Correction doses

[Jodi-19]

Hi all,

Hoping someone can shed some light on their thoughts on correction doses.
At the moment I am seeing a diabetic nurse weekly to tighten my blood sugar levels after meals and first thing in the morning.
Recently, she asked me to decrease my background insulin from 27 units to 24 units and today I have woken up with a fasting reading of 10.5 whereas before I have been between 3.7 and 4.7 everyday.
I tried a correction dose with my breakfast insulin dose as my diabetic nurse has instructed me to only correct when injecting for my next meal?
Unfortunately, after an hour of my breakfast my blood sugar was 15.9.
What would you do? Wait until the next meal like she's told me to do or give extra insulin straightaway?
Thanks in advance

 

[catapillar]

I would give a correction straight away at 15.9. I certainly don't see the benefit/purpose of hanging out at 15.9 for another 3 hours and doing nothing about it. I certainly don't like the thirst, peeing, tiredness, lack of brain power that comes with it - it's not fun to be peeing every 30 minutes and certain that you actually actively causing kidney damage, it's not fun not to be able to concentrate or finish a task because my sugar is high. And I'm not pregnant so I don't have any fear that high blood sugars are going to be having an adverse impact on a growing foetus.

So long as you correct sensibly and cautiously - don't rage bolus, don't stack your insulin - and you keep a close eye on blood sugar following a correction with hypo treatments handy I don't see the problem with correction doses. Obviously I'm assuming you aren't about to do anything like run a marathon or go to bed.

Do you have a bolus calculator? That would help you take any active insulin still on board from any mid meal correction dose off of your bolus dose for the next meal and help avoid stacking insulin.

Have you done any basal testing in regard to your basal reduction? You were waking up a bit low so a reduction sounds sensible, but maybe it only needed 1 or 2 units knocking off instead of 3. I understand insulin requirements during pregnancy can change pretty quickly so basal testing might be a bit frustrating.

Did you wait for the correction you took with the breakfast bolus to work (coming down to under 7) before you actually ate breakfast?

 

[Jodi-19]

So, last time I went to the diabetic nurse I got told off for taking a correction dose after testing because I then had a hypo....
And this bolus testing thing? I didn't know existed nor have I heard of it! Sounds pretty handy to have to see how much existing insulin is in the system.
No, I didn't test this morning to wait for it to go below 7 as having a busy schedule I can't afford to have the luxuries of selecting when I would like to eat
Thank you for the reply and advice it has been extremely useful and insightful for me and nice to just read somebody else's perspective on it all
I think this evening I'm going to increase my background insulin up by another unit and try and correct it myself...fingers crossed better readings tomorrow!

 

[catapillar]

So, last time I went to the diabetic nurse I got told off for taking a correction dose after testing because I then had a hypo....
And this bolus testing thing? I didn't know existed nor have I heard of it!

If correction doses are causing hypos you probably need to reconsider your correction factor. Do you know how many mmol/L 1 unit will bring you down? The 100 rule can help with figuring that out (bear in mind the 100 rule doesn't work for everyone, approach with caution) - http://www.diabetes-scotland.org/ggc/documents/pdf_files/Insulin Dose Change.pdf

If you know how much 1 unit will bring you down then you can work out how many units to take to correct a 15. And if previous corrections have caused hypos you might want to knock a bit off the correction dose to avoids that happening again.

It's basal testing, not bolus testing, here's a guide on what basal testing is, and how to do it - https://mysugr.com/basal-rate-testing/

There are glucose meters that have bolus calculators built in. There are a few apps that have bolus calculators, I've not used any of them because my pump uses its bolus calculator, but mysugr is an example of how it works - https://mysugr.com/mysugr-bolus-calculator/

 

[Scott-C]

So, last time I went to the diabetic nurse I got told off for taking a correction dose after testing because I then had a hypo....

There's a bit of a paradigm shift going on at the moment. Traditionally, DAFNE courses and such like will say don't test between meals unless feeling hypo, and save corrections till mealtimes. I can see some sense in the latter in that insulin stacking by adding another bolus for correction while the earlier meal bolus is still working can be awkward to handle, as people often under- estimate the kick down in the last 2 hours.

But now that cgm/fgm are becoming more common, some hospitals are taking a different approach. The one I attend publishes a leaflet about use of cgm and specifically mentions the book Sugar Surfing by Stephen Ponder. He, in turn, is a huge fan of taking inter-meal correction doses. But he's got the benefit of cgm to keep an eye on things, and it's not necessarily as easy with strips.

I suppose it also depends on the attitude of the dsn and where they're coming from. Some older school ones will say this is how it's done, whereas others might be much more receptive to newer ideas.

Personally, I think inter-meal corrections are absolutely fine. It just makes sense to do a 1 or 2 u tweak now and then to save it from going too much out of range, so that I'm heading into the next meal ok instead of compounding the difficulty by eating on top of an already high sugar. But it does have to be acknowledged that insulin stacking can take a bit of practice and experience.

And this basal testing thing? I didn't know existed nor have I heard of it!

