Stress Bolus

Hi, Just got back from a 2 day ordeal testifying in a trial. A lot of anxiety, mental stress etc. Try as I might, I could not shake a high BG up around 200 +/- 20 despite corrections every few hours plus cranking up my I:C ratio at my slow carb lunch. Walked about 2 miles in the lunch break with no reduction of BG. As soon as I got off the stand at 2 PM today, a normal correction bolus eased me right back into range over the 3 hour drive back home. I am certain that mental stress was the cause of the persistent high BG.

Just wondering if anybody has gone through something similar and developed any rules of thumb for adjusting/correcting? I was pretty wary of overdoing my correction bolus during breaks, did not want to go low. Also decided not to fiddle with my basal as I am fond of Tresiba.


I have never personally experienced this but I know Stephen Ponder talks about this phenomenon in his book “Sugar Surfing”


I have experienced a few things like this. The stress factor is tough to manage because it is not nearly as predictable as taking insulin for food, where you have a known amount of food on your plate you are about to eat. Stress is unpredictable.

There are no good formulas for insulin dosage amounts for stress. Nothing that tells you “if you are 6 out of 10 on the stress scale, take X units…”.

But the more times you experience it, the more you will become comfortable with taking preemptive insulin. A small dose up-front helps to alleviate it. And if it is not enough, next time in a similar situation you can take a bit more. The thing that makes you bold is having a bit of candy or sugar source in your pocket. That enables you to take more preemptive insulin.

As far as a rule-of-thumb, this is - pardon the pun since you were testifying at a trial - “trial and error”. But one of the general rules for insulin I have found - it takes less to prevent a high than it takes to correct a high.

Each error brings you one step closer to perfection.


Thanks Tia and Eric,
I’ve been planning to get the Ponder book anyway and will check it out to expand my knowledge. Hopefully will not find myself in a witness chair again any time soon. Thanks again!

John, Ponder says that his stress correction factor is about 1/2 of his regular correction factor (for regular glucose incursions).

On the other hand, when my son gets puberty peaks, his correction factor varies between 1/2 of his regular glucose corrections to 4x… It is unclear to me why that because I think they are generated by exactly the same hormones.

That’s interesting…On the second day I attempted double my usual correction factor in late morning and a 2 mile brisk walk after lunch without success. In hindsight I could have been much more aggressive with the Humalog and (as best I can determine looking back) probably would have been OK at 4 times usual correction. Hindsght also tells me I probably will chicken out and use 3 times usual next time this comes up if ever. Oh well, we live and learn don’t we?

There were some issues on this case that really bugged me and probably increased my stress level way above my normal steady approach to life. I’ve been declining this type of work for a few years now getting ready for 100% retirement, so I just have a few wrap up cases like this left. Hopefully I won’t have to put my home brew stress correction factor to the test again.