Correction factor for lower BGs

[Redkite]

Just wondering what works for others in this situation. My son's target BG range in his pump is 5.5-7.0, and I regularly review his correction factor so that the Bolus Wizard adds enough extra insulin to correct higher levels. The problem seems to be that this correction factor doesn't reduce a meal bolus by a sufficient amount when he is starting off from a lower level. E.g. This morning he was 4.6 - I knew from experience that he needed to knock more insulin off the BW dose to prevent a hypo (he has a long walk to school). Do other people find they have to manually adjust in these circumstances?

 

[everydayupsanddowns]

Well... yes... and no...

I do find i need to manually adjust corrections, but more often to override what Artoo thinks is plenty of IOB to deal with a post-meal high, when I know that there is too much food still in play and the IOB is effectively zero.

If part of the dose reduction is to account for the walk in, would that not be a good argument for a TBR - or if it is too bothersome to set up everyday a tweaked basal pattern for weekdays that takes the activity after breakfast into account?

I guess you've only got 1.5mmol/L to play with for the dose reduction (below range before you have to start treating as a hypo), which won't be that much if your correction factor is 1u:3mmol/L or whatever... but might be sufficient if basal from breakfast to 10am is running at a fairly significantly reduced %

Either that or you could up the lower limit of the range to 6.5 or 6.0 to the Veo will aim to bring him just that little bit higher. The only downside to that is that you get a few more warbly complaints when taking premeal BGs 🙂

 

[trophywench]

Yes, I'd alter the 'range' for that partic time block on my pump - eg 6 to 7.5 or even 6 to 8 because the Roche goes for the midpoint - the first it would correct to 6.75 and the second, 7.0.

Pick your number, and enter a lower and upper figure equidistant from both ! LOL

 

[everydayupsanddowns]

Yes, I'd alter the 'range' for that partic time block on my pump - eg 6 to 7.5 or even 6 to 8 because the Roche goes for the midpoint - the first it would correct to 6.75 and the second, 7.0.

Pick your number, and enter a lower and upper figure equidistant from both ! LOL

Important to realise that on Medtronic, it isn't the midpoint that is aimed for... The Veo aims to bring up to the lower edge of range, and down to the upper edge of range.

I preferred the 'midpoint' approach on the Expert tbh, so as soon as I realised I just set both edges of my Veo range to the midpoint I wanted 🙂

 

[Redkite]

Thanks both. It's a tricky one for him for several reasons. No room for manoeuvre with the basal since it's low-to-zero at that time of day because he uses a superbolus to eliminate the breakfast spike. So the only options are reducing breakfast bolus and/or eating extra free carbs. When he wakes on 4.6, he is either on a steep downward trend, or else he's been stable in the low 5's and 4's for a number of consecutive hours, which makes him more sensitive to insulin for a while. Yes we could have a single target of 6, but then there is no safety margin for corrections - they rarely take him down to spot-on 7, it's usually anywhere between 5 and 9! I suppose there is only so much that can be programmed, you always need some creative thought as well.

For info, today he woke at 4.6. Breakfast of 65g carb would normally be 6.5U, pump suggested 6.25U, I rounded it down to 6.0. He was 5.6 before leaving the house at 7.45 (usually 7-9), and next tested at 10am before P.E. and he was 4.4. If he hadn't had P.E. for lesson 2, he wouldn't have tested until break time at 11, so would have most likely been hypo before that point. So I got it wrong today! 🙂

 

[trophywench]

Well I didn't recall that Mike, though I did remember we'd had a discussion about this a couple of years ago.

And felt sure there was a difference on different pumps though I couldn't remember what it was exactly, hence why I prefaced with 'on the Roche'.

I'm sure this info will be useful to lots of people though !