Hello! I’ve been fortunate in my first few months of insulin use that things have been sort-of easy to control. I am certain this is a temporary state and as things progress things will undoubtedly get more squirrely. The past several days have been more in the squirrely category, and i’m trying my best to not get frustrated, and learn from it. The bonus, I suppose, is that a few higher-than-normal numbers have given me the opportunity to experiment a little with correcting, and learning how much a unit drops me, how long it takes, etc.
My endo’s initial instructions were to add a unit or more with the next meal if i’m high at that point. Depending on where i’m at, I don’t necessarily want to hover at a higher number or meander slowly down over the course of several hours while waiting for my next meal, so I’ve experimented cautiously with a small correction between meals.
All this to get to my question, finally, which is the timing of those corrections. Is there a rule of thumb for how long you should wait after your initial bolus before adding more? I have a Dexcom and if I can see I’m high but heading back down, it makes sense leave it alone. But if i’m high-ish and holding steady, or still climbing, how long is it recommended to wait before adding more? Is it best to give it a couple hours to make sure the peak of the first bolus is done working? (Note that i use injections, not a pump, for what that’s worth)
I got a little cranky this morning when my usual breakfast didn’t work out the way it normally does, and added another unit after about an hour and a half. It’s coming down now, but i have a feeling I’ll be snacking in a bit. Oops
Wait at least for the onset time of the insulin before adding another correction. The initial correction should take about 30-35 minutes before it registers on the Dexcom. (10-15 for insulin onset, 15-20 for Dex to recognize). The rise should display at least a slight down arrow at this time.
It sounds like you are in a good place, re: control. It will get harder when you have an unpredictable pancreas and higher insulin needs, then once your pancreas poops out, it will get easier again. Just know that the ratio’s you develop won’t be true for very long during a honeymoon, but the skills you develop in understanding how to test/adjust your ratio’s will last a lifetime, so build good habits. Of course, discerning diabetics choose FUD, so you are far ahead of the game on that front.
Docslotnick’s advice is reasonable. If you want to see lots of examples along the lines of “this is what I saw on the CGM graph and so this is what I did,” you could take a look at Steve Ponder’s book Sugar Surfing.
thanks guys. I appreciate the book recommendation, too. I’ve considered ordering it but wasn’t sure if it would be as useful to someone using injections. One unit does quite a bit of work on me , and I’ve not yet got my hands on a half unit pen, so i wasn’t sure how much i’d get out of the book. Even still, the types of examples you mention would still be useful, so maybe I’ll give it a go!
When to correct? With your dexcom it should be easy. But you need to experiment with the food you eat. Eliminate other variables. Try one type of food, say 30 grams of bread. Using your carb ratio bolus for this. Watch your dex trend. If after a few hours you go back down to where you started, then your carb ratio is correct. But there are other variables that can throw this off, like the duration of the insulin you are taking as well as how good you have set your basal insulin.
When you have figured out how carbs affect you, you can experiment with protein and fats. Or do the pizza bolus test. Good luck to that. LOL
There are a lot of variables and you have to figure out which one is doing which.
F U D !
Here’s a related question. If my blood sugars aren’t behaving how I’d expect over the past several days, is it possible the new insulin pen i started late last week isn’t working properly? Or is it more likely my body rebelling?
Not with every meal, but often over the past few days I find myself eating a meal I’ve successfully handled before, but my blood sugar goes higher than normal, or goes up the normal amount but stays there instead of going back down. Any chance that could be a symptom of insulin that’s gone bad somehow? It’s not every meal, but it is interesting that this started around the same time I started the new pen. At the same time, I hate to open a new one and waste one if it’s just user error or my own body acting up.
Diabetes is not a linear disease. There are so many variables that it is impossible to duplicate situations. When we say that a strategy works, it is that that strategy works most of the time but not always. Things will always work differently than you were expecting.
Only @Eric can eat like he’s not diabetic, but that’s because he puts so much effort into it for the past 50 years.
Lol, definitely didn’t bake it in the oven! I appreciate the info. I figured it was unlikely, but the timing of the changes sorta coincided with the new pen (which was a sample so not from the same box as my others), so I wondered. I’m sure you’re right that this my pancreas continuing it’s little rebellion.
Honestly, it’s probably not the pen, but if you can easily replace it, and the timing fits the new pen, then you may as well swap it out and see if that makes a difference, especially if it came from a different source and maybe wasn’t stored properly at some point a while back.
So, I switched the pen last night just to see what would happen. Dinner and breakfast behaved the way I’m used to. Lunch did not (a little higher than expected and did not come down as quickly). So I’m thinking it wasn’t the pen, as was suggested, but instead my body is done with breaking me in gently and is going to start rebelling a little more!
That being said, would keeping my insulin:carb ratio the same but correcting when I can see it’s needed be a good approach at this point? I hate to change the ratio right now when it’s pretty sporadic and sometimes I seem to need more and sometimes I don’t. I’m sure the ratio will need changed at some point, but I’m not sure I’m there yet.
I’m in the variable place where some (increasingly rare) times my pancreas will function right (cool!), most times it just does what I expect based on past experience, and then sometimes it just doesn’t contribute at all. My ratio has been something around 1:20-1:35 for the past year, but I can’t really give you a good reason for why I dose like I do nowadays - I eyeball my food, guesstimating carbs, and depending on how the day has been going (or day before) I dose somewhere within that ratio and correct as needed. It works most of the time. I have gotten much more aggressive with both boluses and corrections the past few months, too, which has meant pretty great control most days.
Good to know there’s someone here in a similar boat. I’ve pretty consistently been 1:15 for the past couple months (except when I’ve been particularly active with exercise). The past several days to a week have been a little less predictable though and I’m a little nervous about control getting more challenging just as I was starting getting things figured out! That was expected though as I know nothing stays the same with this challenge. I’m sure I’ll continue to get accustomed to my body’s patterns and get more comfortable with dosing and corections when necessary, but it’s a little anxiety provoking in the meantime!
Sounds about right. I had everything pretty nailed down, and then life happened and things changed. I was initially nervous, but many of the changes are predictable in their unpredictability, and at least right now, my body is still very forgiving; I am still managing a 5 A1c with very few lows (and very little effort).
i found this approach to be very helpful for my tight control as well. i use to be afraid of over-bolusing and going low. now i enjoy a good low if/when it comes along. my weakness is good chocolate, Ovaltine, and chocolate covered Malt Balls. (and i find this meatho to be a lot more fun than being stingy with my dosing .)
I was just thinking about this today. I had a really bad day a couple days ago - rollercoaster - and have been very aggressive since. Definitely have tried to take advantage of the mild lows that came with that (and thank goodness for my Libre so I could catch them early)! I’m out of chocolate now, though…
i am baffled by this! i have 8 different ICRs based upon the time of day, and they range from 1:8 all the way to 1:12. when i was first put on the pump, i had one ICR which was 1:10. my post meal BGs were all over the place. depending on the time of day that i was eating. before pumping when i was doing MDIs, they werent as honed in as they are now as there was no fast acting insulins at the time. its a whole different ball of wax now.