when to correct

[bev]

I know it might sound unlikely, but I've looked back over my records since diagnosis, and it has never happened. What used to happen was that I would be below 4.0 more often, but that has improved now. In fact, I've only had 5 hypos in the last 30 days and one slightly false reading above 10 (false because it was taken at bedtime, before my NR had finished doing its stuff).

Hi Northerner, just interested to know if you do the 2 hour check? If i didnt check A for the 4 hours between meals - then most of the time he would be in range (apart from the odd blip of course!) - so when i ask about corrections - i mean for the in-between meal levels etc..

I have read accounts of people having hba1c's that are too high, but meter levels are all within range, however, its the time inbetween the meter checks that they have been running high and just not been aware of it - so i now check A 2 hours after a meal - sometimes he is over 12 so i do correct - but then he will need a cereal bar or similar so he doesnt hypo before the 4 hours is up (nr running out). This is why i am looking forward to the pump to iron out the 'blips' inbetween meals - although i realise that sometimes this cant be done - but i think the pump at least gives us a fighting chance!🙂

Also, i think A might be very sensitive to lots of foods as he seems to spike with about 50% of food - which might explain the early days of huge swings and us tearing our hair out!😱Bev

 

[Becca]

I don't think Bev means this though. I think she means at what number do we do a corrections. Becca do you correct everything over 8.0 now? (obviously within the timing rules)?

Hi Adrienne

We do corrections of anything over 8mmol/L if the bolus wizard allows it. If no correction offered then we might overide depending on how high she is etc.....

At night we correct over 10 purely because she is so sensitive to insulin during the night.

 

[Northerner]

Hi Northerner, just interested to know if you do the 2 hour check? If i didnt check A for the 4 hours between meals - then most of the time he would be in range (apart from the odd blip of course!) - so when i ask about corrections - i mean for the in-between meal levels etc..

I have read accounts of people having hba1c's that are too high, but meter levels are all within range, however, its the time inbetween the meter checks that they have been running high and just not been aware of it - so i now check A 2 hours after a meal - sometimes he is over 12 so i do correct - but then he will need a cereal bar or similar so he doesnt hypo before the 4 hours is up (nr running out). ...

Yes, I have frequently done checks at 1, 2 and 3 hours just to give myself an idea of possible spiking, absorption and timing for the novorapid. It just doesn't happen to me that I go high, but I do occasionally hypo at around 3 or 4 hours, not very often though. I can sort of see why you'd want to correct if the spike was really high, but then you are just feeding the insulin. Perhaps that matters less in a growing boy, but I'd be piling on weight if it happened to me. But a 12 at 2 hours? No, it might be on it's way down, and the problem then is really one of timing the NR peak to coincide with the glucose peak, which I think is too difficult to predict most of the time.

I can probably say all this simply because it rarely happens to me, so it's not an issue - I hope I'm not coming across as unsympathetic or critical! Just explaining how I personally behave regarding my own levels.

I have no doubt that the flexibility of the pump will give you a huge increase in confidence - roll on pump day!🙂

 

[Twitchy]

I'm having a nightmare re corrections at the mo...just over 2 weeks ago, my BI was 14u am & pm, with ratios of 2u:1CP at b'fast, 1 1/2:1 at lunch, & 1:1 at tea time...which seemed to work ok...normally 1u drops me by 3mmol quite reliably, when factored for ratios - ie 2u = 3mmol am, 1u = 3mmol pm...

In the last week or so my BGs have gone nuts, I've progressively increased the BI up so it's now 16u am & pm, and for a trial today have had no carbs yet with the following results:

0200: 13mmol - 3u QA (lispro)
0630: 9.0 mmol - 2u QA, 16u BI (Determir) egg & cup tea for b'fast...
0830: 8.8 mmol - relatively good these days so now correction as dashing off to work etc!!
0930: 11.0 mmol - 2u QA to hopefully nudge it <10 without going hypo later...
1030: 12.1 mmol - 3u (thinking might drop it by 4.5mmol, realise is on the back of other corrections, but tired of feeling groggy & sick!!!)

