Correction doses? Puzzled.

[chocoholic]

My DSN worked out my correction dose as 1 unit bringing me down by 6mmol. This seems to match the table given in "Think Like a Pancreas", as I'm only on small amounts of insulin. (0.5 to 10g carb. and total of roughly 15 units of all insulin daily.)
However, that correction dosage doesn't seem to work for me usually. Before bed last night my reading was 12.2.(Smacked hand for Valentine's meal that inc. Potatoes Dauphinoise) I had my Lantus as per usual but was obviously unhappy with such a high reading pre-bed, so decided to try 2 units of Novo, which is double what nurse recommended but matched what others on here say they take as a correction dose. Morning reading shows this was spot on, as this morning I awoke with reading of 6.0. Now, the only thing which could throw this out would be if I went too low in the night.
When I tested my background insulin two nights ago, I went to bed with 8.3 reading, set alarm for 3.00 a.m.Reading then was 4.9. Went back to sleep and on waking reading had gone back up to 6.0. Now from what I've read, this could be the Somogyi Phenomenon.
I intend re-doing the test several more times before I adjust the Lantus but did not want to do it on a night when I'm taking a correction dose.
Can someone more enlightened than me, tell me why my correction dose would be twice that recommeneded by the nurse and the book? Isn't it harder to test a correction dose in the daytime, when there might be an overlap of fast-acting insulin? Is it, as I suspect, that my Novorapid ratio is wrongly half what it should be, which in turn would make the correction dosage 1 unit= down by 3mmols, correct. IYSWIM. Obviously I shall be working on Novo thing once I have Lantus spot on. I guess I just need confirmation of me tackling this correctly and clarification of the puzzling correction dose thing.
Sorry if this sounds confusing.

 

[chocoholic]

Guess I'm just an 'odd' one then?!!

 

[LWA]

Hi chocoholic,
You replied to my comment with regards to Liver dumps and thought i would reply to your 'unanswered message.

like you i take Novorapid 3 times daily before meals, but i take Levimir as night time. I have had type 1 for 21 years (since 15) and only recently joined forum to connect with others (i've obviously gone quiet at work)! my ratio is approx 1 unit to 10g carbs albeit as i have recently commented this never seems enough for breakfast so i insert 7 units for approx 50g carb (and it still not always enough)

its nice to know that you do 'correction' doses as i have done this off my own back (without Docs consent etc) and have done for a long time. if your anything like me then you get dissapointed when you have a high reading and do something about it straight away Eg correction dose!!

i find that through experiance i am able to give myself the right amount when correcting. mine equates to 1unit Novo to reduce blood by 2 mmol. Example if i were 13mmol 1 would take 3 units to reduce blood level to a more respectable 7mmol.

hope this may at least give you an indication of others

 

[diabetesmum]

Hi Chocoholic,
My 14 year old daughter (who is physically an adult!) has a correction ratio of 1 unit Novorapid to bring her down 2 mmols. It used to be 1:1 , but she had a few really scary night time hypos so it was changed and she's been fine at night since. We are wary of a bedtime correction overlapping with any late night eating boluses tho'. Hope this helps.
Sue

 

[chocoholic]

Thanks LWA and diabetesmum. The great thing about this forum is that it is reassuring just to know that, even when you are getting it wrong, others know what it's like. I think I'm at my 'most determined' stage right now with my insulin. It's just confusing when you want insulin to do 'exactly what is says on the tin' and it bloomin' doesn't, if you see what I mean. The longer I have diabetes, the longer I realise nothing works better than trial and error. Up 'til now I think I've used guesswork, trial and error, so now I'm trying to reduce the guesswork. I think I'm just too impatient.
Onwards and upwards though.

 

[suzi]

I'm always surprised how people vary with their insulin requirements (wouldn't the world be a boring place if we were all the same) though it would probably help the medical proffession My son is 10 and we find he also needs 1 unit of humalog to bring him down by 2mmol for a correctional dose. Breakfast he needs 2 units for every 10g carbs, 1 1/2 units per 10g carbs at lunch and 1 unit per 10g at teatime. He has his 19 units of Levemir at bedtime, His total daily dose of insulin is between 34 and 45units. Suzi x

 

[malice67]

From that one off reading at 3am and then again in the morning I don't think you have too much to worry about. At 3am your bodiest is at its most restful time. All your major organs have slowed down and so your bllod glucose level will also. As your body awakes your organs do also and so you would naturally start to have a slightly hogher blood glucose level than at 3am. It would have been worrying if you had been higher. When my daughter was diagnosed we were recommended Type 1 Diabetes in children, adolescents and young adults By Dr Ragnar Hanas. I have found this invaluable.

