Correction dose

[Minion#2]

Had an argument with my teen son regarding correction doses.

It was late evening and he was going to do his Levimir before bed. His BSG was 17.7 so I asked if he'd drank enough - he said yes but I'm doubtful - then I said he would need a correction dose of novarapid. His correction dose is 1:5. I thought 2 units, possibly one seen as he is sensitive at the moment.

He refused and said he didn't think he needed it and said that was what his levimir is for.

Who is right please?

Just for extra information - he is currently trialing the freestyle libre 2 which has been waking him through the night saying he is having a hypo when he isn't (confirmed by finger prick). I believe he is avoiding the correction dose as he thinks going to bed high means the libre sensor won't sense a hypo and will leave him to sleep. I have tried talking to his specialist diabetic team about this issue with the sensor and two further issues but they have failed to call me back after leaving 2 messages.

 

[Ronancastled]

I'm a T2 but can only say that 17.7 is high & needs attention
He is young & not thinking of the long game which is the reduction of risk of complications.

From your info you are correct but we can only be our own keeper.
When I became diabetic I first found a guy on Reddit giving out that he couldn't get a date on Tinder once he revealed he was on dialysis because of diabetes.
Then he bemoaned the fact that women judged him cause he had erectile dysfunction.
Last I heard he was giving out about the US health system cause he had lost sight in his right eye.
He is only 33 but has never done anything to take ownership of his own BG, thought the meds were the fault.

Tough love can hurt but be amazing.

 

[EllieM]

Hi @Minion#2 and welcome to the forums.

I have to be careful what I say here because forums rules don't allow me to recommend insulin doses.

What I can say is that if your basal dose is correct your morning bg level should be close to your evening bg level (assuming that your evening level isn't still being brought down by bolus, which it might be, depending on when he had his evening meal). Most bolus insulins last 4 or 5 hours so you have to be wary about stacking them.

How long has your son been diabetic? I think you have to be a bit careful about advice here, because at 17 most childhood T1s are ready to do their own thing dose wise and may not appreciate a hovering parent. (Not that I can talk, my teenage T1 years were pre glucometer and I am sure my levels were all over the place then. Luckily I got away with it and after 52 years I'm still (mostly) complication free.)

But if the issue is the libre? How much is it under reading? Compression lows or a bad sensor? I use a dexcom which sometimes under reads slightly for the first 12 hours but in your position I'd probably be on the phone to Abbott asking for help (they may give you a new sensor.) Waking through the night with false lows is no way to live and in my opinion could be the biggest issue here.

Good luck.

Edited to add: not sure where I got the age 17 from for your son, looks like he could be anywhere from 13 to 19?

 

[EllieM]

His BSG was 17.7

Was that from the libre or a finger prick. I wouldn't be confident that the libre would be accurate at that level... And if a finger prick, double check clean hands etc.

 

[Minion#2]

Yes, sorry, wasn't asking for insulin dose, just if people thought a correction was necessary or not. He's been type 1 for a year and a half. He is 17. Does brilliantly with finger pricks and carb counting/injecting but doesn't think about water intake, prescriptions, appointments, etc.

17.7 was from a finger prick but the libre also said 17.6 - this was about half 11. He had had some chocolate cake after his evening meal that he had to estimate the carbs for at about 6.45.

 

[becca59]

Sounds like the carbs in the chocolate cake were underestimated. As he has obviously had his nights sleep now, what was the outcome?

 

[In Response]

The purpose of our basal insulins like Levemir are to keep our levels stable in the absence of food and definitely not to manage highs.
All correction doses must be fast acting bolus (e.w. NovoRapid) insulin.

 

[Minion#2]

I agree it was the cake which is why I'd suggested the correction dose.

He was 12.9 when he woke up. Unsurprisingly, his app that he uses to calculate his insulin factored in a correction dose and he injected it no problem.

His brother has since told me that when I left the room last night, he did inject a correction dose but only half of what I had suggested. He's also had a broken night's sleep as his high glucose alarm has gone off during the night.

 

[In Response]

He's also had a broken night's sleep as his high glucose alarm has gone off during the night.

And a bad night’s sleep is likely to raise blood sugars.