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Correction dosing - more needed per mmol/L drop for higher BG?

Discussion in 'Insulin' started by T1Mike, Nov 12, 2021.

  1. T1Mike

    T1Mike Type 1 · Member

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    Hi All,

    I hope the title makes sense. I wanted to know from people's experience whether it is common for people to need a different correction factor to correct a very high blood glucose (say 14 mmol/L or higher) than for a moderately high BG (10 mmol/L). I have read somewhere that high blood glucose makes people more insulin resistant, so am thinking the correction factor may need to be different depending on the current BG level.

    From my experience, I feel like 1 unit of Novorapid will drop my BG less when it is high/very high compared to when it is moderately high. Or does 1 unit just take longer to bring the BG down by the same amount? I'm a bit confused and still trying to work out a correction factor that works for me under different conditions.

    I am on basal-bolus therapy with twice-daily Levemir and Novorapid before meals and for corrections between meals if that helps. I also use an app to calculate insulin on board to avoid stacking.
     
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  2. Hopeful34

    Hopeful34 Type 1 · Well-Known Member

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    Hi T1Mike welcome to the forum. For me, both of the things you mention apply. I need a higher correction factor the higher my bloods go, and it also takes longer for it to bring it down. At times, the insulin can seem like water, and then suddenly it starts to work.
     
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  3. T1Mike

    T1Mike Type 1 · Member

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    Thank you Hopeful34. At least I know I'm not going crazy trying to work out correction factors. I know insulin sensitivity can change throughout the day and can affect I:C ratios and correction factors, but BG level adds another level of complexity :(
     
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  4. EllieM

    EllieM Type 1 · Moderator
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    Yes, I am afraid I have to agree, the higher my bg is, the more insulin (per mmol/L) I need as a correction dose.
     
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  5. In Response

    In Response Type 1 · Well-Known Member

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    When our levels get higher, it is common to experience insulin resistance so we need more insulin to correct.

    I find I need to double my correction ratio when my levels are in the high teens.
    The best way for me to manage this us to try and avoid high levels. Unfortunately, with so many things which can affect our levels such as stress and illness, it is not possible to completely avoid highs but accurate carb counting helps.
     
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  6. T1Mike

    T1Mike Type 1 · Member

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    Thank you EllieM.

    A follow-up question to this is: are there any "rules of thumb" or recommendations on how much extra might be needed? I assume it is specific to each person but would like to learn a bit more on this as I have had a number of situations where I end up correcting a few times based on what I thought was an acceptable correction dose. Then my BG finally drops quickly, sometimes a few hours later, to the point of going low. Like Hopeful34 stated, it seems like injecting water to begin with. Then it seems to kick into "turbo" mode and work too quickly.
     
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  7. EllieM

    EllieM Type 1 · Moderator
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    Well, there may be rules of thumb but I honestly haven't managed to work them out yet. And I'd be interested in anyone else's input on this, though we have to be very careful here not to recommend specific doses for fear of breaking forum rules on medication recommendations.

    For me, it's still a work in progress I'm afraid (only been T1 for 51 years :)).
     
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  8. T1Mike

    T1Mike Type 1 · Member

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    Yes, understood. Need to be careful as we are all different and need different doses. In Response (and others here) provided some information, which was helpful in that I know to add a little extra when higher than normal. BTW, you trump me in number of years - I am about 43 years T1 and still learning :)
     
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  9. KK123

    KK123 Type 1 · Well-Known Member

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    Hi there, this was a question posed at a course I went on. I don't know if this applies to you but they said, when you do a correction you must give it time to work and not panic if it doesn't seem to be working 'immediately'. So, if you do a correction, it can take 2/3 or even 4 hours to bring your levels down, so if you decide to take a 2nd correction at the 2 hour level you will go low later on. It's tempting to over correct as you sit there thinking 'I don't want to sit here in the teens' but you are better off being patient. If you end up low later on because of over correcting, then you end up correcting that low and up it goes again, the medical term I believe is the yo yo effect! Many people seem to think a correction should work instantly almost but it doesn't and I don't think injected insulin is designed to work like that (or simply can't). When you think that bolus insulin for mealtimes takes up to 5 hours to work to lower glucose then you can see why a correction takes a while too (it should be a bit quicker of course because it's not got the food to contend with) but as I said, it ain't immediate.
     
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  10. T1Mike

    T1Mike Type 1 · Member

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    Yes, and that's exactly what happens. Very true!
    Great advice. I think I just need to be a bit more patient in the future. I still need to work on my ratios and correction factors, but I think I will hold off on overcorrecting. Just hate being high. Thank you.
     
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