It's the idea of waiting till your last bolus shot wears off completely (usually about 5 hours max) and then just not eating anything or doing much for about 8 hours, to see if your basal holds you more or less steady over that time. If it drops too much, basal is maybe too high. If it goes up too much, your basal is maybe too low. Some people find that they need to take a bolus shot at unusual non-meal related times of the day to stop a creeping rise, for example, 6 hours after last meal, and that's often a clue that basal is too low.

Personally, I just have a long lie in at the weekend or put a box set on if I decide to basal test! This T1 can be a hard task master at times!

 

[ickihun]

All I remember was increasing or decreasing by too much caused bouncing hypos and hypers.
Correct in small volumes as the process of maternity can cause many factors affecting your bgs as fetus matures.
I think reducing your basal by 3units in a pregnant type1 seems too much to me. Your lower bgs werent that dangerously low. I aimed for 5, 6 and 7, 8s.
So 3.7 and 4.7 wouldnt get lower with increased hormones, less inactivity and insulin resistance of a mature pregnancy. Newly pregnant is more like your normal occasional stressful day so yes can aggravate a hypo possibility.
As a type2 my bgs increased as my pregnancy progressed not lowered. Only over correcting my insulin did that.
Small increases are essential in pregnancy to avoid hypos. Small decreases are important too.
It seems in your current stage of pregnancy doesn't need a decrease of 3 units of basal. 1 or 2 would have been as effective.
I bet your tempted to call dn and ask to go back to 25-26units of basal?
Basal tests are a godsend. Are you advised to skip a meal in your pregnancy?

 

[Jodi-19]

I am overwhelmed with the amount of knowledge from everyone! I am finding it hard to keep up with you all! So sorry if I am unsure of a few things...
So an update of what has happened today - I took a correction of 5 units plus my normal 8 units with my lunchtime meal and an hour after testing has come down to 6.9.
This seems like a big correction so do you think I am right in wanting to increase my long acting insulin up to 26 units?

 

[Jodi-19]

I've not been asked to skip a meal during pregnancy as of yet. What is the reason behind this? To test if long acting insulin is keeping my blood sugar steady? Do you not get the same results from evening to morning?

 

[jade88]

Hi Jodie-19 my diabetic midwife advised correction doses when pregnant as it's important to get sugars down a quick as possible when pregnant but as others have said be mindful of hypos! Skipping meals during pregnancy is not advised because you need to eat regularly when pregnant. It's possible that your long acting was lowered too much I was always increasing mine during pregnancy but never changed by more than 1 or 2 units at a time and then had to give it a few days to make sure it was working.

 

[azure]

I've not been asked to skip a meal during pregnancy as of yet. What is the reason behind this? To test if long acting insulin is keeping my blood sugar steady? Do you not get the same results from evening to morning?

I was advised NOT to skip meals during pregnancy. It seems some people responding here may not have realised you're pregnant.

I corrected after meals if necessary. As the pregnancy targets are very tight, that's sometimes necessary. However, if you're still in the earlier stages of pregnancy where hypos are a big risk, you should be cautious.

If you're on MDI, ask for a half unit pen if you haven't got one already. This will allow you to do more accurate corrections.

Did the DSN reduce your basal because you were having hypos?

 

[novorapidboi26]

You could have carb free meals so that you could do a test of the basal but still keep eating if thats what the pregnancy requires....

if your looking to keep the mid meal numbers down then its the meal time [ fast acting insulin] that will have to deal with it...

5 units of correction seems a lot, assuming 1 unit drops your BG by 2.5mmol, which is the standard factor for most people....but can be different....

how many mmol does a unit drop you in your correction calculations...?

 

[Jodi-19]

I was advised NOT to skip meals during pregnancy. It seems some people responding here may not have realised you're pregnant.

I corrected after meals if necessary. As the pregnancy targets are very tight, that's sometimes necessary. However, if you're still in the earlier stages of pregnancy where hypos are a big risk, you should be cautious.

If you're on MDI, ask for a half unit pen if you haven't got one already. This will allow you to do more accurate corrections.

Did the DSN reduce your basal because you were having hypos?

Hey, yes I'm 12 weeks now. Hypos are still very regular and doesn't seem to follow a pattern to which I'm finding it all very difficult to work out whether it is background insulin or fast acting insulin!
I'm hoping it will either start to form a pattern or it will ease up a bit??? At the moment, the nurse has changed my doses every week so it is extremely hard to see a trend xx

 

[Jodi-19]

You could have carb free meals so that you could do a test of the basal but still keep eating if thats what the pregnancy requires....

if your looking to keep the mid meal numbers down then its the meal time [ fast acting insulin] that will have to deal with it...

5 units of correction seems a lot, assuming 1 unit drops your BG by 2.5mmol, which is the standard factor for most people....but can be different....

how many mmol does a unit drop you in your correction calculations...?

I find it varies how much a unit drop can bring my blood sugar readings down to. Sometimes a unit drop can bring it down between 2-3mmol...other days a unit doesn't seem to make much difference!

I just feel like I'm having to learn everything all over again now that I'm pregnant very frustrating!