 

[chocoholic]

But I thought the background insulin (in my case Lantus) was supposed to keep levels on an even keel throughout the night, so to go from 8.3 to 4.9 to 6.0 is quite a variation. I'm doing the test again tonight, to see if the same thing happens. My intention was to drop the Lantus by one unit and re-do test, if the same pattern presents itself.

 

[suzi]

Hi Choc, if your evening levels are spot on i would honestly think your Lantus is carrying you through 24hrs (for many it doesn't) your morning readings are good, as for the one at 3am then on waking finding it has risen after it has dropped, i would be inclined to put it down to the dawn phenomenon. I personnally would only be thinking of reducing the Lantus if the 3am reading was below 4mmols. If you did the correctional dose on the same night as above readings the 3am reading could have been the novo and the morning reading the novo having worn off. See how things go for a week then you can always concentrate on your novo dosage. Hope this has helped a bit, i always think when dealing with insulin as well as being a mathematician a crystal ball would help, take care, Suzi x

 

[LWA]

Ive been diabetic a long while and i honestly think the nightime(mines levemir) gets you through the night and does not actually last 24hrs as they say. My normal evening is level is between 6-9, i take 30 units and i awake with levels between 4-6 which i am happy with. If my blood is a bit higher/lower i adjust nighttime accordingly with no problems.

I have in the past missed my nighttime (by forgetting - very annoying!!) and my blood will increase to 20 by morning (now im angry, ha ha)

next day however i will correct my levels with my fast acting insulin at breakfast and im back to square 1 by lunhtimeat the very latest

the alternative option would be to take the nightime in morning alongside my fast acting but this doesnt feel right.

any views appreciated

 

[chocoholic]

Thanks, suzi, that is helpful. Last night's test had me going to bed on 7.4, 3 a.m. was 6.2 and morning, on waking, 5.6. Would you say the lantus is set okay then? Advice in the book says if the Lantus does need adjusting, reduce it by 10%. Don't know how I'd manage that anyway when total Lantus is only 7 units a day.(I have it split 4 morning/3 night-time).
You're right about the crystal ball. Thank you for your time in replying to my posting. Tried to talk to hubby about this before he went to work but he had his nose in his laptop and the almost hummed 'mmm' response I got, told me his mind was elsewhere. Bless him! He must get so fed up with my diabetic ramblings.

 

[totsy]

hya choc,
i think that seems ok, im puzzled at moment too , its annoying isnt it? as for correction dose i havent had to do that yet so im not sure,
anyway you arent alone with getting used to basal bolus :? so good luck

 

[chocoholic]

Hi LWA,
According to the book I spoke of, if your night-time reading varies up or down by more than 1.7mmol, then it recommends background insulin probably needs adjusting.(In stages of 10%) This is why I'm finding it tricky. My two tests so far have very different ups and downs and this morning I'm only just outsde the 1.7 range. I think if I adjusted by even 1 unit, I could actually push myself too low because of the small amount I'm on. Because your dosage is that much higher than mine, that change in dosage could be easier for you to do. Of course,please don't adjust any medication from my say-so though.The 'Think Like A Pancreas' book was recommended to me and this is what made me decide to test my insulin dosages but inconsistency, for me, makes forming a pattern difficult in this early stage.
I just want to get the background insulin correct before tackling the fast acting insulin.
Why is it all so bloomin' tricky?

 

[chocoholic]

Hiya totsy. I thought you had everything well-sussed with your insulin. You are one of the people I've admired for getting your head round basal/bolus so quickly.Sorry to hear you're going through a puzzling time too. Sure we'll both get there in the end.
All the best, choccie.

 

[totsy]

lol i did have it sussed, its just im usually 4mmol on a morning and last few days im 6mmol grrr nothing major i know but its annoying :evil: you are right tho hun ,we will get there

 

[LWA]

Chocoholic (great name) thanks for your comments
think i will get that book as im sure it will help
Generally my averages are good but always room for improvement

 

[Trinkwasser]

Someone I know elsewhere who is pretty anal about his control (A1c in the low fives) finds he has a marked rise in insulin resistance (presumably) as his BG rises and needs something in the region of twice what he espects to knock down a high over about 11 than he would normally use for a lower high

I find some of you Type 1s highly impressive, just thought I would say that