Insulin Corrections

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Mbabazi

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Type 1.5 LADA
Hi all,

I have a quick question about corrections. I'm working out that my ratio is around one unit of insulin for 3 Mmols but its not always accurate. I sometimes over correct especially in the evenings. Can I ask if for example in this case where I'm at 12 and going up, would you correct by one unit to bring it from 12 to nine or would I assume that since I'm going up it would be 15 so I should correct by 2 units. Im aiming for good numbers but find thay i under dose ans then over dose to corect. Its a balance trying to avoid hypos and high numbers. Thanks
 

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How long is it since you injected fast acting insulin for your evening meal?
Bolus insulin generally acts over 4-5 hours so you should not correct during that time because it may suddenly come down.
Also, Libre very often exaggerates these rises and then later corrects itself, so you would be well advised to do a finger prick if you do decide to correct and definitely don't consider predicting that it will rise higher and therefore calculate a correction from a level you have not and may not reach. You are still very new in your diagnosis and really injecting a correction before bed is not a great idea when you are still so new to insulin use.
 
This is one case where you really ought to check your BG with a finger prick. The Libre often over predicts a rise, because it tries to catch up the lag that it has (because it reads the interstitial fluid, not your actual blood). So you may find that if your rise has actually stopped, the Libre will overestimate it. Later on, if you look at the graph, you may find the highest figure has disappeared, and you’ve got a smoother graph. This is one of the disadvantages of the Libre, and why sometimes you need to check with a finger prick.
 
Also, you need a half unit pen. That way you can do more accurate doses and corrections. In addition, it’s not uncommon to have a different correction factor at different times of the day. Any evening/night corrections should be cautious anyway.

If you’ve eaten within the last 4 hours, I wouldn’t correct now and I agree with the above advice to fingerprick first.
 
Mbabazi said:
I had dinner 2 hours ago around 7. 7.30 so had injected around 7
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Ok, so I’d leave it a while and see how your blood sugar goes. You haven’t been on insulin long. I wouldn’t panic at a 12 (which might actually be lower if you fingerprick).
 
rebrascora said:
How long is it since you injected fast acting insulin for your evening meal?
Bolus insulin generally acts over 4-5 hours so you should not correct during that time because it may suddenly come down.
Also, Libre very often exaggerates these rises and then later corrects itself, so you would be well advised to do a finger prick if you do decide to correct and definitely don't consider predicting that it will rise higher and therefore calculate a correction from a level you have not and may not reach. You are still very new in your diagnosis and really injecting a correction before bed is not a great idea when you are still so new to insulin use.
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Thanks Barbara. I'll skip.the correction and see what happens in the next hour
 
Inka said:
Also, you need a half unit pen. That way you can do more accurate doses and corrections. In addition, it’s not uncommon to have a different correction factor at different times of the day. Any evening/night corrections should be cautious anyway.

If you’ve eaten within the last 4 hours, I wouldn’t correct now and I agree with the above advice to fingerprick first.
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Inka said:
Ok, so I’d leave it a while and see how your blood sugar goes. You haven’t been on insulin long. I wouldn’t panic at a 12 (which might actually be lower if you fingerprick).
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Thanks Inka..I'll leave it for now.
 
How did it pan out last night? Did you do a correction later or did it come down itself?
 
It is fine to wake up on 7 or 8, particularly at this very early stage and indeed your health care professionals should be absolutely delighted with that result. I think perhaps you are trying to run before you can walk and it is much better to get really good at walking, gain experience and become more confident, than trying to run when you aren't ready and have a nasty fall. I think this is the benefit of time in range over those set targets of 5-7 before breakfast and 4-7 before other meals. I always really struggled to hit those targets but hitting 70% time in range is usually much easier and encouraging, rather than waking up each morning and finding that I have failed to get under 7 yet again. It is better to have less variation and have reasonable good results where levels drift along mostly in the 7s and 8s, than have levels going up and down very sharply even if they are always in range. Libre does unfortunately encourage some of us to chase the dragon's tail to try to micromanage things a little too much and want to act the minute our levels go into double figures, but we have to remember that our insulin works over more than just 2-3 hours and those Type 2 guidelines of no more than 8.5 two hours after meals don't apply to us as Type 1s because our injected insulin takes longer to work.
 
rebrascora said:
It is fine to wake up on 7 or 8, particularly at this very early stage and indeed your health care professionals should be absolutely delighted with that result. I think perhaps you are trying to run before you can walk and it is much better to get really good at walking, gain experience and become more confident, than trying to run when you aren't ready and have a nasty fall. I think this is the benefit of time in range over those set targets of 5-7 before breakfast and 4-7 before other meals. I always really struggled to hit those targets but hitting 70% time in range is usually much easier and encouraging, rather than waking up each morning and finding that I have failed to get under 7 yet again. It is better to have less variation and have reasonable good results where levels drift along mostly in the 7s and 8s, than have levels going up and down very sharply even if they are always in range. Libre does unfortunately encourage some of us to chase the dragon's tail to try to micromanage things a little too much and want to act the minute our levels go into double figures, but we have to remember that our insulin works over more than just 2-3 hours and those Type 2 guidelines of no more than 8.5 two hours after meals don't apply to us as Type 1s because our injected insulin takes longer to work.
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Thank you for this explanation. Indeed the insulin must take longer to work because some dips in the night come almost 5 or 6 hours after my last dose so that would mean it's still working. I'll allow myself more time to ease into it all.
 
Mbabazi said:
It came down but not low enough , I was hovering in 7, 8 on waking. But it was a helpful lesson because I avoided a hypo.
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That’s a really great learning experience @Mbabazi (and I'd be perfectly happy waking at 7ish). I think this outlines the complexities behind balancing insulin on board, resistance at higher levels, level of activity 24-48 hours earlier, carb estimation errors and all the other (many!) factors that can affect the outcome of a correction dose.

If I see a rapid rise after a meal and suspect it was a carb estimation error I’ll sometimes consider a correction within 4 hours, but I’ll only look at the BG above 9.0 (since that’s the suggested 2hr max). However, most of the time it is simply an insulin action / carb absorption timing mismatch and 5 minutes up and down the stairs or a brisk walk around the block is enough to kickstart my insulin and level off the rising numbers 🙂
 
everydayupsanddowns said:
That’s a really great learning experience @Mbabazi (and I'd be perfectly happy waking at 7ish). I think this outlines the complexities behind balancing insulin on board, resistance at higher levels, level of activity 24-48 hours earlier, carb estimation errors and all the other (many!) factors that can affect the outcome of a correction dose.

If I see a rapid rise after a meal and suspect it was a carb estimation error I’ll sometimes consider a correction within 4 hours, but I’ll only look at the BG above 9.0 (since that’s the suggested 2hr max). However, most of the time it is simply an insulin action / carb absorption timing mismatch and 5 minutes up and down the stairs or a brisk walk around the block is enough to kickstart my insulin and level off the rising numbers 🙂
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@everydayupsanddowns, I think that is a brilliant response. It explains so succinctly why Gary Scheiner tells his readers that "Diabetes is Complicated, Confusing and Contradictory".

I probably didn't need to be told either your response or Gary Scheiner's reflections on day 2 of my diagnosis (post op still in ICU!). But if only I'd been told that a couple of weeks later and then reminded a couple of months later, with your "D is fickle" and be aware of "odd socks days" (to reinforce the theme) - then I think so much of the frustration, fear and stress that went on for so many of those first months would have been eased.
 
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