if i notice that i am trending up after a meal more than usual, i wonder if i should make a correction bolus at that time, or if i should “wait it out” and make my correction before my next meal pre-bolus. i know several things that help me to make my decision, but i don’t know if they are the best options for me. i can do a quick correction right away; i will look at my IOB to try and predict the speed of my trend and if there is enough on board to control the spike. sometimes my BG is climbing too high too fast, and i want to bring it down before it gets too stubborn and refuses to respond to my correction bolus (like above 200)
what do you do to make these decisions, and what is your range pre-bolus and how high your BGs climb before you do a correction? i try and stay between 80 and 180. what can you suggest i do?
( i am a MM pumper )
It’s great when bg is predictable. I’ve been on 300 mg of Invokana and that brings my bg down too. It’s like it takes care of dosing mistakes. But my doctor is having me go down to 100 mg because of DKA concerns and hypoglycemia concerns. So I’m going to have to start dealing with this dosing decision business more carefully. Before seeing doctor I was trying to treat aggressively and had a lot of 50s bgs. I kept adding to my correction bolus and blushing more than my carb ratio. But I run in to so much trouble trying to pre-bolus. And I feel bad during a post prandial spike. I think we need to eliminate as many variables as possible so we see how our bg responds to certain amounts and timings of insulin doses.
just emailed my cde. her suggestion was to wait until i bolus before my next meal. i don’t know whether i agree w/ this as to contemplating the IOB. i try and wait the 4 hours till my bolus insulin (novolog) drizzles out, but of course this is not always reasonable.
i am still confused about how to evaluate the different choices/options. i do use my CGM to give me a hint as to how fast and how high i am trending.
When I hit my upper limit. Right now at 170. And, and ,and gosh I don’t have a system. It’s just random. I’ve long just stacked and more than the wizard to bring down fast thinking I can wait for the low and correct in time but that doesn’t work so good. Worked good with “regular”. ? Long ago.
It’s trial and error. So variety is not helpful.
when i was on R insulin, i couldn’t even understand my D. i was too overwhelmed; everything was so new for me. i was passing out from hypos on a pretty regular basis b/c i never could quite figure out when to eat. and i was told to wait about 1/2 hour before eating after the bolus shot. i couldn’t plan my meals so that i could sit down w/ others and eat when they were eating.
remember the beef and pork insulins?
yes. I’m very allergic to beef insulin and unfortunately for me, the idiot endo that didn’t understand I was allergic to what he prescribed was kicked to the curb and I got a new endo who changed my insulins to Purified Pork formulations. Problem solved.
For some reason a doctor suggested I use beef insulin instead, after using pork. Probably was just to give a patient a little hope for improvement. After 20 years of regular insulin I got the high speed analogue insulin. And I didn’t get training on the difference. But a low could come on fast. And a high could be corrected. A high bg could not be corrected with regular. What you could do with regular was try again tomorrow. So back to topic question: if you don’t pre-bolus you know if you eat carbohydrates a spike will occur. Will the spike reverse and come down is the question. Since that question is only answered by previous experience it’s best to avoid the spike by eating low carb and/or pre-blushing. Ok now failing that we see a graph rising we take one unit and wait 25 minutes and repeat? Not saying I do that, saying I think that is recommended. And keep an eye on the Dexcom receiver. That’s why I’m eager to get the Apple watch but I’m saving money using an Android and since I have pcs metro service provider I get unlimited data and don’t need home WiFi, saving about 200/mo over Apple service. But that wrist access I want. I have an armband I can put receiver in, that’s pretty good too.
i thought, in the very beginning, that b/c i am jewish i couldn’t use the pork insulin.
i don’t know how i would feel about an arm band for my receiver. i feel hooked up enough just clipping on my pump. i usually toss the receiver in my bag, but then if i am sitting down at home and just watching TV, i put the receiver in the middle of the room so that i can accommodate the inside 20 feet radius for reading the dex.
when i was starting on the R insulin, i was using that old method of checking your BG (on one of those HUGE meters that took forever) and then deciding how many grams of carbs i wanted to eat. then i would match my BGs to the carbs and give myself that amount of insulin needed. i suppose in some weird way, it was an archaic version of the MM Wizard function. but you’re 100% right about not being able to correct a high BG.
This is complicated because there are different scenarios and the appropriate response is potentially different for each.
I should preface this by saying that (a) I am not a pumper, and (b) my BG behaves pretty predictably. For a given amount of food and/or a given amount of insulin, I usually know pretty closely what it will do. That makes the dosing somewhat simpler. Unfortunately not everyone is that lucky, as I fully realize. So as with everything else involving D, your mileage may vary.
If I am following my “normal” meal plan and things are behaving like they should, I’ll usually wait until about 2 hours after the meal. If I’m not very close to my PP target by then, I will correct. This doesn’t happen often.
If I’ve just eaten something that I know is going to cause a major spike – for instance, a dessert in a restaurant – I will correct right away, somewhat conservatively, and track it for the next couple hours, adjusting as needed.
Any other time, if I am high and don’t know why (or even if I do, for that matter), I will correct immediately, usually with an IM for faster action. I generally try to err on the safe side, but since I know my sensitivities to food and insulin pretty accurately, I can usually hit reasonably close to target.
We are Jewish, too, so this made me laugh…
I suppose G_d looks the other way if it’s what you needed to stay alive!!!
For me, this is much more art than science. There are so many variables to monitor and weigh that any rules of thumb do not stand the test of time or individual variability.
I’m a data nerd and love to fall back on well worn formulas and ratios. After reading Sugar Surfing, I’m much more trusting in my gut instinct and I threw my fear of insulin stacking under the bus.
Vigilance is key with correcting. I take as much insulin as I think is needed and then pay attention!
exactly! - - - - - - - - -
My endo suggested I always wait until the next meal to adjust in order to prevent taking too much insulin. I followed his advice for about a week. What I discovered works much better for me is to adjust a half unit at a time. I am not on a pump. I will wait two hours after eating and, if bgs are rising higher than where I like to keep them, I inject a half unit and wait an hour.
Yikes. He was basically telling you not to do corrections, as waiting to do a correction only at the next meal is a whole lotta of “too little too late” or “the train already left the station”. Some endos can be a royal PITA. Glad you don’t follow that method.
This is the classic sliding scale protocol that many hospitals use. It serves best the hypo-phobic so-called medical professionals.
yeah, I was thinking the exact same thing, Terry. I had a terrible endo for years (blame myself for not switching sooner) who refused to rx a pump for me. His rationale?? that I would have MORE hypos using a pump. Getting a medical degree doesn’t equate with good doctoring, in his case. I’m so glad I found a pump-rx’ing doctor. I got my first pump within a month of seeing the “new guy”.
There’s nothing wrong with a healthy respect for hypoglycemia, but to allow it to completely dominate the insulin protocol is uncaring, unscientific, and unprofessional.
I understand the power of an insulin overdose much more than any medical professional. I also understand the power insulin wields when used by a thinking person who pays attention.
More than once, I’ve been told by doctors that I am a “difficult” patient… mainly because I do my own research and require them to back up their opinions with something I can go research for myself