Corrective injections

[miguel81]

It is extremely difficult to calculate a corrective dose of Novorapid and I know that we are all different and therefore respond to insulin in as many different ways. This morning I tested and was only 2.7. I had one small slice of toast with marmalade and then had to go to the surgery for a blood test. It is only 1 km there and back and when I returned home I tested again - it was 5.5. I had to go and collect my car from the garage which is a 2 km walk and on the way there I felt a bit woozy so I ate 2 jelly babies and a biscuit, especially as I was going to drive home. When I returned I tested again and it was 19.4 so I gave myself a dose of 2 units of Novorapid. 2 hours later including one very small walk with my dogs I was 4.2! Novorapid seems to have a mind of its own. I know that it is impossible but wouldn't it be nice if there was information available that told you - approximately - what one unit of insulin would reduce your blood sugar level by? Dream on Michael.

 

[trophywench]

Michael - there is a way to do it - roughly speaking if 1u of Novo deals with 10g carb, then it will reduce your BG by 2,5 to 3.0.

However - you can only test this when you haven't done strenuous activity - eg taking a 2km hike! Cos activity can affect BG for up to 48 hours after doing it. Novorapid is absolutely single minded, and so is exercise. However they each take absolutely no account whatever of the other!

Activity means we use insulin much more efficiently, hence basal has a greater effect and so does bolus - so if we don't reduce at least the bolus/correction insulin after exercise - then both of them will reduce our BG - so wham we're hypo.

Your breakfast was not enough carbs to get rid of the hypo AND do the walk - meanwhile back at the ranch having dropped low again, your body went oh sheet, he's still low - so your liver threw out its store of glycogen into your bloodstream by which time you'd already treated the hypo with 2 jelly babies and a biscuit. So a double whammy of hypo treatment but because the liver's timing cannot be relied upon, to do these things - there's absolutely no way humanly possible to stop this happening occasionally.

 

[eggyg]

Thanks for that TW, I was told 1 unit reduces BG by 3 but I have found that to be too much and TBF I hardly ever correct because I was going too low. I do loads of walking and didn’t realise that about the 48 hours. Can you come and live with me please?
I hope TW’s explaination helps you @Michael12420 as much as it helped me. I am going to see the specialist diabetes dietician on Monday and corrections was on my list of questions to ask. Have you ever been referred to one, if not it might be worth asking, I did, they don’t volunteer these things! 😉

 

[miguel81]

Thank you TW and thank you eggyd for you response. I'm low again so I'm looking forward to chicken curry and rice. Scientists have put men on the moon, dammed rivers, men and women have wrote great books and music and yet we supposedly can't tell Stork from butter or cure diabetes! Light-hearted I know but it makes me feel better.

 

[eggyg]

Thank you TW and thank you eggyd for you response. I'm low again so I'm looking forward to chicken curry and rice. Scientists have put men on the moon, dammed rivers, men and women have wrote great books and music and yet we supposedly can't tell Stork from butter or cure diabetes! Light-hearted I know but it makes me feel better.

Oh I can definitely tell the difference between Stork and butter, that Leslie Crowther was a big fat fibber!

 

[Nikki35]

I have been advised that 1 unit can reduce blood sugar levels by 3.0. However this doesnt take into account activity. I have a different carb-to-insulin ratio for a work day and a more 'leisurely' day. I work as a teaching assistant and so im active all day. Do you count differently depending on what you are doing?

 

[stephknits]

Have you had the opportunity to go on a DAFNE course - this really helped me work out how my Novorapid worked for me, my correction dose etc. I would really recommend it. Took a lot of the guesswork out of working out doses and gave me a systematic approach to managing my insulin dose, carb ratios and adjustments. Life and the diabetes fairy still put a spanner in the works of course....

 

[miguel81]

Thank you Nikki35, I am methodical in my life, I walk the dogs 3 times a day and Monday through Saturday go to the shops once. So I am pretty much the same every day as are my meals and their carbo contents - it's just that some days things go haywire - hence the question about how much 1 unit of Novorapid has an effect on blood sugars. Stephknits, there are no such courses in Spain and although my doctor and my nurse are really helpful they have very little knowledge of diabetes - but they do their best and I am grateful for it. Diabetes is not a 'one fits all' situation as we all know and I try really hard to control it all and am, thankfully, reasonably successful. I thank you both for your responses - chicken curry awaits.

 

[SB2015]

I hope that you have got yourself more sorted Michael. The curry is giong one interesting. How do you deal with those meals. I know that I had to split my dose of bolus, but all too often I forgot the second part of it. Now on a pump I use a multiwaev bolus with some up front and the rest spread over a longer time.

My corrections are different through the day, and as others have said they work differently depending on what I have been diong, what type of food I ate, when my last bolus was, ... Diabetes is never simple but all we can do is the beast we can.

 

[miguel81]

SB2015, was it a spelling error - but beast is most appropriate when it comes to us who have the beast that is diabetes. I deal with my meals by trying to count the carbs. I always cook my own meals so am reasonably sure of what is in them and therefore can inject appropriately. Sometimes however things go ever so slightly wrong - it's happened to all of us at some time or another. Chicken curry was delicious and a rare treat. Am off to my bed now as it is well past my normal time - I need at least 11 hours a night - how indulgent is that? I wish all of you a very good night.

 

[Amberzak]

I was told when doing a correction, to aim to bring sugars down to 8 rather than 5. Reduces the risk of hypo.

