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Permalink Reply by Jan on May 5, 2011 at 12:11pm

We do correct at hour 2, which is one and a half hours prior to the end of her duration but that is because we use Apidra, where most of the bolus is gone by hour 2. To avoid a crash we correct to a higher target (where endo wants her blood sugar to be two hours after eating). Her two hour postprandial target is 150. This has proven to be safe. Cgms is not always right on so if I were you I would do a fingerstick 1.5 to 2 hours after the correction and then check insulin on board. You can then always cover some or all of the IOB. We do this all the time, as well, though no endo would sanction this. Just be on top of it.

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Permalink Reply by Jason_D on May 5, 2011 at 12:22pm

Thast interesting because I find that with Apidra, I get my largest change in BGs between hour 2 and 3. So I generally wait until hour 3 to correct.

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Permalink Reply by Zoe on May 6, 2011 at 9:35am

I also find that Apidra lasts about 3 1/2 hours, Jason. But I don't like to wait to correct. If you take into account the insulin on board (either with a pump or just doing the math yourself on MDI) you can make sure you don't overcorrect and go low.

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Permalink Reply by Jason_D on May 6, 2011 at 10:43am

I guess my biggest issue is, I generally get the most variance from my dinner meal. I don't like the idea of trying to correct before I go to sleep, unless I know for sure I won't be going low. The other thing is, I feel like its hard to estimate the glycemic load, or how many carbs has been processed. I have found many times that I will check at 2 1/2 hours and be at 150, then at 3 1/2 hours I've dropped 60 points. Other times, I may stay at 150 or, even go higher. I guess I like to just wait till the 3 hour mark to make a correction.

Thast just the way I do it. i haven't been at it very long, and am sure at some point I will be slightly more aggressive with corrections. My last A1c was 6.1, and believe it will better this time, so it seems to be working so far.

Anyways, have a good day.

Jason

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Permalink Reply by Zoe on May 6, 2011 at 11:13am

Sounds like you have a well-thought out approach and it has been working well! I definitely agree with ultravires that "one size doesn't fit all".

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Permalink Reply by ultravires on May 6, 2011 at 9:24am

There's no one-size fits all answer to this. Here are some of my thoughts:
-If I don't bolus (like if I have a steak and salad or something), I don't typically force myself to check until my next meal.
-If I have something that requires only 1 or 2 units (the majority of my meals), I check after 2 hours unless I feel funny (either hypo symptoms or unusually groggy/fuzzy)
-If I have something that requires 3+ units, I check at 1 hour and 2 hours. If it's b/w 150 and 200 at 1 hour, I wait another hour before correcting (I once corrected a 170 1 hour out right before class and had a nasty hypo right in the middle of the class). If it's 200+, I instantly correct, although if I have significant IOB I try to be conservative.
-Highs fall into 2 general categories: (1) I ate a small amount of carbs and simply took too little insulin by mistake (in which case I correct more aggressively because there's less harm from stacking); or (2) I ate a ton of carbs, took a bunch of insulin, and I'm not sure it has kicked in yet (in which case I'm more conservative)

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