Correction dose

[Karen999]

How high do you go before you would do a correction dose?

 

[helli]

There are three things I consider before a correction
- how high is my BG? I tend to correct when in double figures IF I have insufficient insulin currently active to bring my BG down.
- when was my last bolus? There is a general fear of “stacking”. I am a little less conservative in this regard than many DSNs suggest but we need to remember that most fast acting insulins are active for about 4 hours. So some of the insulin bolused 3 hours ago, for example, can still continue to reduce my BG. I would probably correct after 2 hours if I believe I have insufficient insulin “on board” to bring my BG back to required level.
- what is the correction dose required? If my correction dose is less than 1 unit, I probably don’t need to correct. However, as I use a pump, I do sometimes correct with a smaller dose.

 

[Standup]

Pretty much what helli said to which I'd add when did I last eat? The surgery I've had means I absorb food much slower than expected and peak carbs for me can be up to five hours later. This means I'm splitting bolus as a matter of course as they don't remain active long enough.

In terms of numbers I tend to start thinking about it at 12 although it depends on the trend and if its 3 hours or 6 hours after I've eaten.

Or if its late and I don't want to go to bed 'high' I might be more likely to 'correct' than in the day when I can monitor things or go for a brisk walk.

 

[everydayupsanddowns]

If I know it was an estimation error, and I can see my levels rising briskly I prefer to correct my mistake earlier rather than waiting until my levels are already high.

One thing I started doing several years ago if responding to a higher-than-I’d-like 2hr reading is only to target whatever the BG is above 9.0. So rather than reacting to the whole high level I view it more as being whatever has gone up over 9.0 (which I’d have been quite happy with at 2hrs).

These days, I very rarely add any extra insulin at all (my hybrid loop looks after that), but what I do sometimes to is to ‘activate’ the existing IoB with a brisk walk round the block (while letting the pump know I’m doing that with a brief ‘activity mode’ setting). Just a 5 minute walk at a brisk pace seems to kick-start the existing insulin that might have taken an hour or more to get going otherwise!

 

[everydayupsanddowns]

Or if its late and I don't want to go to bed 'high' I might be more likely to 'correct' than in the day when I can monitor things or go for a brisk walk.

That’s interesting @Standup - if anything I was always more reluctant to adding insulin late at night / at bedtime, because I’d not be able to watch the late correction play out, and react to BG changes if I’d overdone it.

 

[Inka]

It depends what I’m about to do. I’m always very cautious with correcting near bedtime. I tend to know what my usual blood sugars are during the day (I eat similar breakfasts and lunches most days) so if I see something wrong, I might correct a little, bearing in mind if I still have insulin working.

 

[Standup]

That’s interesting @Standup - if anything I was always more reluctant to adding insulin late at night / at bedtime, because I’d not be able to watch the late correction play out, and react to BG changes if I’d overdone it.

I probably under correct to avoid going too low but I've found the long lead time on carbs leaving my system means going low isn't too much of an issue. I use to be very paranoid about hypos overnight but after a year it doesn't seem to be an issue so working on getting my average down.

 

[everydayupsanddowns]

I probably under correct to avoid going too low but I've found the long lead time on carbs leaving my system means going low isn't too much of an issue. I use to be very paranoid about hypos overnight but after a year it doesn't seem to be an issue so working on getting my average down.

Hooray for sensors as far as that’s concerned for me! At last I was able to see what my levels were doing during the (roughly) third of my day - and no overnight waking to fingerstick. It was a huge relief, and really helped me because sadly, unlike you I was having long overnight hypos that I was sleeping through.

 

[Inka]

I probably under correct to avoid going too low but I've found the long lead time on carbs leaving my system means going low isn't too much of an issue. I use to be very paranoid about hypos overnight but after a year it doesn't seem to be an issue so working on getting my average down.

Nighttime is the one time I’m happy to run a bit high. I’ve had a nighttime hypo and it was awful. I wouldn’t wish that on anyone. I know we have CGMs now but they’re not a failsafe if you’re dropping fast because sometimes the drop will outpace the glucose. That’s a terrifying feeling because there’s nothing you can do about it.

 

[Lucyr]

How high do you go before you would do a correction dose?

Anything above the premeal target range I calculate a correction dose. Depending on IOB that dose may sometimes be 0.

 

[Karen999]

Thanks for this, I'm getting the general feeling that everything is so individual, trial and error. After 5 years I've actually got a consultant appt coming up, now to write my list of questions.