< 140 at 2 hrs after a meal?

[reefedjib]

Hi all,

I starting bolusing for carbs yesterday with a factor of 10. Here are my numbers:

9:02 pm 181 - Before Dinner
- Apidra 10 units (2 unit correction, 8 unit carbs)
- Dinner 81g
9:59 pm 289
- Lantus 78 units
11:11 pm 236 - After Dinner
2:28 pm 117

My dinner consisted of a variety of fruit and some diet juice. At +1 I was 100 up, and at +2 I was 57 up. It was only after 5.5 hours that I was 64 down from before breakfast. I think that +5 mark proves I was bolusing.

However, I seem to recall that I should be below 140 at the 2 hour mark. Granted I started above 180. What's the rule?

I am not suggesting that I change my carb factor. I have to complete basal testing first.

[Subby]

Rob, as I think we've established, I probably can't help you directly in a useful way... but I can say that if you do start high, then it's logical to expect the same number rise (maybe even more) than if you start at a "normal" BG, when it comes to bolusing just for food.

Assuming a "full basal bolus regimen" which seems to be what you are aiming for:

- Basal should keep you "normal" given a "normal" starting point.
- Meal boluses should contain a meal spike to be moderate at 2 hours and back to pre meal after that, whatever that might be
- Correction boluses should correct your high BG levels (get you back to "normal")

It's pretty much as simple as that, in theory. It often isn't, but those are the separate "functions" you should aim for with basal, meal bolus, and correction bolus.

As such, your meal bolus didn't contain your spike staggeringly well, but appeared to be functioning to some degree. Its hard to say without knowing what would you normally expect with this meal and no bolus AT ALL (no carb bolus, no sliding scale bolus?) As well as commenting on the effectiveness of the bolus, it might also be commenting about the suitability of the food.

So to answer your question about the "rules", absolutely numbers like 140 etc, absolutely depend on starting at a number like 90 or 100. If you are high, you need to employ some other tactic to get to better BGs (such as correcting as per the same set of rules as laid out in "using insulin"). The carb bolus will (should) just contain the spike from the carbs with that slight rise in BG at 2 hours and back to near pre meal levels at 3 or 4 hours, nothing more, nothing less, regardless of where you start from.

[reefedjib]

Rob, as I think we've established, I probably can't help you directly in a useful way... but I can say that if you do start high, then it's logical to expect the same number rise (maybe even more) than if you start at a "normal" BG, when it comes to bolusing just for food.

Hey Subby, thanks for your response. I do think you can help in a directly useful way. You have lots of knowledge about this subject. I see what you mean here and that is what I would expect as well - my rise should be the same if I start at 100 or 180.

Assuming a "full basal bolus regimen" which seems to be what you are aiming for:

- Basal should keep you "normal" given a "normal" starting point.
- Meal boluses should contain a meal spike to be moderate at 2 hours and back to pre meal after that, whatever that might be
- Correction boluses should correct your high BG levels (get you back to "normal")

It's pretty much as simple as that, in theory. It often isn't, but those are the separate "functions" you should aim for with basal, meal bolus, and correction bolus.

Ok, this makes sense. In my case for the meal I cited, I gave myself a 2 unit correction, since I was elevated at 181, and an 8 unit carb bolus, since I ate 81g for dinner.

As such, your meal bolus didn't contain your spike staggeringly well, but appeared to be functioning to some degree. Its hard to say without knowing what would you normally expect with this meal and no bolus AT ALL (no carb bolus, no sliding scale bolus?) As well as commenting on the effectiveness of the bolus, it might also be commenting about the suitability of the food.

Here is a sample meal without bolus:

7:30 am 191 - before breakfast
- breakfast 138g
9:35 am 331 - after breakfast

A little math...the BG difference is 140 and assuming it is the peak, which it probably isn't given glycemic indexes and all, the the rise in (mg/dL)/carb is pretty much a 1.01.

My earlier example, with the bolus - which should drop the (mg/dL)/gram ratio, is a BG difference of 55 which gives a (mg/dL)/gram of 0.68. The bolus definitely had an effect.


So to answer your question about the "rules", absolutely numbers like 140 etc, absolutely depend on starting at a number like 90 or 100. If you are high, you need to employ some other tactic to get to better BGs (such as correcting as per the same set of rules as laid out in "using insulin"). The carb bolus will (should) just contain the spike from the carbs with that slight rise in BG at 2 hours and back to near pre meal levels at 3 or 4 hours, nothing more, nothing less, regardless of where you start from.

I am actually quite close to this. I had a rise from before to 2 hours after of 55. This should be 40-50 according to the "rules". I had a correction bolus thrown in. But I am using a factor of 10 and the 500 Rule says it should be 7.

Once I get my basal dialed in, I can start bolus testing and fine-tune my factor.

Thanks again!

[Subby]

No problem. But that correction is vital to mention and negates half of my first post. As you had a bolus for the meal (8u) plus a correction of sorts (2u), it suggests that one or other, the correction, or the food bolus, was inadequate.

Why do I say that? Because, put together, they acted solely like a bolus within the bounds of rough normality. They should not have - if the bolus did its job, and the correction did its job, you should indeed have dropped lower, quicker, towards normalisation. Does that makes sense? (Yes there was a drop later, but 5 hours is probably moving out of the range of the bolus, and may well have been other things)

Doing both at the same time, means you don't know which one (or both) were not quite doing its own job.

What I am saying, is you can't test both corrections, and food boluses, at the same time - well, not particularly well. You need to just do one or the other, (obviously if there is food involved, there needs to be a food bolus... if there is not food involved, it is time to just use a correction...) in order to make headway in finetuning them.

If you are testing how successful a food bolus is, you are looking for the slight spike and return to pre meal levels, whether they are 100 or 180. There should be no correction bolus involved.

If you are testing how successful a correction bolus is, you are looking for a downward drop in BG over the next few hours to your "aimed for" level, without big hypos. There should be no food or carb bolus involved.

So, pick A or B to test... not A and B at the same time.

[Subby]

And yes, sorry, you did have the correction specified and seperated in your notes at the start, managed to completely overlook it :)

[reefedjib]

No problem. But that correction is vital to mention and negates half of my first post.

:) It was good solid reading, nonetheless.

As you had a bolus for the meal (8u) plus a correction of sorts (2u), it suggests that one or other, the correction, or the food bolus, was inadequate.

Why do I say that? Because, put together, they acted solely like a bolus within the bounds of rough normality. They should not have - if the bolus did its job, and the correction did its job, you should indeed have dropped lower, quicker, towards normalisation. Does that makes sense? (Yes there was a drop later, but 5 hours is probably moving out of the range of the bolus, and may well have been other things)

This makes total sense. I suspect it was my high carb factor that is the culprit but I will have to prove it through testing. I am very worried about overcorrecting. I don't want a low!

Doing both at the same time, means you don't know which one (or both) were not quite doing its own job.

What I am saying, is you can't test both corrections, and food boluses, at the same time - well, not particularly well. You need to just do one or the other, (obviously if there is food involved, there needs to be a food bolus... if there is not food involved, it is time to just use a correction...) in order to make headway in finetuning them.

If you are testing how successful a food bolus is, you are looking for the slight spike and return to pre meal levels, whether they are 100 or 180. There should be no correction bolus involved.

If you are testing how successful a correction bolus is, you are looking for a downward drop in BG over the next few hours to your "aimed for" level, without big hypos. There should be no food or carb bolus involved.

So, pick A or B to test... not A and B at the same time.

So, I pick A. :)