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When do you inject an adjustment dose?

S

Saka

Member
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Hi, I seem to have developed a bit of an issue where I'm a bit trigger happy with adjustment doses. I think it's a psychological issue with high sugar levels that worries me and has made me way too quick to inject adjustment doses, which inevitably end up being unnecessary and cause a hypo. Every day I tell myself I'm going to learn and wait but come 8pm (2.5 hours after my tea), if my levels look to be creeping up, I inject. Then an hour later when going to bed my levels are low.

Should I just wait for 4 hours after eating or can I wait less?

Has anyone ever suffered a similar psychological issue with high levels that almost pushes you into having an adjustment dose prematurely?

This has been going for a while now and I need to grip on it.

Thanks in advance.

Ian
 
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Hi Ian,

What's the trigger level that makes you want to correct ?

Ideally you shouldn't correct within 4 hours of eating as you need to see the result of the quick acting dose before deciding upon a correction, however I completely understand where you are coming from to, as I am also guilty of over correcting at times if I see it creeping above 12, psychologically I seem to feel that the quick acting isn't doing the job it should do if I go so high but I have to remind myself that I will also pay for it later if I am too quick to act. The other danger is where you end up in the yo yo of correcting a high but then having to take glucose to correct a low, and at this point I can start to bounce off the walls. The other solution is to just go for a walk as this will naturally bring levels back into range too, and I do this often if I don't want to risk the insulin.
 

Hi, and thanks for your response. It's usually when it goes over 10, regardless of how much insulin on board I have. I just don't seem to be able to wait say half an hour. And you're bang on the money there, I often end yo yoing, and also have time hypos, which are absolutely awful.
 
Hi Ian,

Tbh 10 isn't much at all, am sure you're aware even non diabetics get spikes but I wouldn't correct at 10 as you've only got a small margin, can you try to ignore the 10 and wait 4 hours, set a timer if necessary to check at 4 hours and try to ease off the gas, if it's making you anxious then gentle exercise so as I do, got for a walk. You also have to remember at night time when you're asleep it's often harder to wake to correct with either insulin or glucose so if you're around 10 before bed then that's fine.

Also have you spoken to your nurse/consultant about this ?
 

Thanks! This is the problem, I know deep down that I should wait but I just don't think things through thoroughly. It's definitely a problem I've developed over the years which I need to kick.

No, I've never mentioned it, tbh I've just been kidding myself into thinking I'll get on top of it eventually.

Thanks for your answers, just talking about it with a fellow diabetic may give me the kick I need to stop being so trigger happy.
 
Stacking insulin is a sure way to trigger a hypo for me.
 
I’d say the simplest method is this.

If you’re finding taking action after 2.5 hours as premature. Wait till three hours. Keep an eye on the success or failure you take at that time and if you have to increase it again, do.

There’s obviously other approaches but for getting rid of the trigger happy impulse you’re worried about this is probably the best and simplest.
 
I'm bad, if I start to go high I'll correct (even if within 3 hours)... in my defence ...

I know that if I go too high my Fiasp turns to water and then hits me like a train on the way back down so I correct by increasing my basal rate (I'm on a pump) which will stop having an affect within 15-20 mins.

My DSN still doesn't approve!
 
@IanPozz if you are concerned about going high, how about learning how soon after eating your levels creep up and adjusting the timing of your meal bolus?
Then you will be less likely to need the correction dose because the peak of your insulin potency is more likely to match the peak of your carb digestion.
 
yep the rule is 4 hours but maybe also do some detective work to understand if your carb to insulin ratio or basal rate needs a tweak?
I appreciate that fear of going high is drummed into us type 1s with visions of blindness, kidney failure and amputation regularly raised.
10 is not high for an after meal rise and this will happen if you've had a meal that was high carb low fat for example versus a meal that's higher protein and fat for example.
Another idea is to get a smart bg meter which calculates the bolus based on the
a) carbs you are eating b) bolus already on board usually based on a bolus life of 4 hours. I think you can enter a bg level manually rather than having to prick your finger but not sure as my pump does it for me now.
 
You don’t need a smart meter, there are apps that can do the calculation for you. I think MySugr does it. I have never used it, I used to use mental arithmetic to calculate my doses until I got a pump.
They use a very simple algorithm to calculate insulin on board - they assume it is linear. So, if the insulin life is 4 hours, it assumes a quarter of the dose is used up every hour. So, again, you can do this via mental arithmetic, especially if you have an insulin pen such as NovoPen Echo which shows you when your last dose was.
 
For me i adjust (sometimes) as little as 2 hours after meal, but i have a constant glucose monitor so can see the trend of whats going along with 12 years experience on insulin so i can quickly calculate in my head whats likely to happen..

without the above i doubt id give a correction unless i was really high ie 14plus
 
Maybe you could resist the temptation once or twice and monitor blood glucose to see how high it actually goes and what response to already injected insulin is vs time.
 


Hi searley,
I was wondering if u do not give a correction, what u do in this case?
 
Just wanted to say I am with you on this - I'm pregnant and every time my sugars go high I panic that I'm harming my baby so I inject then hypo.

I recently did DAFNE and they said that corrections should ideally be given at mealtimes on top of your mealtime bolus. I've been trying to stick to this religiously to break the habit but I understand how hard it is once you're in that mindset x
 

Thanks for your reply, and good luck with the pregnancy. How far along are you?
 
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