end up with a hypo couple hours later?
Thanks!
Insulin that is injected is not nearly as fast acting as the insulin produced by the body. Novolog, Humalog, and Apridra all have a duration as stated in their manufacturer’s literature as five to six hours. So it is possible that it will continue to lower one’s BG that long.
Cheesecake has a lot of fat in it, which causes your food to be digested more slowly. Therefore your 1 hour reading was only 190. Had you eaten frosted angel food cake (low fat) with the same number of carbs, I’ll bet your one hour reading would have been close to or over 300, since without fat the glucose would get to your bloodstream much more quickly. If you corrected for the 300, you’d have gone hypo later.
So correcting that early is risky. I rarely if ever correct until I can combine the correction with my next meal bolus. If you correct between meals, you may still have insulin working from your previous bolus and then when you take your reading for the next meal, you have to adjust for the insulin still in your system from the correction. That can be done, but I’d suggest you get more experience with seeing how things react first.
I’ve had my BG drop as much as 59 points after the 4.5 hour point after my bolus! That was with Novolog, which is the slowest for me. I’d suggest that you do some testing to see how long whatever fast-acting insulin you are using takes to usually finish dropping your BG. Try it with different types of foods, as sometimes you can be fooled if the continued absorption from your food happens to closely match the drop from the insulin. In that case you’d think the insulin action was over far sooner than it actually is. But getting them to match is exactly the desired outcome!
I always wait until at least four hours after my dinner bolus to test as a bedtime reading. Then if I need a correction I do it with a target of BG 100. That would give a 30 point safety zone for my BG to drop beyond the four hour point without a hypo. By doing this, I’ve only had two night time hypos in over three years on insulin, and those hypos were 52 and 60, so nothing serious.
I’m not a doctor or CDE, so I can’t give you direct medical advice. Have you worked with a CDE (Certified Diabetes Educator) yet to figure out if your basal dosage is correct, and test to see what your I:C (insulin to carbs) ratio should be, as well as to get any help you need with carb counting? Or did your doctor just give you insulin and tell you to figure it out on your own unlikely, but not all that far from what my doctor originally did!)?
Personally, I watch my BG very carefully, and if I see a spike like that - even after just one hour - I do correct, sparingly, as you did; however, doctors may tell you to do otherwise. In my case, I’ve been on insulin long enough to have a good idea when a spike indicates that I misjudged what I ate, as opposed to an expected response to food that will be handled by already on-board insulin. That knowledge, however, comes from lots of experimentation – No one’s diabetes is the same. Only you can discover what works best for you.
Also, when your total daily dose (TDD) is low (less than 30 or so), a correction bolus may work unpredictably and drop your BG too much or too little. John Wlash’s book Using Insulin has a lot of detail on how to manage correction boluses, calculate carb factor, etc.
In addition to the good advice given in the posts above, have you learned about the importance of pre-bolusing in order to optimize the chances that the insulin action is timed to coincide with when the carbs you consume elevate your BG?
I’m not on basal yet. I have LADA and still making my own insulin so my fasting BG is perfect. I only need help for my meal carb intake. My doctor just gave me insulin and didn’t do much training. I’m trying to figure out my I:C on my own by testing very frequently. Maybe its a good idea to see a CDE but most of them work with higher carb intake/more insulin approach. I prefer to have Dr. Bernstein approach but less radical and I don’t think my endo treats me seriously as I don’t want to comply to his idea of good control. He told me 180 after a meal is not bad…I beg to differ
If you’re on injections, do you have a way of figuring out your active insulin? It’s a great benefit of having a pump, since it calculates it for you and factors that number into any bolus calculations. That said, I am pretty sure there are ways to figure this out manually. That way you can be a little more precise in calculating your correction boluses, especially if it’s still within that 1-2 hour window after eating. Ah! Integrated Diabetes Services has a website where you can access a spreadsheet to help you calculate this: Mealtime Dosage Calculator | Integrated Diabetes Services
I’m trying to stay under 140/150 max, so if I’m higher than that within the three hour window post-prandial, I’m likely to do a correction. If I’m under, I’ll wait it out and not do any corrections until after three hours have passed.
Went thru a lot of that, too - my endo was concerned with fasting in a range acceptable to me, but, like yours, felt that higher postprandial (after meal) numbers that were higher, were just fine. I was eventually able to get him to go along with my plan, but it took a while.
As to CDEs… Sure, most are accustomed to working with higher carbs/insulin intake; however, at least in my limited experience with them, they usually leave specific nutrition concerns to dietitians, and focus on the “mechanics:” insulin action, carb counting, I:C, basal rates (when applicable). Truth is, the CDE was one person on my ex-endo’s team that was on the same pages as I was. Only truly helpful conversation I had in that office was with her!
I guess seeing a CDE won’t hurt and the “mechanics” you talk about are actually what I need to learn most. My body reactions to insulin and food I need to figure out on my own.
hi! excellent work on the correction for the cheesecake. well played.
someone mentioned the fat content and that is something i always take into consideration when having desserts like ice-cream or cheesecake. i would have done the same as you, injecting only part of the insulin i would need, testing an hour later and then correcting based on my numbers at 1 hour and the fat content as well as the carb count. its the mdi answer to a square wave bolus.
