[singh]

hy guys
i just got a query about correction dose.If someone is on 4 injections per day one 24 hr lantus and 3 fast acting humalog bfr meals , does he need correction bolus all the time or is it just for heavy snack u had after those meals.And is it possible for you to add extra correction dosage to your before meal fast acting insulin.What i mean is it possible to keep ur injections to 4 a day rather than keep increaing to 5,6 or 7?
Regards
Singh

[acstokes]

My opinion is smaller, more frequent doses are better. This is the principle behind the insulin pump---small basal doses rather than several larger injections per day. However, when injecting more than about 8 times per day you start to feel like a pin cushion and also will begin to devlop hardened tissue at your injection sites.

Fred

[BlueSky]

If you get your basal insulin dosages and timing right, you shouldn't have to do too many corrections. The correct basal regimen holds blood glucose steady in the absence of food. But it may require splitting the Lantus dose into morning and evening shots, and you just have to experiment until you get it right.

On most days I don't do any corrections. I inject Lantus in the morning and before bed, and it covers my basal needs pretty well. And I bolus for meals which are normally similar and easy to cover. But if I have a stressful day, I eat a larger than usual meal, or I get sick, I do corrections as and when required.

[Mindstorm]

It is possible to keep your injections to 4 a day as long as you're on a good schedule. I did this when I was first diagnosed and had a morning & breakfast shot of NPH & novolog, a lunch shot (if needed) of novolog, a dinner shot of novolog & NPH... OK I'm at a loss as to whether it was 3 or 4 shots a day at this point, but it is plenty possible. What you need to do is ask your diabeetus doc to help you set up a sliding scale of insulin to inject as a correction bolus at mealtime.

I should clarify how we did it so it makes more sense why we did it this way. I did not do carb counting when I started off, I ate similarly "carbed" meals and ate at the same time each day (this kept it simple for the honeymoon period, but worked well even when the honeymoon started to wear off). If my sugar was higher before meals I would give myself 1, 2, or 3 units of fast acting insulin with the shot for the meal. Perhaps you should find a scale that works for you?

[singh]

Thanks guys,
Reason i say that is not only to minimise effort and pain of less injections but also as you know there are 5 parts to inject.Me being living alone i cant inject on my arms on my own and my tummy has less fat so its painful to inject there.so that keeps my thighs only part where i can inject and there are sometimes i see blood comming out and less spots to inject so i wanna keep good control with my injections at max 3-4.
Regards
Singh

Originally Posted by Mindstorm

It is possible to keep your injections to 4 a day as long as you're on a good schedule. I did this when I was first diagnosed and had a morning & breakfast shot of NPH & novolog, a lunch shot (if needed) of novolog, a dinner shot of novolog & NPH... OK I'm at a loss as to whether it was 3 or 4 shots a day at this point, but it is plenty possible. What you need to do is ask your diabeetus doc to help you set up a sliding scale of insulin to inject as a correction bolus at mealtime.

I should clarify how we did it so it makes more sense why we did it this way. I did not do carb counting when I started off, I ate similarly "carbed" meals and ate at the same time each day (this kept it simple for the honeymoon period, but worked well even when the honeymoon started to wear off). If my sugar was higher before meals I would give myself 1, 2, or 3 units of fast acting insulin with the shot for the meal. Perhaps you should find a scale that works for you?

[Subby]

I can understand wanting to avoid needles. However injection site issues are minor compared to health issues that occur from poor control over the years.

So that is to say: there is one guiding principle for how many correction doses to take. Take as many as you need to maintain good control.

That's the single biggest issue to consider about. If you can do that on 4 a day: good. If not, take more shots.

[singh]

Originally Posted by Subby

I can understand wanting to avoid needles. However injection site issues are minor compared to health issues that occur from poor control over the years.

So that is to say: there is one guiding principle for how many correction doses to take. Take as many as you need to maintain good control.

