Replies to This Discussion

Permalink Reply by acidrock23 on May 11, 2012 at 8:27pm

I would still think of it as sort of linear math though, even w/ really small amounts of food? I don't recall his diet strategy which might affect the size of the doses. When I was on MDI, I was always "splitting" doses in between the lines to get all sorts of different approaches, etc. I figure if he's a sailor, he's probably pretty handy with math and, if he's not, he has a calculator on his phone? I have different approaches for different sorts of meals?

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Permalink Reply by Terry on May 11, 2012 at 7:58pm

I'm looking at my copy of Think Like a Pancreas by Gary Scheiner. He advocates using the 1500/1800 rule to calculate the insulin sensitivity factor or ISF. Take the average amount of total daily insulin, basal + bolus (novolog + lantus), and divide it into 1500 and 1800. This will yield a range of ISF.

For example, if the average total daily dose is 30, then calculate 1500/30 = 50 and 1800/30= 60. That means that 1 unit of insulin should bring down your blood glucose by 50 to 60 mg/dl. In this case, use 50 to be aggressive and 60 to be conservative.

As others have note above, it's important to consider how much insulin is still working and subtract it from the calculated correction dose. Novolog takes about four hours to complete its work. At two hours post-shot, you'll have about 1/2 the meal dose left to work.

So, if, for example you take 6 units to cover your meal and you check two hours after your insulin dose, then there are 3 units still left to work. Let's say your two hour BG = 200 and your target BG is 100. Then here's the math: (200-100)/50 = 2. Since there are 3 units still left to work, then no correction is needed at this point.

There is as much art as science to this, so the best thing is to take note of the numbers and write down what happens to your BG. Live and learn. Your diabetes will vary, of course from any textbook examples.

AS MegaMinx observed, playing with the timing of the bolus before eating may be all you really need. Knowing how to calculate a correction dose, however, is a useful skill to know.

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Permalink Reply by Zoe on May 11, 2012 at 8:21pm

I agree that your diabetes may vary from the textbook examples. I find the formulas both Gary Scheiner and John Walsh use to be only guidelines, they don't work exactly for everyone. For example, using my own 25 units (average) a day it would come out between 60 and 72. My night ISF is, in fact, 60, but my day ISF is only 40. I think the best way to figure out any of these numbers, whether ISF, I:C ratio or basal rate is trial and error/trial and error.

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Permalink Reply by KatieT1 on May 11, 2012 at 8:53pm

these factors, rates, etc...aren't designed really for those going through a honeymoon phase...i did not do any corrections for a while after Dx and while honeymooning because I was still producing some insulin and I would eventually, like abellseaman did, drop down. abellseaman, please be careful with this and these suggestions and discuss with your endo. When I did start correcting, it was only with meals..then, eventually corrected for anything above 140, it took a while. Also, remember 1/2 doses, 1/2 doses you can do for both basal and bolus with a syringe.

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Permalink Reply by Terry on May 12, 2012 at 6:00pm

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Permalink Reply by Sam on May 11, 2012 at 9:09pm

Thanks everyone for the advice. So far I've only used the pens so half doses haven't been an option yet. But definitely something I might look into-- have some serious doubts about the precision of doses this small with the pens. I had a previous discussion on here on that topic.

I'm just looking hard and trying to spot all the patterns-- seems to be anything but consistent. Hoping to get CGM asap-- I think that'd help a lot to understand the patterns.

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Permalink Reply by Chris Miller on May 11, 2012 at 9:28pm

I just hope for the best after meals that my blood sugars will come down on their own, which they mostly do if my basal rate is accurate. If they don't come down, I can correct it later. I only administer a correction dose at mealtime.