I want to emphasize the point @rgcainmd made about pre-bolusing. It’s probably the single most underutilized yet highly effective tactic to limit post-meal blood sugar excursions. Be aware that pre-bolus times should be customized for you with careful personal experimentation and observation. The stock 10-15 minute pre-bolus time is a standard that will likely serve you poorly and inconsistently. Discover your optimal pre-bolus time!
I find that I need a much longer pre-bolus time in the morning (till noon) than I do in the afternoon or evening.
You would learn a lot more about your post-meal BGs if you had a continuous blood glucose monitor or CGM. You can still learn a lot by doing and recording blood glucose fingersticks at meal-time as well as every hour after til about 4 hours. Failing to keep notes is a short-cut that will markedly slow-down your learning process. I know it can be a pain but you don’t have to do it forever, just when you want to learn more about your unique metabolism as well as your favorite 10-15 meals you like to eat.
I have to suggest some level of caution. It takes some time to figure stuff out. I really don’t like correcting at 2 hours. If I sit at a high level and after 3-4 hours and am still high, then I know that my mealtime bolus was insufficient and I correct. But I am loath to correct. I will figure out a correction for a pre-meal high and when I am 3-5 hours after my last meal and injection, but otherwise I score it one for the other team. I take it as a learning lesson and try to figure out my bolus better next time.
ps. Modern rapid insulins like Humalog have an action time of like 5 hours. After one hour you can’t really tell where you will be at 3-5 hours. I err on the side of caution. Don’t worry about the 1-2 hour reading, worry about where you end up at 3-5 hours.
It’s not just that our artificial insulins are slower to act–they’re also slower to get out of your system. So, I would suggest caution about aggressive corrections. Only YOU can figure out how much and WHEN to take a bolus or correction. But, I have noticed I have been doing a few things to get my BG in a better place.
How much insulin and when are not dictated by one factor, it’s a multiple of factors.
What is my BG now?
Have I been physically active? (Am I about to crash?)
Do I plan on being physically active? (Should I lower my dose because my activity level will be high?)
Will the meal I’m about to eat have a lot of fat in it (which will delay the action of the insulin–sometimes for hours)?
Have I been experiencing long periods of serial hypoglycemia? (Do I need to sit down, treat and WAIT to get up to a higher level?)
Have I been experiencing long periods of hyperglycemia?
Have I been sick or am I becoming sick (I may need a lot more insulin)?
This, like nearly everything in diabetes, is very individual. You have to figure out your own personal patterns of response to food, insulin, exercise, etc., because they may be similar to or wildly different from someone else’s. Sounds like you know that already and are proceeding accordingly.
As illustrated by the previous comments, each person has their own style, suited to their temperament and lifestyle. I am generally quick to correct. I am aggressive about control in the first place, and I count carbs pretty carefully and know my ratios and factors, so I usually have a reasonably accurate picture of where I am regarding meals, IOB, etc. The consequence of all that is that I am pretty quick on the trigger. Any time I am significantly higher than I calculate I should be for the circumstances—say, more than 30 points or so—I will correct.
But you have to discover what works well (and safely) for you, and what you are comfortable with. You’re on the right track. Keep learning. “Diabetes is a marathon, not a sprint.”
A good attribute, I think, when flying in a relatively tight BG range. I also stack with abandon, pump, Afrezza, IM shots. I think I would make most CDEs nervous. It works out though, they don’t have my diabetes!
I typically wait until 2 hours after an injection to correct. I figure my insulin is 60-70% spent by then. If my bg is rising after 2 hours, it’s time for a correction.
I like the idea of 3-5 hours better than the 1-2 hour reading. Why are the books and endo’s mostly concerned about the 2 hour pp BG numbers? At 3-5 hours, there is less insulin on board than at 2 hours. If a correction were necessary, there would be less risk of hypo from insulin stacking. If the BG number at 3-5 hours is under 140 is it correct to conclude that the bolus quantity matched the food reasonably well? If the BG number at 2 hours is high, could it be caused by incorrect bolus quantity? or the high 2 hr BG be caused by incorrect timing/matching of insulin peak and food type peak? It would still be necessary to test at 3+ hours. If high BG at 2 hours pp and high BG at 3+ hours, I guess it’s safe to conclude that there was insufficient bolus.
Having said the above, why test at the 2 hours post meal?
Because that is about when a non-diabetic person’s blood glucose is back to its pre-meal state. If the objective is to mimic a healthy pancreas to the extent we can (and I don’t know about anyone else, but that’s my goal), then it’s the target to shoot for. Understanding, of course, that it’s not possible to achieve perfection, but it is still the ideal objective to aim at.
I took 2 units Humalog and had a beautiful piece of cheesecake(it was totally worth it:) I was 190 after 1 hour and figured 2 units didn’t do the job. I added 1 more unit then and managed to drop to 149 by 2 hours and 120 by 3. I figured with 2 units I would run around with 190 for next 3 hours.