Replies to This Discussion

Permalink Reply by Zoe on July 8, 2012 at 3:49pm

Since you don't yet know how to do corrections there isn't a lot you can do. If you want you can do some exercise which might help bring it down. But otherwise all you can do is try and eat a reasonably low carb dinner and bolus accordingly. Hey, at least it's not in the 200s!

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Permalink Reply by Gerri on July 8, 2012 at 4:05pm

Your ratio needs some tweaking & your basal most probably does as well to be that high between meals. For bolus, eat something with a definite known amount of carbs. It's best to start with a meal that has few carbs. I don't know what you're doing now, but doctors tend to start people off with a conservative 1:15 ratio. One unit of rapid acting for every 15 carbs. For purposes of testing your bolus, eat a meal of 15 carbs. Test at one hour & at two hours. Timing is just as important as dose to head off the spike. Fifteen minutes before meals is merely a general guideline. Make any changes to bolus by only 1 unit & stay at the dose for three days to see a pattern.

People usually have different ratios for different times of day. Most are most carb sensitive/insulin resistant in the morning, so their ratio is smaller. Afternoon, when many are more active, can have a larger ratio. Dinner, usually the largest meal when our bodies are winding down, can also have a smaller ratio.

But, start with one meal & then move on to the next as you figure out your ratios. Too overwhelming to tackle it all at once. Log everything.

Keep meals 4 hours apart & don't snack while you're calculating dosing.

Corrections are individualized & loosely based on weight. You can figure this out by trial & error. I'm a small person. My ISF (insulin sensitivity factor) is 1:60. For each 1 unit of rapid acting my BG drops 60 pts. You can start carefully by using 1/2 unit to learn how much that lowers you. Test a 1 hour & at 2 hours. Remember that rapid acting tends to peak at around 2 hours after injection.

Testing basal involves fasting. When I test basal, I skip a meal. One day, I won't eat breafast. A couple of days later I pass on lunch & then a few days later I skip supper. Of course, you're checking to see how stable BG is with no food. Don't test basal when you're ill, super stressed, hormonal or exercising. Make any adjustments to basal in one unit increments. If you make big adjustments, you won't learn anything to know what's working or not.

The fewer carbs you eat, the smaller your doses will be. Smaller doses result in smaller mistakes.

You can do it. Realize it sounds confusing & involved, but we've all done it & are doing it. Ratios aren't fixed. They change over time.

Using Insulin is a great book.

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Permalink Reply by Doris D on July 8, 2012 at 4:46pm

Good advice there Gerri!!! The exact way to go.

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Permalink Reply by Gerri on July 8, 2012 at 5:03pm

I can relate to how Denise feels. I left the hospital not knowing a thing to do. All I was told was take 35 units of basal & that was way off. Had to flag down a nurse the day I left to show me how to inject. Pitiful.

We're all our own guinea pigs. I learned to correct on my own, so Denise you can as well. Just use a small amount, 1/2 unit & test.

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Permalink Reply by denise102206 on July 8, 2012 at 5:09pm

This is how I have been doing it. I started out at 1:15 about to weeks ago my breakfast is at 1:10 and still going over 200, my lunch I thought I had right but I guess I was wrong. The past 2 days I've been in the hot sun all day so I'm guessing that's why my numbers were so great at lunch today was my third day at lunch with the ratio 1:13 and I was inside air conditioner and my number was ok 1 hr with lunch then just kept going up.. I went for a walk and drank a bunch of water and got it down to 130...so I took my novolog waited 20 minutes and ate my ratio for dinner is at 1:11 I ate 22g my 1 hr number is so far 177. I can't take corrections of 1/2 units because I use the pens there are no 1/2s on mine. My basal was started at 6u at bedtime but I was going low and because I was high between meals I've split it 3u at night about 8pm and 3u morning at 7am. My fasting this morning was 123 yesterday with this and 109 today with this. Although in the book ..think like a pancreas it says if your blood sugar goes up 30 or down 30 it needs to be adjusted. My blood sugar went from 195 at bedtime to 109 this morning. But when I had my basal(Levemir) at 2u 4 days ago it was making my fasting in 140's so I figured this was to low so that's why I did 3 at night but from 195 to 109 seems like a big drop? I'm trying not to get frustrated but I do feel overwhelmed.
I couldn't find "using insulin" but I'm going to check again when I'm done with this book. Thank you for the advice.

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Permalink Reply by Gerri on July 8, 2012 at 5:21pm

The heat effects me the same way. Breakfast can be the hardest meal because the dawn phenomenon can continue. I eat very few carbs for breakfast & mostly protein. Otherwise, I spike.

