How close together can you safely bolus?

[grace girl]

I'm using humalog, but I know that novalog is basically the same so I imagine someone here can enlighten me. I know not the first hour after a bolus, but what about the second hour? My endo told me how to calculate how much insulin is still working in my system, but she really didn't give me a guideline as to when this is safe. I guess I just don't want to stack it up too much and get in trouble.
I've done it at the third hour without a problem..I just wondered if there's really a hard and fast rule, or what you guys do. Thanks!

[Funnygrl]

If it's a meal bolus, I'll do those back to back if I am eating again. A correction bolus I would wait til 2-3 hours after the first bolus and then inject if I was still quite high. Ya kinda have to use the 25% gone after each hour rule.

[BlueSky]

..... I know not the first hour after a bolus, but what about the second hour? .... I've done it at the third hour without a problem..I just wondered if there's really a hard and fast rule, or what you guys do. Thanks!
The graph below shows the typical action profile for Humalog/Novolog. At 2 hours, the peak is past and action should be fading fast. But remember that absorption rates differ between people. And there can be up to 20% variability in absorption for the same person. So bolusing at under three hours is taking a bit of a chance. Having said that, if my BG is high (10+mmol/l) and it hasn't at least started coming down after 2 hours, I will do another small bolus. :)

[grace girl]

Thanks, that helps. I've noticed that at certain times of the day I don't get much more action out of the humalog after the two hour mark unless I am extremely active, and I just wasn't sure if that was really a safe place to correct from.

[rzrbks]

"Stacking" your insulin can indeed be a problem, but if you do stack and check your B/G regularly, then you shouyld be ok.

I stack all the time, sometimes I just can't wait 2 hours to eat again, and I just be sure to check B/G often enough Not to go hypo.

[Scratch]

It depends on how confident you feel in keeping track and calculating. I'm willing to stack 2 boluses together, and would be willing to add on a third if those 2 boluses are on their last legs.

If you do stack, aim to be conservative some, don't go targetting 80. Target for 110 or so, so you've got extra sugar to avoid a hypo.

[FrankDr]

I just wondered if there's really a hard and fast rule, or what you guys do. Thanks!

I usually wait 2 hours for corrections after meal boluses and 1 to 1 1/2 for 2nd corrections.

When I do the 2hr BG check, I have an idea where the reading should be. If it's a normal meal, you should be catching your BG on the way back down to your target - not there yet, but heading the right way. This varies with what you ate, and you'll start remembering how the common stuff you eat will react.

If it's a straight correction, it should be *about* 65-75% of the way between your start point and target

If the reading is way off (40-50 or more) then I stop to think about what might have caused it to not work as expected. Most of the time it's a miscount on the carbs or a food that has a difficult absorption schedule, or any one of a million other factors. If I'm really suspect, I check BG after washing hands etc.

When things are way off, and I can't rationally explain them, I try to avoid big insulin changes until I get some more BG data points. I've overcorrected incorrect BG's and crashed before, so I've learned that lesson! Of course if you're getting into BG's that you know are dangerous, you need to take other actions.
-The point being that your best tool at this point is your brain. Use it the most. Think about where you came from, where you're going and where you should be now. I've seen people act before they think and get bad results. Of course sometimes you just get slapped by the D fairy for no good reason. :pcguru: Hopefully those days are few and far between.

Later-