Alright - Here we go. One final attempt or I am throwing in the towel (Okay--this isn't possible, but still, humor me.)
Let's pretend I know nothing about Type 1 Diabetes. I know nothing about modern day treatments and I have never visited a doctor in my life. God simply just came down, handed me Novolog and Lantus, and said have at it.
Alright, before God left he told me to take 45 units of Insulin before bed each night-- Thanks God.
However, he forgot to talk about the Novolog.
The last time I visited my Endo, she put me on a 15 carb to 1 Unit of Novolog ratio. She set my target BG at 120. She told me to take whatever my BG was at the time (EX: 320) and then subtract my BG Goal(120) then take that number (200) and divide by a "correction" of 20. In this case the insulin I would need to just correct my high of 320 would be 10 units. If I had a sandwich (30 carbs)this would be an additional 2 Units; so a total injection of 22 Units.
NOW. When I check my BG level 2 hours from the moment I put the fork down... Let's say my sugar is at 220 now. DO I CORRECT THIS? or do I wait FIVE hours and check before the next meal.
Should I be using this ratio or should I be on some sort of Sliding Scale and Diet and Hell. I am just so flustered. It seems sometimes my dosage works and sometimes it doesn't. Sometimes I get it right, Sometimes I don't. I know it's an art and not a science, but I suck at both subjects. I can look at numbers all day and plot graphs and log journals, but I can't do much without understanding the full concept of what I am working with. I have the insulin; I just don't know what to do with it. I do not have a pump. I give myself my injections and I do not have the health coverage to see a specialist or and educator right now (hopefully soon, after another 90 days.)
Can someone please help me? I am really trying here. Can someone just put it "simple stupid" for me.
which particular smart phone apps have you found for this? I resisted getting a smart phone for about as long as I can-- but I suppose it is time.
It's also sort of useful to keep track of changes. When I was "off the ranch", I'd just guess all the time, if it'd run up, guess and take some more, etc. which led to lots of hair raising ups and downs. With a gizmo (e.g. my pump...) it's pretty easy to see where I've been and come up with ideas about where to go next?
Re specific apps, Glucosurfer.org is run by a member and has a couple of things I like a lot: a very good graphic rendering of your BG graph, incorporating insulin boluses, food and exercise in a convenient picture. At one point, they also were incorporating a means of taking pictures of food so if you had x square inches (or CM, as they are in Germany...) of pizza or salad or whatever and got a result that was "off", you could have a pic of it handy for next time? I used "Lose It" to track food for a while, although it didn't incorporate BG into it's measures, it was handy and I noticed a few things BG-wise, simply by tracking what I was eating.
In 90 days you could ask for a CGM, a Dexcom.
why 90 days?
Well, there's a few things wrong with your post here:
1. If I was that high, I wouldn't eat! I would get my BG down first (preferably under 200) and then eat something.
2. When you're high, your correction factor is going to probably be different. Usually, my correction (or insulin sensitivity factor) is 1:40 - for every unit I take, my BG will drop by about 40 points. HOWEVER, once I'm over about 280, I get more insulin resistance and my ISF becomes more like 1:20.
3. I think you also made a math error (which someone points out below), but no, I would not do a full correction again 2 hours after eating. You would still have some insulin working in your system and correcting again at that time would probably cause a really wicked low a couple of hours later when all that insulin kicks in. That said, if my numbers hadn't budged, I would probably do a partial correction.
But I think you hit the nail on the head - this is an art form. And everyone reacts differently under different conditions.
If you are able to obtain health coverage that allows you to get a pump, definitely consider it. The bolus wizards really take the headache out of the math factor once you get everything set properly.
I second all of the other advice. Most likely, any doctor or diabetes educator you encounter will not be diabetic. The information they give you will either be textbook or clinical. Not first hand. Novolog / Lantus will not work like it says it will on the bottle. Smaller shots will be more accurate and consistent than large shots.
Go to Walmart or some place, and buy a cheap monitor and a couple hundred cheap test strips. I reuse lancets a lot, just cuz i'm too lazy to change them, but it's never caused a problem. Then, just test your BG a lot. This is the only way to figure out how your D works.
Be patient and relax. Consider yourself fortunate that you have much, much better tools available to you now, than if you were diagnosed 50 years ago.
I would also add a simple rule: You can NOT eat whatever you want.
Sigh. Truer words were ne'er spoken.
Chill. Take a happy pill. Relax and educate.
There is a huge difference between the insulin to carb ratio and the correction ratio. Correction will tell you what 1 unit of insulin will reduce your glucose level. Mine is 1 to 65. So, if I am 180, one unit would bring me to 125 in 4 hours. So you need to understand both ratios.
Also be wary of the insulin on board. It takes about 4 hours for fast acting to be disspated in your body. The bolus wizard is a fantastic tool for all ratios and on board insulin. If you have one, program and use it--it does the thinking (well, calculation) for you.
Good wishes to you!
"When I check my BG level 2 hours from the moment I put the fork down... Let's say my sugar is at 220 now. DO I CORRECT THIS? or do I wait FIVE hours and check before the next meal."
OK, I'm too lazy to read all the replies, so I'm just going to answer this one question to the best of my ability:
The answer is NO, you do not want to correct again before your last correction if fully metabolized, because then you will be in danger of STACKING insulin, which can be very bad, resulting in hypos. What you do want to do is NOTE the time and the value and then use that information to adjust your correction factor in the future. Then you want to test again at four hours and, if you're still above target, do another correction.
You test and you're at 320. Your current IC ratio is 1:20. You're correcting to 120.
You calculate a correction at 320 - 120 = 200 / 20 = 10 IU and you inject that.
(Let's ignore the bolus part of your injection for now.)
You test at 2 hours and you're at 220. You resist the impulse to "stack" and wait.
You test at 4 hours and you're at 180.
OK, what did you learn? Your injection of 10 IU was supposed to drop you 200 mg/dl (or one unit for twenty mg/dl or 1:20), but in fact it only dropped you 140 mg/dl (or one unit for fourteen mg/dl or 1:14.)
Make a note of that "dropping power" and use it to adjust your correction factor in the future. When you're more sure about your actual correction factor, doing additional corrections (not waiting for the next meal) will become more safe. Sometimes I do (conservative) corrections right before bed, because I'm so sure of my factor after tweaking it for months.
Maybe next time you'll need to correct a 220, and perhaps you'll calculate it thus:
220 - 120 = 100 / 18 = 5.5 if you have a half-unit pen or syringe.
That is, you inched down your correction factor to a number between your original 1:20 and your suspected new ratio of 1:14, because it's usually not a good idea to make sudden moves in treating diabetes. That 1:14 might have been a fluke due to exercise, alcohol or some other factor; don't leap down to it, inch your way down to it and test, test, test.
If your factor is off the other way, raise it to 1:21 or 1:22 and test, test, test.
I have fairly crappy insulin resistance and my doc's started me at a correction factor of 1:30, which was like injecting water. Now I'm at 1:4.8 (morning) and 1:6 (evening) and this seems to be about right. I didn't leap there, however. I inched there, because there are so many other things to take into consideration: dawn phenomenon, infections or not, exercise or not, (for women) hormonal weirdness or not, usual and customary carb intake, usual and customary protein intake, whether or not you calc for gluconeogenesis from the protein, insulin resistance caused or ameliorated by other medications or conditions (e.g. thyroid, steroids), alcohol consumption or not, etc.