Ineffective correction doses

[andyfrith]

Hi,

I've been type 1 for over 20 years and have been using a pump for the last 5 years. As those with pumps will know, the pump calculates the insulin required for correction doses when I am high.

There are times when the correction doses barely change my BG, which I find very odd. Particularly seems to happen when I'm very high - for example:

22.4 came down to only 18.7, after 5 units
Another time I stayed at 17 for a few hours, despite a dose of 4 units​

It seems like the correction doses in such cases would need doubling - but I know if I were to change my pump settings, such a correction ratio would be far too high in cases when my BG is not so high (eg around 12).

Has anyone else had such experiences? Is it possible than when BG is very high, more insulin is needed to correct than at more normal levels?

Thanks for any advice!
Andy

 

[Rokaab]

Has anyone else had such experiences? Is it possible than when BG is very high, more insulin is needed to correct than at more normal levels?

This seems to be quite common that people need higher correction doses the higher you are. Many seem to get more insulin resistant when their level are high.

 

[kitedoc]

Hi @andyfrith, What you are experiencing jibes with me. I find if I happen to have a BSL >12 that I need to up the correction dose and even the basal dose. The reason is given as the BSL rises the insulin resistance increases (or insulin sensitivity decreases). Also trying to do exercise with high BSLs can just drive them higher.
The tricky bit is by how much to increase the correction doses.. As a diabetic for 52 years, 7 on a pump, not as professional advice or opinion: For me, and this may or may not apply to you so please check with your DSN/doctor:
if it appears to be a one off high from perhaps too much to eat etc I add a 20% increase to my correction dose if BSL is 12 to 15mmol/l plus up my basal dose by 10 to 20% for the next 2 to 3 hours. And I check my BSL at the 2 hours mark (I am on Novorapid). And I find it is better to get the BSL down stepwise. Doing a big hit of bolus risks a hypo later with BSL then going up and down like a yo-yo!!
if my BSL > 15 mmol/l I also check for ketones (I have a meter and strips that will check for ketones): I ring my DSN and discuss with her what to do: with no ketones present I will discuss whether to just add the 20% as above and see what happens but if ketones are present the decision is often to use a small dose of Novorapid intramuscularly to bring the BSL done more quickly plus keep the basal dose increased for longer in case I am in the early stages of an infection of some sort.
There are occasions when I know my BSL is going to be out of whack such as after a flu injection. Apparently the challenge of the vaccination to my immune system is still a stress to my body the way a cold virus etc is, some I have a routine for this which is, as soon as the BSLs start to rise (usually on the day after the vaccination) I increase my bolus and basal doses by 20 to 30 % and stay with that provided my bsls stay below 12 mol/l and continue like this for about 4 days.
Best of luck with those correction doses. And never be afraid to ask for help from your DSN/doctor.!!!

 

[Bluey1]

Hi @andyfrith, What you are experiencing jibes with me. I find if I happen to have a BSL >12 that I need to up the correction dose and even the basal dose. The reason is given as the BSL rises the insulin resistance increases (or insulin sensitivity decreases). Also trying to do exercise with high BSLs can just drive them higher

Go find your own Diabetes and stop stealing mine Same with me.

 

[LooperCat]

Also stealing yer diabetes, I find the same thing. What pump are you using? With my Omnipod, it suggests a dose based on IOB and BG (plus carbs) but it’s very simple to increase or decrease it - and that dose t change any settings. Just up and down buttons on the control unit. So while it suggests a dose, I don’t have to accept what it tells me.

 

[andyfrith]

Thanks for the replies! It is good to know that others face a similar problem

@kitedoc yes I am also keen to avoid over-correcting and then end up low... That's the hardest part, working out how to adjust the corrections in the right way.

@Mel dCP I have a Medtronic Paradigm pump. It also offers the same feature where I can override its suggestions, and I do from time to time.

I'm currently making a spreadsheet to keep track of how my corrections are working (or not working) so I can come up with a similar scheme to @kitedoc where I have some confidence in my adjustments to the corrections. Need a few more carefully monitored examples so I don't extrapolate from a single data point (sorry I have a maths degree )

 

[DunePlodder]

"Another time I stayed at 17 for a few hours, despite a dose of 4 units"
I'd guess it probably stopped you going higher though.
I have the same problems, it can be very frustrating. I've found that the longer I'm high, the more insulin resistant I am.
We all develop our own techniques, mine is to hit it it hard then keep a careful eye on my readings & have some jelly babies handy! Easier with a CGM of course.