No obvious reason for this sudden shift in blood patterns, I don't feel dramatically ill (shattered, queasy & grot, yes!) but I can't believe this is all down to being a bit stressed & tired??

Any ideas?!

 

[Twitchy]

...should also add have changed both insulin cartridges & test strips vials a couple of days ago just in case...!

 

[sofaraway]

I don't that often need corrections pre-meal, never pre-breakfast I don't think in 3 years I've ever had a fasting above 10. My biggest issue is pre-evening meal and I am often 7-12 at that time so can need a correction.

I correct anything over 9 usually, because my correction ratio is 1 unit to drop me 5 points. I rarely correct at 2 hours because well I don't often test then and I am not usually high enough to warrent a correction. If I am above 15 then I will consider correcting. But am nervous of correcting before bed.

Last night is a perfect example
pre-dinner 7pm 9.1
35g carbs gave 2 units novorapid
9pm 16.9
so corrected 1 unit (aim to bring me down 5 points, as dinner n'rapid is still working)
10pm 12.8 (had dropped 4 points in 1 hour, was thinking maybe correction wasn't needed)
11:30pm 8.6 (all dinner bolus now gone, and less than 0.5u correction left to go so thought I'd be ok with no snack)
3:15am 6.2 (Hey 3am club!)
6am 6.2

So basically it worked out perfectly, showed me I can correct over 15 before bed.

 

[sasha1]

Hi All...

Oh dear...I think I might just set the cat among the pigeons here...As regards to Nathan...I was told by DSN at diagnosis not to correct between meals...unless he was ill.....😱...

But however I have ignored there advice...and will do a correction..between meals..if Nathan is reading anywhere between 11-14....obviously if he is over this reading I will correct as well.

Heidi
xx🙂

 

[bev]

Yes, I have frequently done checks at 1, 2 and 3 hours just to give myself an idea of possible spiking, absorption and timing for the novorapid. It just doesn't happen to me that I go high, but I do occasionally hypo at around 3 or 4 hours, not very often though. I can sort of see why you'd want to correct if the spike was really high, but then you are just feeding the insulin. Perhaps that matters less in a growing boy, but I'd be piling on weight if it happened to me. But a 12 at 2 hours? No, it might be on it's way down, and the problem then is really one of timing the NR peak to coincide with the glucose peak, which I think is too difficult to predict most of the time.


I can probably say all this simply because it rarely happens to me, so it's not an issue - I hope I'm not coming across as unsympathetic or critical! Just explaining how I personally behave regarding my own levels.



I have no doubt that the flexibility of the pump will give you a huge increase in confidence - roll on pump day!🙂

Hi Northerner,
Of course your not coming across as critical! 🙂

I think the difficulty is with children their levels seem to be a little more erratic than an adult - i think because they dont have 'routine' - one minute they are sitting watching tv, the next they are on the trampolene - so quite varied activites!
I do get your point of 'feeding' the insulin - and its something that i worry about - but then he is growing and very skinny - so i suppose he has that luxury! Also, he only ever has a yoghurt for a desert - so having a cereal bar to A is wonderful - a great treat!
Your very lucky that your levels dont seem to fluctuate between meals - if A's didnt - then he would be in range 90% of the time.
If he is over 12 ( he can be as much as 18) after 2 hours of eating - i do worry about the damage it is doing - it may only be a couple of hours that he is at this level - but it is doing damage during this time and i just cant bring myself to wait until he gradually comes down - which he does by the time its his next meal - so if i left him he would be within range so i know his ratios are right - its just the damn food spiking him! I think the dual wave and square wave will help him with these food spikes and he will then need less intervention - although at present he only has a cereal bar every couple of days or so - so nothing too much to worry about. I have been trying to give him the odd no carb meal - just until we can get on the pump as i hate him having high levels.😱🙂Bev

 

[sofaraway]

Bev how do you time the insulin for meals? It seems like the doses are right because he's back to range once the insulin is done working but food is peaking before insulin so would be better given earlier.

