correction boluses of 9% TDD

[Tranly]

Hi!
I am reading "Pumping insulin" by John Walsh I just having some question about correction boluses..
The book says people with good glucose management need 9% of correction boluses a day (9% of the TDD). While correction boluses means there are fluctuations that we really can't do anything about, it happens everyday, causing stresses and risks of complications in the long run. My limited knowledge and experiences have it that correction boluses everyday should mean we are far from good control, something the pump should have been able to help us achieve given that it has been around so many years and it is the way to deliver insulin closet to the healthy pancreas.

After trying to figure out the TDD, basal rates, carb ratio and so on, I still have unexpected highs happen once almost everyday, my correction boluses made up of about 9% to 10% of the TDD. I just wonder if anything can be done to lessens these daily fluctuations rather than excepting the 9% figure?

Should we expect such spikes/fluctuations everyday? Is it true that even people with good management have this everyday? Can the best become better? I am thinking of complications in the long run due to this problem.

Thanks so much for your help!!

 

[catherinecherub]

Can anyone help @Tranly?

 

[donnellysdogs]

To me, if correction doses are needed at all then something is out of sync or kilter... I personally could not live happily with my disbetes having 10% correction doses.. No way.

Howver thats me, if others find yhat world for them, then fine.

A pump which I am on enables you to fine tune. The latest roche pump is enabled to fine tune amazingly accurately so I personally would kick my ar*e if I was running at 10% TDD for corrections.,

 

[donnellysdogs]

It is not only based on basals, ratio's etc but your acting time and offset time need to be tested and correct too. This may change from winter to summer because of heat or cold.

You should be able to fine tune on a pump. I don't basal test often but I do change my levels according to:

1) bolus 2-3 hours after eating, basals at other times;

2) if high, do a correction and test every 15 mins for two hours... This will give you an accurate "offset time"- when it is the biggest jump in lowering then that is when its at it's peak for starting to work....

3) if basals correct see eat, bolus n test 3-5 hours and test every 30 mins between these hours.. This will give accurate acting time.. You should see when the insulin tails off and rates stay stagnant.

 

[ElyDave]

The other thing to look at if you are requiring correction doses frequently is your carb counting skills, are you being as accurate as you could be?

The last few days for me have been slightly out of my normal levels of control and accuracy, some foods I don't eat often, plus a couple of pints of bitter, which I like but have to be very careful with these days. Knowing the effects, I had the beer not long before a meal, knowing I'd drift high but then incorporating the carbs into the bolus for that meal.

Of course I could also have just done a microbolus for that beer, which I did do for a few snacks over the last few days.

The thing that really got me was a moroccan vegetable stew which has raisins in it. I think I underestimated how many and ended up at 10.3 post meal, that was given a correction bolus as it was obviously wrong.

 

[Tranly]

Thanks so much for your sharing! I am so so grateful for your help!!! Esp. ElyDave for your recommendation for the book, I'm reading it and find it just what I needed.
As a new pumper I'm still trying to work out the correct rates and settings to match my body's insulin needs. According to what has been going on so far, I don't need 9% of correction bolus everyday. On the contrary, as I try to keep my sugar below 6.5 two hours after meals (the ideal sugar level of non-diabetic), I have to eat carbs during that 3 hours left to make up for the active insulin in my body (my active insulin time is 5) and to prevent lows. I don't find myself in need of 9% correction bolus everyday and wonder how a successful person manage that. The idea is to keep your sugar below 6.5 two hours after meals to prevent long term complications right? So I bolus more and eat carbs back to balance the active insulin left over.
Is this a right way to go?
The contradiction here is the book often says the goal is to bring your glucose back to normal after 5 hours eating. Not 2 hours eating. So I'm kinda confused about this. I'm very concerned of how to prevent any long term complications in the future.
Your sharing is greatly appreciated!

 

[himtoo]

rapid acting insulin such as what is used in a pump has an active life of 4-5 hours with the peak at 90min - 2 hours.
so bolusing correctly to bring blood sugar to desired range after 5 hours when basal rate in the pump should keep you steady is the goal.