How long between correction doses

[freesia]

Hi. No idea whats going on today. Had good levels all day. 3 and half hours after tea levels were high so i had a 1u correction dose. 2 and a half hours after the correction they are still going up!! Now over 13!!! Too early to take a other correction. Would need another 2u but i'm worried i'll go low overnight then

 

[freesia]

Given up on waiting, they're creeping nearer to 14, 2u correction coming up! Will set alarm to check

 

[Kaylz]

Sorry nobody responded to your query, generally I wouldn't take a correction until 4 hours after the last seen as that's the active time of rapid and it risks stacking, hope everything has settled back to normal for you and you didn't crash or anything xx

 

[Inka]

It would depend how high my blood sugar is. The higher it is, the longer it takes to start moving down. I don’t stick to the 4hr rule if it’s obvious I need more insulin.

However, I am extra-cautious at night and setting an alarm is a sensible idea.

 

[freesia]

Morning @Kaylz and @Inka , what a night! No idea what caused that as i had really good levels all day. The only thing i can think of is that it was a higher carb tea than i would usually have even though i bolused for it. My worry was more that the first correction dose just didn't work. I would usually leave about 3.5-4 hrs between but the fact that it carried on climbing worried me. I set my alarm for 2.30am to check and it had come down to the top end of target range and at breakfast 5.3. Phew!
Thanks for replying both, i just wanted to see how long people left between correction doses if it wasn't working. I don't like correcting at night just in case it drops but needs must last night.

 

[helli]

We are taught to fear "stacking" but, if you can manage to understand and confident to calculate insulin on board, you can correct more frequently than every 4 hours.
Insulin on board is the amount of bolus you have that is still active. The simplified calculation is assuming that it is used at a constant rate. So, if you are using NovoRapid which most people consider lasts for 4 hours, you can assume there is half a dose still to be used in your body 2 hours after injecting. Then you can subtract this from the correction bolus dose you have calculated.

I guess I lost my fear of stacking because I am a grazer so eat more frequently than every 4 hours so bolus more often. Again, I consider insulin on board when calculating my bolus dose.

Another thing to be aware of is that we are more insulin resistant as our blood sugars rise. This varies per person but I find I need 1.3 time my correction dose if I am above 12 and twice as much when my BG is above 15.

With all of this, frequent testing is important because we can make mistakes, our meter can make mistakes and our bodies just misbehave sometimes.

 

[Inka]

I had an unexpected high too last night. For me, I did a small correction at 2hrs after eating because it was just above range. I then sat and watched TV for a couple of hours and assumed it was working. But when I tested again it had gone up to 11.5 so I did another correction, working it out from the 11.5 and ignoring my previous correction.

Those two corrections were approx 2 1/2 hours apart. I knew the first one hadn’t worked and so was happy to do the second. I tested my blood sugar around 1am and was back in range.

While obviously people should be aware of stacking (and rage-bolusing!) if you know your body and know what’s going on, there are occasions when it’s ok to do another correction before 4 hours if you know what you’re doing.

 

[Broomey]

We are taught to fear "stacking" but, if you can manage to understand and confident to calculate insulin on board, you can correct more frequently than every 4 hours.
Insulin on board is the amount of bolus you have that is still active. The simplified calculation is assuming that it is used at a constant rate. So, if you are using NovoRapid which most people consider lasts for 4 hours, you can assume there is half a dose still to be used in your body 2 hours after injecting. Then you can subtract this from the correction bolus dose you have calculated.

I guess I lost my fear of stacking because I am a grazer so eat more frequently than every 4 hours so bolus more often. Again, I consider insulin on board when calculating my bolus dose.

Another thing to be aware of is that we are more insulin resistant as our blood sugars rise. This varies per person but I find I need 1.3 time my correction dose if I am above 12 and twice as much when my BG is above 15.

With all of this, frequent testing is important because we can make mistakes, our meter can make mistakes and our bodies just misbehave sometimes.

Hi
Haven’t heard of the phrase “stacking”. Would be good to understand please.
Thanks.
Nick

 

[Fagor]

Could you have had a bad injection, maybe not all insulin injected or into a lumpy area?
These things happen sometimes for no apparent reason.
When BGs around 14 at bed-time, I've tried correcting (3.0 units) at and gone up by 2 breakfast. Other times with no correction dropped by 8. Asked DSN ant they couldn't explain. Now try to keep around 10 at bed-time.
When BGs are high, it may require extra units to bring them down as it doesn't seem to have same effect. I try to bring them down steadily rather than a large single drop, but doesn't always work.
Hope this re-assures.

 

[helli]

Hi
Haven’t heard of the phrase “stacking”. Would be good to understand please.
Thanks.
Nick

"Stacking" is injecting a bolus dose before the last one has run out.
The fear is that by stacking and not considering insulin on board, you risk overdosing and causing a hypo.