Alan I don't ever see you as being critical, I think that like myself you probably have residual insulin production and would have measurable c-peptide if you had the test. This really helps when I make slight mistakes in my dosing, I have the capacity to produce enough insulin to meet the difference between need and my bolus as long as isn't a huge deficit. And it's why my fastings are always good I have that period of time where my pancreas isn't being challenged by food at all so is able to help reset and bring my blood sugar back to range.

 

[randomange]

I'm having a nightmare re corrections at the mo...just over 2 weeks ago, my BI was 14u am & pm, with ratios of 2u:1CP at b'fast, 1 1/2:1 at lunch, & 1:1 at tea time...which seemed to work ok...normally 1u drops me by 3mmol quite reliably, when factored for ratios - ie 2u = 3mmol am, 1u = 3mmol pm...

In the last week or so my BGs have gone nuts, I've progressively increased the BI up so it's now 16u am & pm, and for a trial today have had no carbs yet with the following results:

0200: 13mmol - 3u QA (lispro)
0630: 9.0 mmol - 2u QA, 16u BI (Determir) egg & cup tea for b'fast...
0830: 8.8 mmol - relatively good these days so now correction as dashing off to work etc!!
0930: 11.0 mmol - 2u QA to hopefully nudge it <10 without going hypo later...
1030: 12.1 mmol - 3u (thinking might drop it by 4.5mmol, realise is on the back of other corrections, but tired of feeling groggy & sick!!!)

No obvious reason for this sudden shift in blood patterns, I don't feel dramatically ill (shattered, queasy & grot, yes!) but I can't believe this is all down to being a bit stressed & tired??

Any ideas?!

It might possibly be because you're feeling stressed, I tend to find stress mucks my sugars about quite a bit. However, I've also found that sometimes things just change for no apparent reason! My ratios normally don't change, but my basal can run between 20 and 30 units of lantus. I've no idea why, but I'll be ticking along quite nicely on one dose, and then suddenly I'll start running low or high, and I have to change the dose!

I'd suggest maybe contacting your DSN to see what they think, and if you're comfortable doing it, increase your detemir slowly until your numbers start coming down. (Though that's just what I would do if I was in your situation) 🙂

 

[Twitchy]

I'd suggest maybe contacting your DSN to see what they think, and if you're comfortable doing it, increase your detemir slowly until your numbers start coming down. (Though that's just what I would do if I was in your situation) 🙂

Thanks! Good to see the background increase isn't totally off the wall! I think I'm only panicking a bit more because I'm going onto the pump next week & have got it into my addled brain that if I can't get my basic numbers right before that the tranisition will be a total nightmare...doh, probably increasing my stress levels!! 😱

Big breath, another bolus, increase BI & watch this space! 🙄

 

[Patricia]

This is SUCH a complicated thread! On the pump we correct anything over 8 wherever we find it (eg between meals, pre-meal) EXCEPT at night. We will correct anything over about 11mmols at night, even at bedtime though we will always test again with any correction at night, bedtime or not... None of this happens much anymore though 🙂, as levels are good.

On MDI we had awful trouble with timing corrections and taking account of residual active insulin, so if we tried to correct anything between 8-12mmols, he would *inevitably* crash, so we stopped doing that. We did correct between meals for anything over 12 on MDI, as long as it was 2 hours since the last meal, and 2 hours before the next, to try to avoid much residual active insulin.

We have figured that E actually is quite sensitive to insulin, particularly corrections without food, and on MDI these corrections often had quite unpredictable results -- sometimes reacting in the 1unit=3mmols way, other times reacting way off target. This does not happen on the pump, except at night where we are trying to figure out a different correction to work to at the moment...

 

[bev]

Bev how do you time the insulin for meals? It seems like the doses are right because he's back to range once the insulin is done working but food is peaking before insulin so would be better given earlier.

Alan I don't ever see you as being critical, I think that like myself you probably have residual insulin production and would have measurable c-peptide if you had the test. This really helps when I make slight mistakes in my dosing, I have the capacity to produce enough insulin to meet the difference between need and my bolus as long as isn't a huge deficit. And it's why my fastings are always good I have that period of time where my pancreas isn't being challenged by food at all so is able to help reset and bring my blood sugar back to range.