Levemir is best in two doses. Good move! I take Levemir & use more at night. Doesn't have to be an equal split, of course.

Yep, 195 to 109 is a big drop. Sorry your pen doesn't have half units. Depends how brave you feel to try a 1 unit correction.

You're allowed to feel frustrated. It's frustrating! Overwhelmed is a natural reaction, too.

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Permalink Reply by denise102206 on July 8, 2012 at 5:25pm

So if thats a big drop do I go back to 2u at night even though it was giving me a higher fasting or just continue to see if the 3u will level out? I do wake up a few times in the night to see whats happening and I noticed like last night it went from 195 to 95 at 5am to 109 when I woke up at 7am.

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Permalink Reply by christy on July 8, 2012 at 5:35pm

It is a big drop, BUT 95-109 is a really good place to end up at. If you arent' already, try checking your BG around 3 AM. I know its a pain, but it helps getting some good idea of what your BG is doing overnight. It's a big drop but as long as I wasn't going too low. I'd leave it alone and do what you are doing with the levemir.

As far as correction factors go. My target range is 90-110, and I take 1 unit of Humalog for every 30 over 110 I am. So If my BG is 170, I'd take 2 units of humalog to correct, and if I was also eating at that time, I'd add my carb dose to that as well. My carb ratio is 1:10...so if my BG was 170 I'd take 2 untis for correction...and If I were eating 30 grams of carbs I'd add 3 untis for a total of 5 units of Humalog.

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Permalink Reply by denise102206 on July 8, 2012 at 5:51pm

how do I figure out what my correction dose is though?Would it be safe say if I was over 200 like tomorrow to tak 1u just to see how much it bring me down? And whatever it brings me down would be my correction dose? And how long after would I have to wait to give a correction dose? When I check at 2 hrs and its high>?

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Permalink Reply by Clare on July 8, 2012 at 6:28pm

I'm fairly sure the correction factor is a mathematical formula. I vaguely remember the dietician came up with 1:34 but my endo said not keep it at 1:50. So for me my target is 110 so I take a unit of humalog for every 50 points I am over 110.

The Rule of 1800!

Correction Factor = 1800 ÷Total Daily Insulin Dose (TDD) = 1 unit of insulin will reduce the blood sugar so many mg/dl

My TDD for yesterday was 85.4 units. (The TDD is the total amount of insulin I take in a day. My basil or background rate is 48.8 units. I use an insulin pump that is constantly feeding me a small amount of insulin. I take boluses prior to meals and snacks, and those amounted to 36.6 units - adding to 85.4).

So... 1800 ÷ 85.4 = 21.

I found this when I googled "calculating insulin correction factors" and this is what came up. I remember now what the dietician/cde said, my total daily dose TDD was 53 units which included lantus and humalog, 1800 divided by 53 was 34 which was the correction factor she came up with for me.

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Permalink Reply by Zoe on July 8, 2012 at 7:41pm

Those formulas are only guidelines, Clare. The best way to determine ISF is by trial and error. As you can see in your own case where the endo said 1:50 instead of the formula which suggested 1:34. Does the 1:50 work? That's the real test. According to the formula, my ISF would be 1:90 according to the 20 TDD I have currently. It isn't. It's 42 during the day and 62 at night.

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Permalink Reply by Zoe on July 8, 2012 at 6:33pm

Correction dose, like all the other things you are working on, Denise, is trial and error, trial and error. No, you do not pick your correction dose based on one experience, any more than you determine a change in your basal by one high. You will need to carefully and conservatively try and correct highs and then keep track of how much it brings down your blood sugar. Over time you will discover your correction factor.

My own personal advice, though, would be not to worry about correction factor yet. The reason for that is you are still working on basal and on I:C. When you do too many different things at once not only is it emotionally overwhelming, but you introduce too many variables and that makes it difficult to determine what causes a result. For example: If you are trying to determine basal and you correct a high two hours after a meal, you will not be able to see how your basal is affecting your between meal numbers. Or if you include a correction with your bolus dose, as most of us routinely do, you will not know if that I:C ratio is accurate. One thing at a time and then look at a few days data.

Also the answer to some of your questions will be in the book you read. I have Using Insulin so I'm unfamiliar with Think Like a Pancreas, but I know many people like it as well. I really don't know that you need to read both. But if you continue to read and re-read the book you already have - Think Like a Pancreas - you will see explanations of things like I:C, basal testing, correction factors, etc.

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