That's the single biggest issue to consider about. If you can do that on 4 a day: good. If not, take more shots.

hy subby,
i am not even on 4 right now , i am actually on 2 right now , my last a1c two months back was 6.4 but my afternoon readings sometimes are fine 2 hrs after lunch sometimes are not.So i was thinking of going to 3-4 injections a day but my diabetes educator told me last time "Dont fix whats not broken" and he is quite a renound diabetes educator in sydney.
We believe i am still in honeymoon period as i am still making some insulin eventhough its been more than 1 year and 6 months now since i got diagnosed.I am all confused now .....
I have good team of endo diabetes educator and gp , his main way of looking at things are not at my day to day readings but majorly on my a1c as he believes that gives u better idea of how ur control is , i dunno wat to believe

[BlueSky]

Originally Posted by singh

Thanks guys,
Reason i say that is not only to minimise effort and pain of less injections but also as you know there are 5 parts to inject.Me being living alone i cant inject on my arms on my own and my tummy has less fat so its painful to inject there.so that keeps my thighs only part where i can inject and there are sometimes i see blood comming out and less spots to inject so i wanna keep good control with my injections at max 3-4.
Regards
Singh

The best place to inject is the butt. There is lots of subcutaneous fat, you don't feel anything, and it doesn't bleed. Not in my experience, anyway. There is also lots of space.

You just have to get used to not being able to see what you are doing .

[DeusXM]

The other option as well, if injections are increasingly a problem, is an insulin pump. It's more expensive though and given your good A1C it's probably hard to justify the expenditure. Perhaps the real key here isn't correction boluses but re-evaluating your insulin:carb ratio?

[Subby]

Just as another point of view on corrections as a necessary evil or not... I adjust a lot through the day (with my pump, but without my pump I'd be injecting) and find that's just the way I maintain control. My control includes all sorts of efforts and considerations for regular lifestyle, regular food, moderate to low carb and carb consumption only on a case by case basis to reduce spikes, much finetuning of I:C ratios, the most suitable basal pattern set up to deal with my basal needs, etc etc. On top of all that, I often need to bump my BG around with corrections through the day. To me it seems most related to variable basal needs and reactivity, which I seem to be a bit unfortunate with my lot in that respect.

So that's the way I do it - I have to if I don't want blowouts through the day - and the pump does make that a whole lot easier and less painful, it's true. But whatever way you take your insulin, what I'm getting at is you your own needs to correct and keep your BG in check - not just through external forces - but variation in the way your body needs and utilises insulin (and deals with stress, activity, food, etc etc). Be guided by how your body works. Does it get by without corrections? Great! Do you need corrections for control you are happy with? Use them! And things may change, just stay up to date with your body's needs.

On a side note, if you can get a 6.4 with two injections, your body does seem very good at dealing with other factors and maintaining stability even with less finetuning. It depends what you want to do and it's your decision and your decision alone. Do you want better A1c? If I could get 6.4 on two a day, I'd be shooting for 5s on four a day, corrections or not. But that's just me, as I said you need to make the decision what A1c and level of control you are happy with. 6.4 is certainly nice in my book.

[TommyC1]

Originally Posted by singh

hy guys
i just got a query about correction dose.If someone is on 4 injections per day one 24 hr lantus and 3 fast acting humalog bfr meals , does he need correction bolus all the time or is it just for heavy snack u had after those meals.And is it possible for you to add extra correction dosage to your before meal fast acting insulin.What i mean is it possible to keep ur injections to 4 a day rather than keep increaing to 5,6 or 7?
Regards
Singh

That's pretty much what I do. Actualy 4 shots of rapid, one when I get up plus one for each meal, and one shot of Lantus before bed.
Corrections are on an as needed basis. Not a regular occurance but not uncommon either. If I am high two hours after eating I correct then. If I am high before eating I combine a correction with the meal bolus.
I think you need to be creative about injection sites. Lately I've been taking my rapid in the undersides of my upper arms as well as my belly, butt and thighs. What ever it takes. The important thing is to have as many options for control as possible including corrections as needed.

Tommy