Hi Sofaraway,
We have tried moving the timing - but only had minimal success, it seems to work a little for pasta and pizza, we do half doses - once before and once after eating, but with breakfast we have tried giving it earlier (only 10 minutes) and he hypo'd before he had finished his breakfast! I suspect A is just really sensitive as even changing his insulin by a half unit can have huge consequences. This doesnt seem to happen to other diabetics - which is why i think he is a good candidate for a pump - we really do need to be using tiny increments of insulin - which the pump can deliver. So bring on the pump i say!Bev

 

[Northerner]

...Alan I don't ever see you as being critical, I think that like myself you probably have residual insulin production and would have measurable c-peptide if you had the test. This really helps when I make slight mistakes in my dosing, I have the capacity to produce enough insulin to meet the difference between need and my bolus as long as isn't a huge deficit. And it's why my fastings are always good I have that period of time where my pancreas isn't being challenged by food at all so is able to help reset and bring my blood sugar back to range.

Yes, I've been coming to that conclusion more and more. My levels are too close to perfect most of the time, and I worked out that my basal is 26% of my total insulin - should be up around 40%, so there's more than likely some of my own homegrown stuff as well. I think that, when I had to make those drastic reductions in April, that was the point at which my body had recovered enough from the dreadful state I was in at diagnosis, so my pancreas sparked back into life. Seems logical! My worry, of course, is what things are going to be like once the honeymoon finally ends.

I wonder if they'd do a C-peptide test?

 

[Adrienne]

Hi Adrienne

We do corrections of anything over 8mmol/L if the bolus wizard allows it. If no correction offered then we might overide depending on how high she is etc.....

At night we correct over 10 purely because she is so sensitive to insulin during the night.

Oh I so want to be there as well. Correcting over 8.0 would be great, we just can't do that with Jessica yet. Its to dangerous. One day.

 

[sofaraway]

My worry, of course, is what things are going to be like once the honeymoon finally ends.

I wonder if they'd do a C-peptide test?

I think you will be fine, you've got all the skills and knowledge of how to adjust things, how to look for patterns etc.

I think they probably wouldn't do the test, because it's not going to change anything. You are a type 1, you need insulin so it's not like there is the option of changing if it does show you have reasonable insulin production. It would be interesting though!

 

[Northerner]

I think you will be fine, you've got all the skills and knowledge of how to adjust things, how to look for patterns etc.

I think they probably wouldn't do the test, because it's not going to change anything. You are a type 1, you need insulin so it's not like there is the option of changing if it does show you have reasonable insulin production. It would be interesting though!

I wonder if I could sneak the test on to my 'testing envelope' that they've given me for my next consultant review - do you think I'd get away with it?😉

 

[insulinaddict09]

I wonder if I could sneak the test on to my 'testing envelope' that they've given me for my next consultant review - do you think I'd get away with it?😉

Ahem !!! I dont believe what Ive just read there Northerner !!!! 😱

Saying that I once had a naughty friend ( not me ) who added a test to her

bloods form as the doctor had said no , hehehe she got away with it too 😉

 

[Northerner]

Ahem !!! I dont believe what Ive just read there Northerner !!!! 😱

Saying that I once had a naughty friend ( not me ) who added a test to her

bloods form as the doctor had said no , hehehe she got away with it too

I'm sure I read once here that someone always ticked the 'fasting' box on the envelope so that he/she would get the LDL/HDL split and triglyceride levels.😱 After all the lab don't know and the doctor probably doesn't remember 😱😉 Might be pushing it to include a C-peptide though, as it's not a necessary test for me.

 

[sofaraway]

I'm guessing on most forms it would have to be manually written on the form, so you can't just tick it and pretend the Dr must have ticked it.
Thye don't use those type of forms anymore in my area they have to be printed from the computer with the tests required.
We will have to think of a way 🙂