Wright or Wrong

[Charl]

Tresiba...Basal
Novo Rapid...Breakfast, lunch, evening meal

One day over the weekend i missed my evening Novo Rapid, had something to eat whilst out, on returning home 4hrs later checked my bloods before bedtime where my reading was in the 17s, made the decision to take 4 units of rapid without food, on checking in the morning it was still 11, should i have done something different, more insulin or none at all, the last novo i had was around 8 hrs earlier. Thanks.

 

[Robin]

It’s always a bit of a dilemma, when you need to correct at bedtime. I’m always loth to leave my BGs high overnight, but I don’t want to overcorrect and have a hypo in the night. I normally give myself a conservative dose, to firefight overnight, and then treat it a bit more aggressively the next morning when I’m awake and alert to watch in case I've overcorrected.

 

[rebrascora]

Sounds like you recovered the situation really well...
Leaving your levels up at 17 overnight would not be great. Clearly the 4 units wasn't too much to risk a hypo but brought levels down to a more reasonable level and hopefully you will be able to bring them gently back down into range through the day today.
Is there anything about it that concerns you? Perhaps that you would normally have 4 units for that meal and stay in range, but it didn't bring you back down into range overnight? If so, that is because once your levels go high you become more insulin resistant, so you need more insulin to bring you down from that level than you would to prevent you getting there.... if that makes sense?

On the whole I think you should give yourself a pat on the back though as I think that was a pretty good outcome, especially if you are fairly new to insulin usage.

 

[Thebearcametoo]

That sounds like a decent result. As long as you have a correction in your breakfast insulin to account for you being 11 then it’s all fine. Safer to underestimate insulin late at night than take a full dose and end up hypo.

 

[Charl]

Thanks for the replies, as I said I missed taking my evening novo rapid so expect that's why my readings were high, there have been other occasions where I have taken my rapid at say 4pm with my evening meal then tested say 5 to 6 hrs later and found my readings are higher than I expected before bedtime, would it be safe to do a correction considering I had 3 doses throughout the day. Thanks still learning.

 

[rebrascora]

Generally correction doses at bedtime are a bit risky, especially if you already have active insulin in your system. NovoRapid has an acting time of about 5 hours although it tails off during the last hour, so if your levels were still very high at bedtime and it was 4-5 hours after your previous NR dose, then in theory you could use another small correction dose of NR to bring them down but you always aim to err on the side of caution. Most people are initially advised not to correct a reading under 10 and at bedtime that is particularly important as you don't want to risk a hypo through the night whilst you are sleeping. And in fact many people are advised to push their BG up to about 8 or 9 at bedtime by having a small biscuit or something in order to keep them safe from dropping low through the night. So I would suggest that if you are just over 10 then experiment with 1 unit and see what that does if you want to try a correction. If that doesn't bring you down enough through the night, then perhaps try 1.5 or 2units the next time, but it is really important to be very cautious with bedtime corrections, at least until you gain more experience.