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Correction doses?

L

Lornypops

Newbie
Messages
4
Type of diabetes
Type 2
Treatment type
Insulin
So after controlling my T2 with diet for 7 years, I am now on insulin following a scary DKA episode (ended up in intensive care in Turkey with a massive infection and DKA, blood sugars were at 50, yes that’s 50mmol!). I am used to low carb, but am struggling with insulin doses. I am taking 24 units of slow acting insulin each night at 11.30 andI have been keeping my numbers in range by keeping carbs less than 40g per day and not needing and rapid insulin.
This evening I (unwisely) decided to have a treat meal with 210g carbs. I took 8 units of my rapid. Alarmingly my glucose went from 6.4 to 21.7 over the next 5 hours (I have a libre CGM) and have stayed high (currently at 20.3 7 hours after eating!)
My questions are
1: how do I know if my rapid insulin is working and not “off”. It looks clear, no stringy bits and was taken out of the fridge on the 15th dec and kept in a Frio case since and not subjected to any temperature fluctuations. It hasn’t been used for over a week, does this matter?
2: should I take a corrective dose when food isn’t involved ie before bedtime? Or should I go for a walk and see if that works? This is the first time it’s gone this high and stayed high.
Sorry for long post, I don’t have an appointment with the diabetes nurse until February 4th and am supposed to be going on holiday to Egypt in 3 weeks and am extremely anxious about how I’m going to cope without being educated about what I’m supposed to do, especially in situations where I won’t know exactly the carb content of my food (how it’s prepared and cooked etc. I’m going to be one of those nightmare people who’s going to be asking to see the kitchen lol).
Thank you
 
Hi @Lornypops , I can’t help you, as I’m not on insulin, but 50 mmol/ls strikes me as very high for someone with T2. Has your Dr tested your C-Peptides ? Just asking, I am certainly no expert, but your post seems very similar to my brother‘s situation, who went on to be diagnosed with LADA after his blood sugars shot up to the 40’s having kept his blood sugars in the prediabetic range for years. He also had DKA symptoms before going onto insulin.
I am sure T2 and T1 members with experience with insulin will be able to help with your questions.
 
The problem with dosing for carby meals is you really need to know your insulin (insulin to carbs) ratio, which can vary dramatically from person to person. (eg 1 person might need 1 unit for 10g, another 1unit for 1g , and they make 3x and 5x strength insulins specifically for people with high insulin resistance.)

Forum rules mean I can't give dosing advice but 8 units for 210g sounds quite a low amount of insulin to me . (A lot of T1s get started on 1 unit to 10g.)
This is complicated by the fact that you are supposedly T2 and may still make some of your own insulin, but I suspect that you probably just massively underdosed for that meal.

I happily give correction doses on the (not as rare as I'd like) occasions when I underdose for a meal. One of my issues is that once I go over 10 or so mmol/L I become more insulin resistant so I need more insulin to get myself back in range.

The issue here is that I genuinely don't know what your correction ratio (insulin per mmol/L) should be and you obviously don't want to overdose and go hypo. I would suggest ringing 111 for advice but if you can't do this, this is what Dr Google gave me as the advice in New Zealand for correction doses for T2s


Bear in mind that short acting insulin doesn't act immediately (specially when your bg is high, in my experience) so you don't want to stack it (give too many doses when there is still insulin in your system.) I'm not sure what kind of short acting insulin you are using but my humalog lasts for 4 or 5 hours.

Lornypops said:
1: how do I know if my rapid insulin is working and not “off”. It looks clear, no stringy bits and was taken out of the fridge on the 15th dec and kept in a Frio case since and not subjected to any temperature fluctuations. It hasn’t been used for over a week, does this matter?
Click to expand...
In theory it shouldn't be off as insulin is supposed to last up to a month at normal temperatures out of the fridge, but I suppose there is always the possibility that it's been mistreated somewhere along the line

Lornypops said:
2: should I take a corrective dose when food isn’t involved ie before bedtime? Or should I go for a walk and see if that works? This is the first time it’s gone this high and stayed high.
Click to expand...
Personally I wouldn't enjoy a walk very much if I was that high. Are you able to test for ketones at all? As for the correction dose, you really need medical advice for the amount, and forum rules mean we can't give dosing advice.


Do please let us know how you get on and I agree with @Melgar that in your position I'd want the tests to know if your are still T2 or actually misdiagnosed T1.

And I'd just like to add I'm very impressed with how well you've managed your insulin and blood sugar up to now by low carbing.
 
The other thing to bear in mind when eating that many carbs is that if you dose for the full amount at the start of the meal you may well (almost certainly will) go hypo after you've eaten as the insulin will take effect faster than the food will be digested - this does depend on what you ate of course. Even a normal meal but especially if it's something slowly digested (due to fat content) such as pizza or take-away will likely require a split bolus - spread the dose across the evening (and probably end up taking more than you expect if you run high as once high insulin resistance kicks in, more is needed to bring you back down).

I don't know what would happen if eating something that contains more easily digestible carbs, e.g. cake or sweets as I don't know what the digestion rates are for these sorts of foods (50g CHO/hr is sometimes quoted for "normal" meals), but there is a high risk of over- or under-correcting by getting the timing and quantities wrong when dealing with large meals like this (which can be dangerous if you end up with large amounts of IoB and are already hypo due to slow digestion). We're also all different in terms of digestion rates!
 
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