Use of target levels to improve HBA1c

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SB2015

SB2015

Well-Known Member
Relationship to Diabetes
Type 1
I use an Accu Chek Combo but the calculation for insulin may well be the same on other pumps. I am aware that my combo suggests a correction dose to the mid value of my target if when I test
- my BG is out of target
- I am eating carbs and I am am not exactly at mid target

My question is do any of you narrow your targets in order to prompt more correction doses when not eating. I quite often end up with a late breakfast (retirement!!) and just miss out lunch. Also there would be more corrections at night but it might be better to just leave that for now.
My current targets are
5.0 - 8.0. During the night
4.5 - 7.5 During the day
 
Our DSN changed ours to 3.7-7.0 for the whole day (from the default 4.0-8.0) which makes it correct to 5.3 instead of 6.0. I think it did improve my daughter's numbers overall just from correcting lower.

I don't see that it will cause more corrections though; well that partly depends how often you're testing, but if you try to correct too often it won't do it because it takes into account how long since your last bolus and whether that insulin is still active. Or it might not do the full amount. I find it more effective to do large corrections occasionally rather than lots of little ones!
 
Yes! - it suddenly struck me to do exactly that, about 18 months after I had my Combo, and I fiddled with it quite a bit from time to time - and it works! I still do with the Insight I had when the Combo was replaced.

I can't recommend it highly enough. At night mine is 5.0 - 7.0, rest of the day 5.0 - 6.5 - at the moment.
 
Thank you both. It just seemed logical. I shall try this and see what happens. It is feeling a bit like the British Cycling Team who focused on lots of tiny changes that together made a lot of difference. Here's hoping.

Sally, without additional tests, in the Aacu Check handsets, if I test for some reason and I am still within the range for that time period it will not do a correction. However by narrowing the range, even if I keep the same central value, the same test could lead to a correction as it may then be out of range. I shan't be doing any additional tests from my usual pattern. My fingertips are feeling hard enough already.

I will give it a try and see what happens
 
My son is currently using 5.0-6.5, however his DSN has advised using a single point, ie 5.6-5.6. We're thinking about it!
 
This is sounding like a useful strategy.

I would have to cope with is no Green readings, as the handset will record most as out of target (unless I am spot on). There is still for me that pleasure of seeing the green highlight when on target, and when things are going wobbly it can be a boost. I think I will cope with that in order to see the impact of tighter targets.
 
I still find correction doses when not eating don't really work unless I am way above target.

Because small correction doses take so long - at least 1 and a half hours - to take effect, it then seems to 'add on' to the residual insulin and will cause a hypo before I am next eating. ie check at 2 hours, too high, give correction, check at 3 1/2 hours, going down, check 5 hours hypo. Obviously I sometimes catch it before the hypo, but I feel like I'm on a roller coaster.

Best of luck!
 
Thanks Heasandford.

My extra readings happen when I am about to drive, and the Combo does suggest corrections, but takes account of the remaining active insulin, so should avoid stacking of insulin. I have an appointment with the DSN tomorrow and will discuss the ideas. I will let you know how I get on.
 
Redkite said:
My son is currently using 5.0-6.5, however his DSN has advised using a single point, ie 5.6-5.6. We're thinking about it!
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There is a major difference in the way Roche and Medtronic wizards work. Roche wizards target the middle of the range, but Medtronic (annoyingly) will only correct down to the upper limit and up to the lower limit. As a result I have always used a single value 'range' on the Medtronic pumps I have used. Thankfully the 640 no longer moans about above or below range results (unless hypo/hyper!) like the Veo did.
 
everydayupsanddowns said:
There is a major difference in the way Roche and Medtronic wizards work. Roche wizards target the middle of the range, but Medtronic (annoyingly) will only correct down to the upper limit and up to the lower limit. As a result I have always used a single value 'range' on the Medtronic pumps I have used. Thankfully the 640 no longer moans about above or below range results (unless hypo/hyper!) like the Veo did.
Click to expand...

Since my Combo corrects to the mid-value of my targets I am continue with a narrow range, and monitoring the adjustments that happen when I test for driving, or other tests around exercise. I am still not sure how to work out whether it is my crab ratio or sensitivity that I need to change. I guess I need a fasting correction, or carbs without a correction. So many puzzles to keep me on my toes.
 
Your carb (or even crab, though with crab, personally I don't need any insulin!) ratio and sensitivity are more or less the same thing.

I mean I'm 1u to 10g, however if I need more insulin since I'm always high after eating - then that can change to whatever time and testing proves it needs to change to. So I'm less sensitive to the insulin but equally my carb ratio has changed.

However - both things require a measured amount of simple carb. Eat 10g, test thereafter and see how much your BG increases by. Increases mine between 2.5 and 3.0. Eat an identical 10g, bolus 1u, test thereafter and see how effective that amount if insulin is, at bringing your BG back down to pre-meal value. For me - perfick. Ergo, 1u reduces my BG by 2.5 to 3.0. I always say '3.0' because that prevents over correction on my part - and it's safer.
 
everydayupsanddowns said:
There is a major difference in the way Roche and Medtronic wizards work. Roche wizards target the middle of the range, but Medtronic (annoyingly) will only correct down to the upper limit and up to the lower limit. As a result I have always used a single value 'range' on the Medtronic pumps I have used. Thankfully the 640 no longer moans about above or below range results (unless hypo/hyper!) like the Veo did.
Click to expand...
I had no idea about his. My ranges are 5.5 to 6.5 so might change this to 5.5 and be done with it
 
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