Under bolus or over bolus? Which is better?

[Goldrun]

I have been diagnosed for 2 years now, and I try really hard to avoid hypo episodes...after just about passing out in a retail store once last fall.

My a1c's have been really good...I've gone from 13 at dx to 6.0 last November (and have been less than 7 for the past 18 months)...so I feel like my control is pretty good...but I do tend to run higher than the 140 my doc has suggested as the high limit during the daytime, which means I usually do not bolus at breakfast or lunch (unless it is extremely high in carbs).

I had my 6 month check up yesterday and my endo worried that I might be doing cumulative long term damage by my excursions to 180 or so (I tend to exercise and get that fairly low prior to dinner)...his suggestion was to take some insulin at breakfast and lunch (even tiny portions)...which leads me to believe I will suffer more lows.

So the question is....do you purposefully overdose the insulin to incur more lows, (cause I purposefully underdosed to avoid them, knowing I could get the bg down a bit with exercise)? This is making me rethink everything...including potentially incorporating more carbs so I can feel somewhat safe injecting at breakfast (specifically)...no biggie as I can do that with fruit I suppose.

[Cyborg]

Sounds like you need to accurately figure out your I:C ratio (http://www.insulin-pumpers.org/howto/ratio.cgi) for different times of the day. Over-bolusing is not a good idea and you can end up in trouble real fast. Under-bolusing will cause you to run high and increase your risk of long term complications.

[Goldrun]

I can see why you'd say that, but I know that I'm a pretty classic 1:15 with almost all foods (unless I splurge for a dessert, then it's more like 1:22 to keep all in check), but I couldn't help but notice on another thread that a lot of people experience hypos almost every day.

I would say that's not tight control, but over treatment...just as my running a little high is under treatment....the problem for me, is that when I'm active (as with anyone else) my bgs drop. I pack (for the most part) provisions to avoid that, but like I said....I have a healthy fear of hypos.

I suppose though, that it is better to go low now and again out and about than it is to have small excursions which may cumulate for long term damage.

I've been treating my food exactly as I should the past two days and have already had one low. So, I guess I'm on the right track?

[Goldrun]

(unless I splurge for a dessert, then it's more like 1:22 to keep all in check)

ahem....make that 1:8 it's still early for me!:o

[Gary_W]

I used to skip injecting at lunchtime because if I did I would certainly go hypo at 4pm. Even with a small injection.

It was all to do with the fact that I was injecting far too much basal insulin which was turning around and biting me at odd times.

If you can eat carbs at breakfast and lunch and get back to a standard BG later on in the day without a bolus, it sounds to me like you are relying on your basal insulin to bring down your numbers which (as far as I'm concerned) is not what it's for.

Have you done any fasting tests to check that your basal dose is correct?

Gary

[Goldrun]

hmm...that may be. About eight months ago I came down with a bug and my sugars went out the roof. The only way I could get them to come down was to up my basal injections. I'm still at a slightly elevated basal rate compared to what I was running before (only one unit, but that's enough for the sensitivity I seem to be experiencing)....

come to think of it, this coincides with the timing of my pretty dramatic hypo out in public (which I SO don't ever want to repeat!)...

Thanks Gary! Once again, it's great to have others opinions on things...

[Gary_W]

Glad to come up with a helpful suggestion :)

Until I dropped my basal, I was so far out of control it was scary... It will be interesting to see if skipping breakfast makes you go hypo, because it shouldn't.

Gary

[rzrbks]

Remembering that free advice is worth what you paid for it:

I do basal check ever 4-6 weeks-----that is, I go 14-18 without eating and check every 2 hours to make sure that Basal is correct

I measure food when we eat at home, I guestimate when eating out and check at 2 hour mark RELIGIOUSLY so that I can do correction as needed.

average A1c for 4 years has been 5.4.

If I have to guestimate carbs, I always over-guess as I would rather be low that high------I HATE the way I feel when over 140/7.7, I'll take a 70/3.8 Any Day, Thank you.

[soso]

I try to be accurate but find if i am not that 2 hr test really helps me out.. depending on that number I eat a small amount of carb (say if it's below 5) carb amount depends on what activity I am involved in at the time.. if I was 7.8(140) or over I will correct with insulin, but very conservatively, unless I was actually exercising at the time.. This is the only way I have been able to make it all work, even though I try to keep everything regular I find I get different results at times, it seems to go in cycles fr me, but as I still have some insulin production this is not so surprising.. I seem to get a couple of days in a row when I will drop down to 3 within my 2 hr window, so I adjust my I/C ratio and then a few days later it goes in the other direction again...
Have not had too much in the way of highs though, although I have seen my A1c rise a little in the last few months.
ss