 

[azure]

Hey, yes I'm 12 weeks now. Hypos are still very regular and doesn't seem to follow a pattern to which I'm finding it all very difficult to work out whether it is background insulin or fast acting insulin!
I'm hoping it will either start to form a pattern or it will ease up a bit??? At the moment, the nurse has changed my doses every week so it is extremely hard to see a trend xx

Ah, prime hypo time then. Yes, they can come out of nowhere. I found Lucozade worked best and I kept some everywhere including by my bed.

if you've been having hypos, it makes sense that your doses are being adjusted. I dropped my basal by approx 25% at a simialr stage to you, but that gradually increased after approx 16 weeks.

Perhaps you could speak to your DSN about correcting earlier but correcting more cautiously?

If you're consistently waking high, then maybe your basal needs looking at again.

Test lots and react if you need to. Pregnancy is a lot of work with diabetes, but with all the extra care you'll find the weeks fly by.

 

[Kateyo]

Hi @Jodi-19 congratulations on your pregnancy! It's an exciting but worrying time as a diabetic isn't it! At your gestation, hypos are not uncommon. I remember lots of hypos at this point too. The best advise has already been covered but test lots - as much as possible, every hour/half hour - whatever is needed to spot any potential lows/highs before they get to that point. You may start to notice some trends and can make tweaks based on this. Remember that NICE recommends that Drs prescribe whatever test strips you need during pregnancy so there shouldn't be any issues in getting extra strips. Make sure you have hypo treatments everywhere. I kept some in nearly every room and always on bedside table for nighttime lows. Try not to panic as that won't help, baby is just taking everything it needs at this point but means mum has to battle the lows. Test test test and leave hypo treatments everywhere!

 

[novorapidboi26]

I find it varies how much a unit drop can bring my blood sugar readings down to. Sometimes a unit drop can bring it down between 2-3mmol...other days a unit doesn't seem to make much difference!

I just feel like I'm having to learn everything all over again now that I'm pregnant very frustrating!

When I was injecting I observed increasing correction factors the higher my blood glucose was....it got quite complicated but the same rules could apply with everyone and its down to an increased resistance to insulin at higher levels....

If I was 17mmol/l or above I needed 1 unit per mmol drop.....might be worth some testing to see......

 

[Jodi-19]

Ah, prime hypo time then. Yes, they can come out of nowhere. I found Lucozade worked best and I kept some everywhere including by my bed.

if you've been having hypos, it makes sense that your doses are being adjusted. I dropped my basal by approx 25% at a simialr stage to you, but that gradually increased after approx 16 weeks.

Perhaps you could speak to your DSN about correcting earlier but correcting more cautiously?

If you're consistently waking high, then maybe your basal needs looking at again.

Test lots and react if you need to. Pregnancy is a lot of work with diabetes, but with all the extra care you'll find the weeks fly by.

I've been testing a lot more regularly than what I used to. The most confusing thing I find is I can have the same breakfast throughout the week and my readings vary one hour after quite a lot. For example, this week it has varied from 4.1 to 10.3?
I follow the same routine everyday whilst at work so don't understand why this is?

 

[Jodi-19]

Hi @Jodi-19 congratulations on your pregnancy! It's an exciting but worrying time as a diabetic isn't it! At your gestation, hypos are not uncommon. I remember lots of hypos at this point too. The best advise has already been covered but test lots - as much as possible, every hour/half hour - whatever is needed to spot any potential lows/highs before they get to that point. You may start to notice some trends and can make tweaks based on this. Remember that NICE recommends that Drs prescribe whatever test strips you need during pregnancy so there shouldn't be any issues in getting extra strips. Make sure you have hypo treatments everywhere. I kept some in nearly every room and always on bedside table for nighttime lows. Try not to panic as that won't help, baby is just taking everything it needs at this point but means mum has to battle the lows. Test test test and leave hypo treatments everywhere!

This is interesting to read! I spoke to the diabetic nurse about testing strips. She wrote a letter to my doctor and when I picked my prescription up it had mentioned they are already giving me 150 strips. This is nowhere near enough...I feel like I'm wasting doctors time requesting an appt over this but it's also very frustrating because I do feel limited as to how often I can test!

 

[catapillar]

@Jodi-19 nice guidelines provide for type 1s to be supported to test up to 10 times a day during pregnancy. If you're not getting this support, ask your GP why they are contravening the nice guidelines ( ng17 1.6.11) and get the DSN to write again for help with access to test strips.

 

[hboyt]

my readings vary one hour after quite a lot

Congrats Jodi-19 on your pregnancy I've had those variances you speak of in my BG's since i've been pregnant as well. im now 21 weeks and my dsn says its all down to hormones...they like to mess with us LOL. The only thing i can say is get good support from your DSN and you will be fine. She has helped me increase my insulin rates since week 5 and yes it is very daunting in early weeks, like learning a new program for diabetes all over again! Though my insulin needs have increased every week with the massive support i have only improved my HA1C now down to 45 the lowest i have ever been in my life!
Hope you can get amazing support throughout your pregnancy too*Hugs