Corrections

[Gangrel]

Ok, I went to see my dietician today for the first time. She seems really nice, and is probably younger then I am, and very French. ;) (if you lived in Ottawa, you understand levels of French-ness according to English guys)

Anyway, we talked very little about carbs actually, because she felt like I was doing a good job of counting already. It helps that here in Canada all packaged food must have a label on it that includes the Carbs per serving. She gave me a few other books and phamplets, including one for chinese food! so I will have to try that one day and report back to you. ;)

We also talked a lot about insulin, which impressed me as I thought a dietician wouldn't know that much about it, but I was wrong. One piece of good news is that I am more then likely starting Levemir next week, so gooood bye NPH and good frickin' riddance!

We talked about correction doses, which is the whole point of this thread. I told her I find my rate to be about 1 unit of Humalog per every 2 mmol i want to drop, and it fits in line with the little chart she gave me for a 1:10 carb ratio, so all is good.

She talked about corrections at meal times, which i do, but I also asked her about correcting at the 2 hour post meal mark. I told her if i test, and i'm 15.0 for example, I would then give myself 3 units of Humalog to push me back down to 10, which is what it should be at 2 hours post meal.

She reccomended *against* doing a fix at the 2 hour mark however. She explained that if I am doing that, then I still have that Humalog in my system when i go to eat my meal in another hour or two, and take my meal bolus, and it causes a risk of making me low.

In one way I can see a risk if I test before the meal, give my bolus, and ANOTHER correction for the current level, because then i'm double dipping. But if I just gave a meal bolus, do you not think I would be ok?

Or should I just do as she says, and wait for the correction at the next meal? She did agree however that if the number is ridicioulsy high, like 20, a dose is needed right away.....

So, I guess all this rambling to ask, do you guys on MDI correct for the 2 hour post meal mark or not?

[BriOnH]

Or should I just do as she says, and wait for the correction at the next meal? She did agree however that if the number is ridicioulsy high, like 20, a dose is needed right away.....

That's what I do. At 3 hours I can very safely assume that novolog has done all it will be able to do. Once and a while I get wicked tails on novolog from stacking doses.

[Scratch]

I'll do corrections at the 2 hour mark. I base my decision on a table that gives numbers of how much of the bolus shot should have been used up.

This is for Novolog, Humalog, and other 4 hour fast acting insulins:

Time used up% -- remaining%
.5 hr 10% -- 90%
1 hr 30% -- 70%
1.5 hr 50% -- 50%
2 hr 70% -- 30%
2.5 hr 80% -- 20%
3 hr 90% -- 10%
3.5 hr 95% -- 5%

So at the 2 hour mark, I can check my blood sugar, and let's say I get a reading of 190 mg/dl. My mealtime bolus 2 hours ago was 6u, so I'd estimate that I have 1.8u bolus units remaining. My correction factor is right around 35 mg/dl, although it varies some due to time of day. 35 * 1.8 = 63 mg/dl drop still to come, which would put me at about 130 mg/dl.

Based upon that, I'd likely give myself 1.5 to 2 units of correction bolus, although as always it's dependent on what I think I'll be doing over the next few hours.

[belyro]

I typically do correct at the two hour mark if necessary.

I can't say it's the right way to do it....but it's what I do.

[grace girl]

For me there are a lot of factors in making that decision. When am I going to eat next? How active am I going to be for the next two hours?
If I'm going to eat in two hours or so, and I'm fairly active I don't correct because my b/s is usually in range by the time I eat.
If I'm doing a whole lot of nothing, I'll correct if it's over 180. If it's going to be a long time before I eat again, same thing.

Ultimately, I think it's just like everything else...you find what works for you and you do that. All of my decisions lean towards avoiding hypos at all costs, so I'm probably more conservative than some.

[Gangrel]

I somewhat agree, i haven't had a real problem with stacking the doses, though saying that, the next time i try I will probably run into problems.... :D

i'll have to try an experiment sometime.

[Cyborg]

I'll do corrections at the 2 hour mark. I base my decision on a table that gives numbers of how much of the bolus shot should have been used up.