Also my corrections change depending on time of day and weather. I’m more insulin resistant in cold weather and in the mornings.

Oh, and apparently the higher you are the more resistant you are, so don’t be tempted to do tour correction twice.

But yes, corrections are difficult. I’d say three quarters of my hypos are linked to corrections.

 

[immyboy7]

It is extremely difficult to calculate a corrective dose of Novorapid and I know that we are all different and therefore respond to insulin in as many different ways. This morning I tested and was only 2.7. I had one small slice of toast with marmalade and then had to go to the surgery for a blood test. It is only 1 km there and back and when I returned home I tested again - it was 5.5. I had to go and collect my car from the garage which is a 2 km walk and on the way there I felt a bit woozy so I ate 2 jelly babies and a biscuit, especially as I was going to drive home. When I returned I tested again and it was 19.4 so I gave myself a dose of 2 units of Novorapid. 2 hours later including one very small walk with my dogs I was 4.2! Novorapid seems to have a mind of its own. I know that it is impossible but wouldn't it be nice if there was information available that told you - approximately - what one unit of insulin would reduce your blood sugar level by? Dream on Michael.

correct me if im wrong but on the dafne course i did we were told not to correct after hypo maybe this is why your results went from 19.4 to 4.2 after 2 hrs

 

[TheClockworkDodo]

@Michael12420 - you might find this online carb-counting course helpful, as you can't get to a DAFNE course - https://www.bertieonline.org.uk/
I think as Jenny says the swinging blood sugars you had were mainly to do with not having treated the hypo you had before breakfast - toast and marmalade might have set you up for the walk if you hadn't been hypo to start with, but it isn't a hypo treatment. Another time if you wake up that hypo, I'd have some jelly babies, wait 10-15 minutes, then test again and then if you're over 4 have your morning insulin and toast and marmalade.

@Nikki35 - it really varies from person to person as well as depending on time of day and on how high your blood sugar is to start with, doesn't it? I was told 1 unit of bolus would lower my blood sugar level by 5.0 so I need much less than you, but as I'm much more insulin-resistant in the morning than I am later in the day I'd expect 1 unit to lower my blood sugar level by something more like 3.0 then. And also the higher my blood sugar is the more extra insulin I need, regardless of time of day or how much exercise I've had.

@immyboy7 - I was also told not to correct after a hypo, and I wouldn't if my blood sugar were 8-12 after a hypo, but I think I would if it were as high as 19.4! But I'd be a bit more cautious about it than I would otherwise.

 

[immyboy7]

@Michael12420 - you might find this online carb-counting course helpful, as you can't get to a DAFNE course - https://www.bertieonline.org.uk/
I think as Jenny says the swinging blood sugars you had were mainly to do with not having treated the hypo you had before breakfast - toast and marmalade might have set you up for the walk if you hadn't been hypo to start with, but it isn't a hypo treatment. Another time if you wake up that hypo, I'd have some jelly babies, wait 10-15 minutes, then test again and then if you're over 4 have your morning insulin and toast and marmalade.

@Nikki35 - it really varies from person to person as well as depending on time of day and on how high your blood sugar is to start with, doesn't it? I was told 1 unit of bolus would lower my blood sugar level by 5.0 so I need much less than you, but as I'm much more insulin-resistant in the morning than I am later in the day I'd expect 1 unit to lower my blood sugar level by something more like 3.0 then. And also the higher my blood sugar is the more extra insulin I need, regardless of time of day or how much exercise I've had.

@immyboy7 - I was also told not to correct after a hypo, and I wouldn't if my blood sugar were 8-12 after a hypo, but I think I would if it were as high as 19.4! But I'd be a bit more cautious about it than I would otherwise.

i would also say that you should have treated the hypo with some glucose sweets or fast acting carbs then wait say 10-15mins check and if alls well have your toast and morning insulin i personally wouldnt treat a hypo with chocolate or any other slow acting carbs which take longer to ger into your system

 

[Nikki35]

@Michael12420 - you might find this online carb-counting course helpful, as you can't get to a DAFNE course - https://www.bertieonline.org.uk/
I think as Jenny says the swinging blood sugars you had were mainly to do with not having treated the hypo you had before breakfast - toast and marmalade might have set you up for the walk if you hadn't been hypo to start with, but it isn't a hypo treatment. Another time if you wake up that hypo, I'd have some jelly babies, wait 10-15 minutes, then test again and then if you're over 4 have your morning insulin and toast and marmalade.

@Nikki35 - it really varies from person to person as well as depending on time of day and on how high your blood sugar is to start with, doesn't it? I was told 1 unit of bolus would lower my blood sugar level by 5.0 so I need much less than you, but as I'm much more insulin-resistant in the morning than I am later in the day I'd expect 1 unit to lower my blood sugar level by something more like 3.0 then. And also the higher my blood sugar is the more extra insulin I need, regardless of time of day or how much exercise I've had.

@immyboy7 - I was also told not to correct after a hypo, and I wouldn't if my blood sugar were 8-12 after a hypo, but I think I would if it were as high as 19.4! But I'd be a bit more cautious about it than I would otherwise.

Yes, you are right. I was just trying to use my daily ratios/experience to show that my days vary too...depending on what im doing etc. And of course its different for everyone, and there are other factors - like starting BG - to take into account too. I'm sorry if it came across as anything else.

 

[TheClockworkDodo]

Not at all, Nikki - I was agreeing with you about how much it varies 🙂