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Permalink Reply by Denise Bevard on May 11, 2012 at 10:31pm

I would correct if I was high 2 hours after a meal (unless I was trending down at a good clip--CGM saves me yes) If I didn't have a sensor in i woulb be very cautious and check again in 30 min

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Permalink Reply by Brian (bsc) on May 12, 2012 at 3:26am

I am a T2 who has only beein using insulin 1.5 years. But my whole idea is that I never want to correct. I want to do things well enough that I never have to correct. And I have to accept that I am not perfect, so sometimes I will not correctly count my carbs, dose my insulin or in fact life will just thrown me a curve ball. I reserve corrections for when I have a blood sugar of "epic" proportion and I have some significant confidence that my existing insulin on board won't fix it.

This happens sometimes after a meal, but I usually wait til 3 hours after my last dose to be sure that my insulin on board won't take care of it. My most common use of a correction dose is in the morning if I wake high. In that case, I am just running on basal and the situation is clear. Then I just add it into my breakfast bolus and do as others have suggested pre-bolus, perhaps 30-45 minutes before I eat.

I am lucky to have good control, so my endo actually suggests that I not correct after meals and that instead if I am high before the next meal I simply add a correction into my next meal bolus. This is a good safe practice when you are starting out and still have beta cell function, particularly if you just have a mild high. Learn from things. If you are routinely high after a meal, you want to improve your counting and bolusing, not regularly correct.

Life is perfect if I never have to correct.

ps. Corrections can be a major source of lows

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Permalink Reply by Oakville27 on May 12, 2012 at 9:17am

This is something I'm planning on talking to my CDE about, as well.

She's told me not to bolus unless it's with food - in other words, i will calculate for a correction at mealtime as well as for the meal's carbs, but if I'm high between meals I've been instructed not to correct and if I'm having a snack and have IOB, I'm only supposed to bolus for the carbs.

Overall, this seems to work for me but I am also taking a lot more basal insulin than you are (16u) - so even when I've had a spike around 180 2-hrs after a meal, it tends to drop into range pretty quickly and I'm extremely confident (afraid?) that any more insulin would send me very low.

Right now, if I'm high I try to get active - even just moving around the house or a quick walk with the dog - which seems to work pretty well and avoids the risk of taking too much insulin.

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Permalink Reply by acidrock23 on May 12, 2012 at 9:29am

LOL @ walking the dog! I had surgery (umbilical hernia...4" scar!) in October and was on the DL, no running for 4 (well, 3 1/2..) weeks and no lifting/ crunches for 8 weeks. Right before "lights out" the OR nurse said "walk, you'll heal faster" so I started out the day after, walking the creature around the block going "please don't poop, I won't be able to pick it up!".

That being said, w/ CGM, testing and experience and wild craziness, I will correct without eating. I think I eat a lot during the day 1) to get more veggies, as I feel better running and 2) it's easier to keep BG pretty flat if I've got insulin and food on board a lot of the time? Then I lay off after 2-3PM, work out when I get home and settle in for the evening. I don't run up to 180 very often these days. I am pretty dull, in that I eat the same thing for lunch a lot of the time during the week, but I am doing ok w/ BG and running goals most of the time.

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Permalink Reply by Sam on May 12, 2012 at 10:20am

Yeah, its just so hard to get a handle on at first. They are not serving food here this weekend, so I actually went grocery shopping and can do some more precise counting. For example-- Woke up today at 84. Dosed basal 4u of lantus and 4u bolus 20 minutes before breakfast. Ate 60g carbs with breakfast-- two hours later 138. Not bad, maybe a little room for improvement. Before lunch started feeling a little twitchy and tested at 64. ate 60g carbs for lunch and took 4u again--We'll see what happens. According to your linear math theory-- that would put me at 118 2 hours after... plus or minus a few for different fat and fiber contents, right? We'll see what happens, it just doesn't seem to work out that predictably for me yet.

I'm obviously going to have to start figuring out how to work some snacks into the routine. I really don't understand why I'd be in the 60s before meals when on such a tiny basal dose and clearly not overdoing the boluses.

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