This is for Novolog, Humalog, and other 4 hour fast acting insulins:

Time used up% -- remaining%
.5 hr 10% -- 90%
1 hr 30% -- 70%
1.5 hr 50% -- 50%
2 hr 70% -- 30%
2.5 hr 80% -- 20%
3 hr 90% -- 10%
3.5 hr 95% -- 5%

So at the 2 hour mark, I can check my blood sugar, and let's say I get a reading of 190 mg/dl. My mealtime bolus 2 hours ago was 6u, so I'd estimate that I have 1.8u bolus units remaining. My correction factor is right around 35 mg/dl, although it varies some due to time of day. 35 * 1.8 = 63 mg/dl drop still to come, which would put me at about 130 mg/dl.

Based upon that, I'd likely give myself 1.5 to 2 units of correction bolus, although as always it's dependent on what I think I'll be doing over the next few hours.

This is a great idea, IMO. It's similar to the way pumps compute IOB and suggest a correction bolus...

[BriOnH]

This can vary from person to person but;

I just need to see this against the Novolog pharmacological graph:
(it's R vs Novolog in diabetics. Diabetics are not typed)
http://www.diabuddies.com/images/NovologFreeSerumGlucose.jpg

Time used up% -- remaining%
.5 hr 10% -- 90%
1 hr 30% -- 70%
1.5 hr 50% -- 50%
2 hr 70% -- 30%
2.5 hr 80% -- 20%
3 hr 90% -- 10%
3.5 hr 95% -- 5%

[BriOnH]

The 4-6 hour tail when combined with a correction/bolus can be a bit brutal sometimes. For me scratch your table works in regards to "potency", I think.

[Scratch]

The 4-6 hour tail when combined with a correction/bolus can be a bit brutal sometimes. For me scratch your table works in regards to "potency", I think.
I don't know.

I can say I'm fairly certain that for me, I don't have any trouble with 4 to 6 hours tails with my Novolog. More frequently I have data from my testing which shows that oftentimes I finish off a Novolog bolus in about 3 hours. But that might be for me and not for someone else. It's something that we all have to work out, and it's a freaking pain in the butt, that's for sure.

[BriOnH]

I don't know.

I don't have any trouble with 4 to 6 hours tails with my Novolog.

I don't either, unless I stack a bolus / coreection on it. And again, like I said, it can vary from person to person.

[xMenace]

IMHO: at the 2hr mark you have active insulin yes, but you also have active carbs. You should correct.

BUT, you have to acurately assess other factors that impact absorption: glycemic index of your previous meal, exercise, activity, stress, blah, blah, blah. If there's no readily apparent reason for going high and no reason to believe it'll drop, I'll bolus.

That said, all but one of my 911's have resulted from mis-correcting.

[carolyn]

hello. i see your name pop up on here a lot and so i figures that you might be able to help me. how do i work out carb/insulin ratio? :smartass:

[xMenace]

Have you ever focussed binoculars? It is very difficult to do with one focusser as both eyes may have different focal points. It's done by closing the left eye and focussing the right with the right focusser. Then you open both eyes and focus with the centre one. It is a similar principal with your rates. You can't assess two sets of rates with one set of numbers. Do you pump? It's much easier IMHO when you do.

1. Establish your basal rates (right eye focussing).

It is a lengthy exercise: pick a period of the day (AM, Aft, PM, and night) and don't eat your normal meal at the start. Test every hour. Adjust your basals accordingly. When you can repeat the test a few times with the same or similar results, you know you are good. Research how to do this. There's many resources. Google "adjusting basal rates" and other such combinations. Night time tests can be every 4 hours and the test can cover several nights to give a full profile. Alternatively a CGMS is an ideal tool.

2. You now have stable and KNOWN basal rates. All future adjustments should be to bolus rates (left eye focussing).
I pick known foods to test with where I can accurately measure the carbs. If you go high after two hours and before the next meal, add insulin. The converse is true too. Again you need to repeat the test.

Generally everyone recommends making small adjustments. Always test frequently when doing these exercises. You are breaking your normal routines, and your rates could be dangerously off, compensating each other. You also want to test when your sugars are normal and you have no abnormal activities.

One should periodically re-profile their basal rates, especially if BGs change.

I am having great success with this. My meter's 14 day average is now at 7.4 and dropping. I've never seen it below 9 before.