When do you make a correction bolus?

Just to throw the medical professionals some kuddos here. They hate the lows because they can be held responsible if one of their patients came to them with problems with lows and than that patient had a car accident. I fell into this catch 22 many years ago when I was pregnant. I had a very ad low. Went from 97 (which I thought was fine to drive home) to driving my car up a hill and got it stuck. Didn’t hit anything or damage anything but the police reported me to the DMV. The battles started, doctors, lawyers,the ADA fighting to get my license back. My endo told me that if a patient reports having lows where they lose consciousness the doctor is suppose to report it to the DMV. If they don’t they could be liable for damages. So I said this USA bad rule because when a patient really needs the help of their doctor, they can’t say anything because they don’t want to lose their license. Kinda sad isn’t it. So I told her from that point forward I would never tell anyone medical professional if I ever lost consciousness again. Thank goodness I haven’t since but this is probably why doctors and CDE’s are so wigged out by lows.

Thanks for shedding some light on this problem from the medical professional perspective. It’s unfortunate that legal fears turn what could be pragmatic health advice into an extreme legalistic stance. I understand it, I don’t like it and I’ll keep my secrets, too.

here’s some DMV info for Calif drivers: https://www.dmv.ca.gov/portal/dmv/detail/dl/driversafety/lapes

Many doctors (perhaps most? not sure, the only evidence I can find is purely anecdotal) take this stance, whether out of arrogance, condescension or fear of litigation I don’t know. Regardless of the motive, it’s unprofessional or worse. 'Nuff said about that.

I have avoided this situation by literally “doctor shopping”. The last time I needed a new doctor, I actually took the trouble to interview them. I basically said look, I am am an informed patient who has very definite ideas about treatment protocols, methods, and philosophies. Are we compatible or should we shake hands and go our separate ways? I ended up with a doctor who treats me like a teammate, not an employee. I can (and have done, at least once) overruled his recommendations, because I had a strong case to make. We’re both fine with that.

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i am very curious about IM injections. i have given them to myself for other meds, but never for insulin. before joining TuD, i didn’t even know that they existed. my needles are the short ones, so i doubt very much i could hit a muscle with one. i used to use the longer needles, but never understood the point of them b/c i was just giving myself a sub q shot. i have been on the pump now for 14+ years, and have had only a few instances wherein i have had to give myself a shot to bring down a hyper BG reaction. can you explain to me about the IM injection? do you use your shoulder for the shot, or is another location best?

look forward to hearing back from you (or anyone else for that matter)
thanks,
Daisy Mae

The big advantage of an IM is faster action, so it only really makes sense to use rapid acting insulin that way. I know a number of pump users who still use the occasional IM when they want a correction to take effect as quickly as possible.

You are correct that a longer needle is usually needed to make this work. That’s why I keep two kinds of syringes handy: 6mm needles for ordinary subQ injections, and 12.7mm (half inch) needles for IMs.

You can use any muscle, really. Some folks use the thighs. I have found, by experimenting, that the deltoids give me the best and most consistent results. (The deltoid is the shoulder muscle where you normally get things like tetanus shots or flu shots.)

Hope that helps! :wink:

Have you thought about using the Dualwave bolus on your MM? A short burst of Insulin at the start of the meal and you can program the pump to spread the rest out over a certain period of time…I know that it takes some adjusting to get the amount spread out correct…But I would think after that you wouldn’t have to worry about a correction bolus so much…Just a thought.

i use the dual bolus for things like starches (which for some reason i am not able to cover w/ a straight out bolus) i like the dual a lot. i can eat the same food every day at the same exact time and still get different results w/ regard to my BGs. most things are consistent, so i never worry. i wait about 2 - 2 1/2 hours if i am trending high. wait till i am near 200BGs and then take into account my IOB and make my correction. this works most of the time. i do notice that i spike ALWAYS after coffee and have to correct for it. i think that tomorrow i will just increase my bolus to cover more of whatever is in the coffee that is making me spike; i already cover for 20gms. i tried 22gms this morning, but still had do do a correction; tomorrow i will try covering for 25gms. we’ll see what happens. thanks for your suggestion.