Not correcting until meals

[PhoebeC]

Hi everyone,
So the lastest from my DSN was to not correct until meal times, which doesn’t make much sense at all because I would actually rather risk a low than sit like this for hours.
I even said what if it makes me feel bad and she said to sit it out until the next meal.

I only had my normal breakfast which is usually fine and my standard dose, after the hypo had gone, I took a normal amount of sweets to correct the hypo so do not understand the high at all.

I feel so rotten, my heads killing, I’m sneezy and well too hot, my eyes stinging. This is what happens when I am over 14 for any length of time and I cannot think straight. I literally cannot work like this and it makes me so upset.
I don’t even want to eat another meal like this as I feel so sick. So how can I wait until the next mealtime I don’t understand.

i don’t know how her advice is supposed to help me.

She said it’s because I have the Libre and can see it’s happening, but no actually it’s because I can feel it, I know I’m too high by the effect on my body.

 

[JJay]

I was once told not to make any corrections within 24 hrs of a hypo! That went well - not.

I would go with your instincts - it's your body, not hers.

 

[PhoebeC]

Thank you
Well I’ve corrected because I can’t leave it any longer and I couldn’t eat feeling like this.
I’ve always been told corrections if needed.
I feel so unwell and I’m so tired of

 

[Robin]

I know that novorapid is all spent by 4 hours with me, and I quite often have a longer gap than that between meals, so if the Libre is showing me that I'm not coming down naturally, I always do a correction. Like you, I can’t stand being high, knowing there’s no way I’m going to come down without more insulin, and not doing something about it.

 

[Bruce Stephens]

So the lastest from my DSN was to not correct until meal times,

It would maybe be better to say to be cautious when doing so. (Obviously the risk is of insulin stacking; by the time your meal comes you'll still have some insulin on board which makes calculating the dose more complex.)

But I'm with you. I start feeling a little unwell when the Libre goes over 12 or so. (Probably not as bad as you feel because at the moment I'm mostly in range so the highs and lows are usually short exceptions.)

 

[PhoebeC]

Well I was just sick, it was mainly acid I don’t know if it’s because I’m stressed, because I don’t feel well or because I am not well.

I couldn’t eat lunch like this.
I am actually unable to think in a straight line let alone work which was the concern I raised with her on Monday. I’m sure she couldn’t do her job feeling like this.

 

[Thebearcametoo]

Do you finger prick to check your numbers before correcting? Libre can lose accuracy the more out of target you are so it’s always worth double checking both hypos and hypers to make sure you’re not overcorrecting in either direction.

I hope you feel better once you’re back in target.

 

[freesia]

Well I was just sick, it was mainly acid I don’t know if it’s because I’m stressed, because I don’t feel well or because I am not well.

Maybe its a bit of both. My DSN said not to correct after a hypo as it risks having another and also i shouldn't correct a high without eating. Do you know around how long your bolus is lasting for before you need to correct? I agree with @Robin, maybe see whether it starts to come down by itself and also as @Thebearcametoo do a finger prick to check.

She said it’s because I have the Libre and can see it’s happening

I thought that was what the Libre is for so we can keep an eye on whats happening and give better control.
Do you have a direct phone number for her, could you give her another call?

 

[Sally71]

If my daughter had that Libre graph I’d do a correction! I'd do it without food as well, if you know your correction ratio then you don’t need to eat if you've calculated correctly.
We've always had smart meters and pumps which do all the calculations for you which makes it a bit easier, they will take into account any active insulin left over from previous boluses and reduce the correction accordingly. Are you using a smart meter? If not then maybe a little caution is advised but I don’t think I’d just leave it, especially if it's making you feel so ill!

As to why it happened in the first place, I think “hypo rebound” can happen when you are low and your body goes into panic mode and your liver starts chucking out glucose reserves, unaware that you are reaching for your glucose tablets whilst it does so. Unfortunately in type 1s this mechanism is a bit dodgy and the amount of glucose the liver chucks out is not very accurately measured and can’t be relied on to work in all cases. That's how I understand it anyway, or maybe it’s the diabetes fairy at work!

One excellent piece of advice I picked up on this forum is that if you are bouncing between low and high and back again, only do half the correction amount. This means that you will be a bit less high than before, possibly not perfectly in range but at least you won’t drop straight back into hypo territory and can then start to get some stability back.

Hope you feel better soon 🙂

 

[PhoebeC]

Maybe its a bit of both. My DSN said not to correct after a hypo as it risks having another and also i shouldn't correct a high without eating. Do you know around how long your bolus is lasting for before you need to correct? I agree with @Robin, maybe see whether it starts to come down by itself and also as @Thebearcametoo do a finger prick to check.

I thought that was what the Libre is for so we can keep an eye on whats happening and give better control.
Do you have a direct phone number for her, could you give her another call?

@Thebearcametoo yes I checked on my other meter too. So I’m confident in the Libre.

Novorapid lasts 3-5 hours, but it should have started to bring it down after less than that, and I waited the full 5 hours and it was still going up.

I can’t correct a high when eating if I don’t feel like eating if I feel sick. Same thing happened with the high, not hypo yesterday morning and it didn’t correct itself either, and then I waited until I ate at lunch.

