Corrective doses

[farmerfudge]

Hello everyone,

1st posting, so here we go. I've been Type1 for 3 years now, done DAFNE early year last but I've largely forgotten everything I learnt there! Need a refresher, I really do.
At time of writing this post I've got a BS of 18.5. I had lunch around noon-ish. What kind of corrective dose of Novarapid should I take? I am at work and will be driving home at 5pm. :|

 

[fergus]

Hi farmerfudge,

I'm sorry but it's impossible for us to answer that question. Your correction dose is dependant on too many variables and is probably unique to you! It would be irresposible of us to tell you how much insulin to take, particularly since you'll be behind the wheel of your car in a few hours and you certainly don't want to risk going low then.

In your shoes, I'd think about a smallish dose, enough to get your blood sugar down to a less harmful level until you get home and sort yourself out. But please test yourself before you get behind the wheel, OK?

All the best,

fergus

 

[farmerfudge]

Hi Fergus,

Thanks for that. Sorry, I perhaps worded my post badly there. I'm not asking for a direct instruction on what dose to take and I'm aware that each to their own dose if you will, but was wondering what people tend to do in the same situation? Are they confident enough to take a large corrective dose or take a series of smaller ones?

Update: I took 8 units of Novarapid @ 3pm, just checked and BS is now 4.3 @ 4.45 pm. Am having a couple of fruit gums to up slightly for drive home.

 

[Katharine]

The standard ADA advice for correction doses is:

If your bs is 13 or over give 10% of the total daily insulin dose.

If your bs is 13 or over and you have ketones give 20% of the total daily insulin dose.

Repeat every 2.5 hours till your bs is below 10.

 

[jopar]

Katherine

The inforamtion you given if sick day rules, this wouldn't apply if it is a standard correction if someone had miscalcualted a meal, stress factors etc and not taken enough insulin..

When correcting your levels you really need to work out how much 1 unit of insulin drops your bg mmol/l this can change at different Bg's though so it's is helpful to know at what BG this does...

For me I know that in general 1 unit of insulin will drop my BG by 7mmol/l with the exception that about 16mmol/l it is near to a 3mmol/l drop per unit...

If I took 10% of my ATD, this would be 2 units, if my BG was 13mmol/l I think that I would actually end up in A&E before my 2 hours were up!!!

The sick day rules assume that you have a infection of some kind that your body is fighting and raising your BG's...

 

[JER]

In a situation like this clearly you do need a correction but you need to remember that your lunch time insulin dose will still be active for another hour.
The generally accepted rule is that 1 unit of insulin will reduce your BS by 3 mMoles/litre so if you target for a BS of 6 mMoles/litre then 4 units of insulin should do the trick. However you need to check for yourself how the insulin:BS relationship works for you. The other thing is you must remember that if you do decide to do a correction between meals then depending upon when you have your evening meal you may get overlap between your correction dose and the dose with your evening meal so you may need to take less insulin a your next meal time.
There is I believe a strong school of thought that recommend not making corrections when you are high mid meals because of the possible issues with ovelap.
However I would do it in the situation you have explained - sounds to me that you might have forgotten your lunch time insulin.
Good luck
JER

 

[LiL]

Hi Farmerfudge,

I was on the DAFNE course in October so it's still quite fresh in my mind.

As long as your ratio is 1:1 then 1 unit of your nova rapid will bring you down by 3mmols.

I still have my book, so if you need to refresh on anything, then i'd be happy to help.

LiL
x

 

[farmerfudge]

Hi Lil,

Yep, that's what I was trying to remember the ratio 1 unit equals down 3 mmols thanks. I guess everyone should know exactly how much a unit of insulin will bring them down by but it's just not been the case with me. Straight after DAFNE it all seemed so obvious and you have this great control for a while but a year on I'm sketchy and it's like being back at square one sometimes. The other day when I first posted here I was 18.5 and just couldn't even think straight!

 

[LiL]

No problem Farmerfudge. I can't think with a BG of 18.5 either, it's not just you!

DAFNE was a great course, but you do forget things. I only did it in October, then was really ill over Christmas, but completely forgot about the whole 'sick day rules' thing, now that is a bad memory!!

If you need to know anything else, just ask, I'm happy to help!

LiL

 

[Stuboy]

you can work out your rough starting point for a correction dose by using the following formula.

100/TDD = X mmol/l fall per 1 unit of bolus insulin. (TDD = Total Daily Dose)

I would aim for half the target bg though as you are driving so you dont want to overshoot the mark.

 

[magsy]

Hi did DAFNE about 3 years ago. Was taught that 1 unit of novorapid can reduce BS by 3 points and 1 CP can increase BS by 3 points.
e.g if BS is 17, giving 3 units of novorapid could result in a BS of 9 but the highr the BS, insulin not so effective
Good luck
Been there regularly but still trying!

 

[farmerfudge]

Hi,
been re-applying this 1 unit of insulin = down 3 mmols for the past few days and already doing much better with my readings.

Thanks guys,

 

[totsy]

well done farmer fudge

 

[fergus]

Pleased to hear it farmerfudge.

All the best,

fergus

 

[ahills]

I was taught a simple correction dose equation on my course last year, i dont know if you will find it useful or not in your circumstances

100 / total injections in the day = 1 unit of insulin to drop ....mmols