 

[Sally71]

Hi
Haven’t heard of the phrase “stacking”. Would be good to understand please.
Thanks.
Nick

Basically it means if you do a correction dose, and then do a second one before the first one has finished working, you could end up overdosing, and I think sometimes it can have unpredictable effects.
LOL helli types quicker than I do!

 

[rebrascora]

Hi
Haven’t heard of the phrase “stacking”. Would be good to understand please.
Thanks.
Nick

Stacking is where you still have active bolus insulin in your system and you add in more for a correction or possibly a snack within the 4-5 hour active period of the previous dose..... so in this case @freesia jabbed herself a correction after her evening meal because her levels were going too high and then 2.5 hours later when levels were still rising, despite the correction, she added another lot of insulin into her system to try to deal with it.... stacking up the insulin doses. It is easy to lose track of how much insulin is in your system by doing this but sometimes when things go badly astray for whatever reason (miscalculation/illness/basal insulin needs changed etc) it can be useful if you are careful.
I needed 5 or 6 corrections yesterday throughout the day/evening to keep my levels in range (combination of not getting out for my usual daily yomp for a few days and starting my steroid inhaler) and I stacked a couple of times. Personally I think it is better to stack small corrections than get frustrated and stick a large rage bolus in! And with the benefit of Libre you can easily keep a much closer eye on what is happening with your levels after stacking.... Obviously not ideal to be stacking corrections at bedtime but it looks like you managed it brilliantly @freesia.

 

[freesia]

looks like you managed it brilliantly

Lol. Thanks @rebrascora . I must admit i was worried as i don't like to correct at bedtime but i just didn't want it going higher, i'd already got a headache coming from what it had climbed to. I always keep a record anyway of what i eat, blood level and how many carbs/units i have. If i need to correct, i add on what the level is, how many units correction and the time so i can keep track. Setting an alarm to check it as well was helpful so i could rest more, although it woke my OH up and he wondered what was going on!!

Another thing to be aware of is that we are more insulin resistant as our blood sugars rise.

@helli thanks for this, i didn't realise that you might need to change your correction ratio depending on how high you've gone. I've learned something new. I always keep on eye on my levels anyway, its easy with a libre so at least if it happens again i can try it and check

 

[trophywench]

Yes @freesia - many of us (dunno if that's all of us or only some) need more added to our usual correction ratio when our BG is higher - cut off point for me seems to be 12 or 13 as well, and I need +20% rather than +30. It increases as the BG increases too, but I do absolutely try not to visit the higher teens often enough to actually get correcting those events down to a fine art. Still treat each one as a one-off.

And any plus this or minus that we mention always have an ' - ish ' on the end !

 

[Sally71]

I never knew that, that your correction ratios change the higher you go! Although I have noticed that sometimes corrections work brilliantly and sometimes they hardly touch it, I wonder if that’s why. I shall be observing with interest from now on!
I do know that if you’ve had a cannula failure for example, or if your cannula fell off in the night and you wake up with blood sugars over 25 and ketones of 3.5 you need a LOT of insulin to get it all down again, beyond that I hadn’t really given it any thought!

 

[Inka]

Yes @freesia - many of us (dunno if that's all of us or only some) need more added to our usual correction ratio when our BG is higher - cut off point for me seems to be 12 or 13 as well, and I need +20% rather than +30. It increases as the BG increases too, but I do absolutely try not to visit the higher teens often enough to actually get correcting those events down to a fine art. Still treat each one as a one-off.

And any plus this or minus that we mention always have an ' - ish ' on the end !

Yep, around 13 for me too. Then 15 is another marker, although I try to avoid getting there except on rare occasions.

 

[freesia]

I usually correct over 10 with a 1:4, if its over 12 then i shall try a 1:3.5 or even 1:3. I'm hoping it will be a while before i get to find out which suits me better though!

 

[JJay]

The MySugr app will calculate correction doses for you, either to a blanket ratio, or you can set different ratios for different times of day. It doesn't let you over-stack insulin (in fact the other week when I was in a similar situation to you it recommended 6g carb instead of a shot!)

 

[helli]

I confess my numbers are guides. They also depend on
- insulin on board
- what direction the trend is on my Libre.

That doesn't stop me rage bolusing (or rage blousing) at times but never late at night and always with my meter and GlucoTabs close to hand.

 

[everydayupsanddowns]

Morning @Kaylz and @Inka , what a night! No idea what caused that as i had really good levels all day. The only thing i can think of is that it was a higher carb tea than i would usually have even though i bolused for it. My worry was more that the first correction dose just didn't work. I would usually leave about 3.5-4 hrs between but the fact that it carried on climbing worried me. I set my alarm for 2.30am to check and it had come down to the top end of target range and at breakfast 5.3. Phew!
Thanks for replying both, i just wanted to see how long people left between correction doses if it wasn't working. I don't like correcting at night just in case it drops but needs must last night.

Great result @freesia

Glad your instincts paid off!

Stacking can certainly get you in bother, and it is always safer to wait, but I confess that I would also have acted if my BG was still rising after 1.5-2 hours as something was clearly ‘up’