I can’t keep feeling like this because I can’t live with it anymore

 

[PhoebeC]

If my daughter had that Libre graph I’d do a correction! I'd do it without food as well, if you know your correction ratio then you don’t need to eat if you've calculated correctly.
We've always had smart meters and pumps which do all the calculations for you which makes it a bit easier, they will take into account any active insulin left over from previous boluses and reduce the correction accordingly. Are you using a smart meter? If not then maybe a little caution is advised but I don’t think I’d just leave it, especially if it's making you feel so ill!

As to why it happened in the first place, I think “hypo rebound” can happen when you are low and your body goes into panic mode and your liver starts chucking out glucose reserves, unaware that you are reaching for your glucose tablets whilst it does so. Unfortunately in type 1s this mechanism is a bit dodgy and the amount of glucose the liver chucks out is not very accurately measured and can’t be relied on to work in all cases. That's how I understand it anyway, or maybe it’s the diabetes fairy at work!

One excellent piece of advice I picked up on this forum is that if you are bouncing between low and high and back again, only do half the correction amount. This means that you will be a bit less high than before, possibly not perfectly in range but at least you won’t drop straight back into hypo territory and can then start to get some stability back.

Hope you feel better soon 🙂

Yes I think the rebound issue might not have helped but I didn’t wake with it for hours, looks like I went low at 3am and I didn’t wake up until 6.30am, scary stuff

 

[Sally71]

Yes we were told when daughter was diagnosed that it's not necessary to check her at night, if she goes low it will wake her up. Erm, no it doesn’t, in fact if anything it makes her even more sleepy! She can be low half the night and not wake up 😱

 

[PhoebeC]

Yes we were told when daughter was diagnosed that it's not necessary to check her at night, if she goes low it will wake her up. Erm, no it doesn’t, in fact if anything it makes her even more sleepy! She can be low half the night and not wake up 😱

I’m the same if not worse high overnight, hyper I am out cold but shattered like I’ve never slept when I wake up

 

[freesia]

Libre showed i had one this morning around 5am. Didn't know until 8am when i woke and checked

 

[rebrascora]

My Libre showed me as 3.4 this morning when I woke up. Finger prick showed 4.5. I didn't treat it because I wasn't low according to my BG meter and I was pretty sure DP would kick in and bring me up soon anyway. 45 mins later Libre still showing me hypo at 3.8 but finger prick had started to rise and was at 5.8. I generally find that Libre shows me lower than I am by at least 0.5 mmol but when I get into the hypo range the disparity seems to get greater.
I am now more judicious about treating Libre hypos, particularly in the morning when DP will kick in anyway for me. I wonder if your high spike was a combination of hypo treatment, DP and breakfast.
DAFNE "encourages" you to only correct at mealtimes and I am pretty sure this is to prevent stacking but I sometimes only eat once a day which wouldn't be very good if I was stuck high and I need a correction for DP every morning whether I have breakfast or not or sometimes I split my dose for protein and don't have the second dose until 2-3 hours later, when the protein kicks in so I need corrections at other times. I think it is important to be conservative with corrections between meals and under dose to prevent causing a roller coaster.
I think if you can show that any corrections you make between meals are not creating havoc (yo-yoing) with your levels then you are justified in continuing. As others have said, we have to live with this minute by minute, not just meal time by meal time.

 

[Ditto]

Don't know anything about Type 1 but I think you know your body better than she does.

 

[PhoebeC]

Libre showed i had one this morning around 5am. Didn't know until 8am when i woke and checked

It’s so annoying not waking up. What we need is something that can wake us up.

Thanks @rebrascora I totally should have checked the hypo with the Libre. I don’t normally get DP but it could have been my Libre kicking into action eventually.

I had no carbs at lunch and no Novorapid and it’s now 9.2 I feel pants still but I’m level.

will have to work tomorrow now even though I should have been off as I’ve got so much to do!

 

[rebrascora]

Pleased you have come down a bit.
It surprises me how naff I feel as soon as I hit 9 or 10, when before diagnosis and in the early stages after I was probably often double that and coped.

 

[SB2015]

Hi @PhoebeC sorry to hear you are having such a rough time.

Like you I hate feeling high, which makes me feel horribly ill. I suspect that the DSN advice is based in the time before the Libre. At the time of just finger pricking we were encouraged to only test at meal times and do correction then. I think is only a way of encouraging us to wait for at least four hours to allow the last Bolus and/or correction to work. I have one DSNwho I simply do not ask for advice now as she is really stuck in the MDI route and when I talk about Libre traces she has no idea, and just repeats old ‘rules’

With the current smart meters they log the active insulin, or insulin on board, and take account of this when suggesting any correction. With a Libre we can see what is happening. @Sally71 has given the same advice as I was given on MDI, to half the correction to account for the stacking of insulin between meals.

Like others I would not want to stay that high once spotted. I would correct. With such a steep rise, I would suspect it would be feeling ill. It could also be no pre-bolusing for a high carb meal, but that would then have started to drop after about an hour as you suggested.

I hope you get things sorted. Whatever you do just keep a good watch on those levels.

 

[freesia]

It surprises me how naff I feel as soon as I hit 9 or 10, when before diagnosis and in the early stages after I was probably often double that and coped

I wonder whether its because we are now more aware of whats going on. I had a hypo this afternoon though, and didn't notice as i was curled up reading my book. It wasn't a bad one but i felt "guilty" that i hadn't been aware and was too engrossed in my book. I find i'm more hypo aware when i'm up and about doing things.