High BG, corrected then crashed!

[Geordie lass]

I checked my BG levels at bedtime last night and they were 12.3, so I programmed my insulin pump to correct this high. 2 hours later I was in hypo mode at 2.5. Now, I'm not sure why this happened and would appreciate some advice.

My daily insulin dosage is around 30units per day, including my basal. So, when I corrected my high BG last night my pump tells me to take just over 3 units of insulin, so I bolused this as a normal bolus, thinking it would bring my BG level to a normal range, certainly not into hypo mode!

Now, I have lost a lot of weight over the last 4 months and my insulin dosages have decreased dramatically over this time period (from over 100units per day to around 30units per day). Do I need to adjust my sensitivity? It's currently 1.6... I know I should know what to do being a pumper for nearly two years, however, I've never changed my settings since I was put on the pump so don't know what it's all about!

My next diabetic appointment isn't until October 16.

 

[CarbsRok]

I checked my BG levels at bedtime last night and they were 12.3, so I programmed my insulin pump to correct this high. 2 hours later I was in hypo mode at 2.5. Now, I'm not sure why this happened and would appreciate some advice.
Were your hands clean, no chance of anything on them to affect the reading? I know it's hard to be wise after the event but did you do a retest to make sure the reading was correct? Another option is the meal you ate, did you give the right type of bolus for the meal ie, was it a high sugar meal with little fat or protein to even out the blood sugar?
My daily insulin dosage is around 30units per day, including my basal. So, when I corrected my high BG last night my pump tells me to take just over 3 units of insulin, so I bolused this as a normal bolus, thinking it would bring my BG level to a normal range, certainly not into hypo mode!
Any correction should be by using the correction bolus not meal bolus as the pump sorts this out for the logbook.
Now, I have lost a lot of weight over the last 4 months and my insulin dosages have decreased dramatically over this time period (from over 100units per day to around 30units per day). Do I need to adjust my sensitivity? It's currently 1.6... I know I should know what to do being a pumper for nearly two years, however, I've never changed my settings since I was put on the pump so don't know what it's all about!

My next diabetic appointment isn't until October 16.

Sometimes though all you can put it down to is one of those things.

 

[Geordie lass]

Thanks Carbsrok, I didn't retest as I know my monitor is usually spot on and even though my meal was not the problem as I don't eat large amounts and I am following a low carb plan. I only had 9g of carbs for my evening meal and I log everything on MyFitnessPal too. I did have a couple of sweets that I didn't account for! So I know my BG should have been high. I'm not usually that high so I don't usually do a correction bolus, but needed to at that level. I just wondered if I needed to alter my sensitivity level.

 

[Spiker]

Yes you definitely need to decrease your insulin sensitivity / correction ratio by at least the same proportion as your body mass has come down, probably more (because you are probably more fit, as well as slimmer).

But change it slowly, and with testing.

 

[CarbsRok]

Did you wash your fingers or hand after the sweets? As too the correction factor, you need to test that to see what you actually need. I would have thought if you have gone from 100 units down to 30 then carb ratio and correction factor would have changed. As from what you are saying I'm just assuming that the drop like you had was a one off, so if it were me I would not change anything unless it happened a couple of more times.

 

[Spiker]

CarbsRok is absolutely right to warn it could be a one off, but if your total insulin needs are down x3 and your weight is down a lot too, your correction factor definitely needs rechecking, at least. I would also recheck your carb ratio and basal rate after that much change.

 

[scoyyt57]

One way of calculating your correction dose is to divide 100 by your total daily dose of insulin. So in your case it would be 100/30=3.333333!. So 1 unit of insulin should drop your bs by roughly 3.5 mmol. Hope this helps

Anne x

 

[Geordie lass]

Yes you definitely need to decrease your insulin sensitivity / correction ratio by at least the same proportion as your body mass has come down, probably more (because you are probably more fit, as well as slimmer).

But change it slowly, and with testing.

Thanks Spiker. My BMI has decreased from 39 to 26, so quite a big drop! I also do a lot of exercising to keep fit. I was thinking about trying the basal test but not got round to that yet!

 

[Geordie lass]

Did you wash your fingers or hand after the sweets? As too the correction factor, you need to test that to see what you actually need. I would have thought if you have gone from 100 units down to 30 then carb ratio and correction factor would have changed. As from what you are saying I'm just assuming that the drop like you had was a one off, so if it were me I would not change anything unless it happened a couple of more times.

Yes, I always wash hands prior to testing as I know how this could affect the readings. I hope that crash is just a one off too! Thanks for responding.

 

[Spiker]

One way of calculating your correction dose is to divide 100 by your total daily dose of insulin. So in your case it would be 100/30=3.333333!. So 1 unit of insulin should drop your bs by roughly 3.5 mmol. Hope this helps

Anne x

I've said this before, but these formulas are just initial guesstimates for the newly diagnosed. If you already have a number that works, or used to work, it's much safer to work up or down from an existing number than to jump to a new number from a formula.

 

[Geordie lass]

One way of calculating your correction dose is to divide 100 by your total daily dose of insulin. So in your case it would be 100/30=3.333333!. So 1 unit of insulin should drop your bs by roughly 3.5 mmol. Hope this helps

Anne x

Thanks Anne. So, does that mean I need to adjust my sensitivity on my pump from 1.6 to 1.35? Or am I just being totally thick here?!

 

[CarbsRok]

Thanks Spiker. My BMI has decreased from 39 to 26, so quite a big drop! I also do a lot of exercising to keep fit. I was thinking about trying the basal test but not got round to that yet!

Basal testing is a must before you change anything else.
Do you have the book pumping insulin by John Walsh? If not please try and get it (amazon) it's the best investment you will ever make.

 

[Geordie lass]

Basal testing is a must before you change anything else.
Do you have the book pumping insulin by John Walsh? If not please try and get it (amazon) it's the best investment you will ever make.

I definitely think I need to do a basal test first. Don't have that book but will certainly check it out. Thanks.

 

[scoyyt57]

Sorry in delay replying. Been to work today!! Just checked my settings and my sensitivity is 1 unit for 3 mmol, so I suppose yours would be 1 unit for 3.5 mmol if you want to make this change.

Anne x