Correction Bolus = Blood Sugar Go DOWN
Generally speaking, when you give a correction bolus, your blood sugar goes down.
I usually operate with that in mind. You know, blood sugar is higher than target, you take an appropriate amount of insulin, and your blood sugar starts going down.
Of course there are all of the scenarios that we know all too well. Being sick, fighting ketones, infusion set or site problems, bad insulin, whatever. Those are (hopefully) rare encounters, and they are easily explained away once we get to the bottom of it.
Here is how my morning went today:
But wait - I did deliver a correction bolus right? You know, that one that is supposed to make your blood sugar go down? Yep, I sure did!
And typically when you take insulin, particularly a bolus it's job is to make your blood sugar go down, right? Yep, I thought so.
So what happened to that 1.20 units of insulin that I took? Did it just magically disappear? Did it wha..?
Well, I do realize that it had only been a tad short of an hour and a half, but on that note, IT HAD BEEN A FRICKIN' HOUR AND A HALF!!! All things considered, I would expect to be at least lower than what it was when I took the insulin.
Just one of those things.
I didn't really have the time this morning to sit back and see what would have happened given another hour or two - but I'm really curious now.
Stepping back a little bit, it makes me wonder if I don't need a different correction factor for a certain time period in the morning? You know, that I might be a little more resistant to my insulin for some time after I wake up.
But is it a "time of day" thing or a "waking up and moving around" thing?
And if I do come to the conclusion that my correction factor needs to be different for some period in the morning, how the hell do you figure what time you go back to your regular correction factor?
A lot of testing. A whole lot of testing. Then some more testing. And yet more testing.
And the presence of mind to watch and see if it worked or not. Sometimes I feel like my attention span is really bad when I can't keep track of something a short two or three hours later.
Or if I get distracted and forget to keep the variables out of the mix during that time.
I feel that there is a shortage of days that I can really take the time to eliminate those variables. So many days where something is going on that I need to take care of. Days where I just don't have the hours to really watch and see what's happening. Maybe two a week, excluding weekends.
With that in mind, it seems like such a big job to work through. Something that takes so much trial and error - and the daunting task of trying to keep track of it all over such a long time span.
I know, I know. I have to do it, and I just have to start. And it's not really as hard as my overly complicated self talk makes it seem.
But still.
Never do today what you can put off until next week.
Wake me up when things are easier.
I usually operate with that in mind. You know, blood sugar is higher than target, you take an appropriate amount of insulin, and your blood sugar starts going down.
Of course there are all of the scenarios that we know all too well. Being sick, fighting ketones, infusion set or site problems, bad insulin, whatever. Those are (hopefully) rare encounters, and they are easily explained away once we get to the bottom of it.
Here is how my morning went today:
- Wake up, test blood sugar. Time is 7:40 am.
- 142 mg/dl
- Not too bad. Three digit number starting with "1".
- Enter that number into pump and deliver a 1.20 unit bolus
- Get ready for work, drive to work, get to work (as in "arrive", not like "yay! I get to work")
- Do some work stuff, walk down to the cafeteria and get breakfast
- Get back to my desk, ready to eat my english muffin & peanut butter
- Test blood sugar. Time is 8:58 am.
- 142 mg/dl
But wait - I did deliver a correction bolus right? You know, that one that is supposed to make your blood sugar go down? Yep, I sure did!
And typically when you take insulin, particularly a bolus it's job is to make your blood sugar go down, right? Yep, I thought so.
So what happened to that 1.20 units of insulin that I took? Did it just magically disappear? Did it wha..?
Well, I do realize that it had only been a tad short of an hour and a half, but on that note, IT HAD BEEN A FRICKIN' HOUR AND A HALF!!! All things considered, I would expect to be at least lower than what it was when I took the insulin.
Just one of those things.
I didn't really have the time this morning to sit back and see what would have happened given another hour or two - but I'm really curious now.
Stepping back a little bit, it makes me wonder if I don't need a different correction factor for a certain time period in the morning? You know, that I might be a little more resistant to my insulin for some time after I wake up.
But is it a "time of day" thing or a "waking up and moving around" thing?
And if I do come to the conclusion that my correction factor needs to be different for some period in the morning, how the hell do you figure what time you go back to your regular correction factor?
A lot of testing. A whole lot of testing. Then some more testing. And yet more testing.
And the presence of mind to watch and see if it worked or not. Sometimes I feel like my attention span is really bad when I can't keep track of something a short two or three hours later.
Or if I get distracted and forget to keep the variables out of the mix during that time.
I feel that there is a shortage of days that I can really take the time to eliminate those variables. So many days where something is going on that I need to take care of. Days where I just don't have the hours to really watch and see what's happening. Maybe two a week, excluding weekends.
With that in mind, it seems like such a big job to work through. Something that takes so much trial and error - and the daunting task of trying to keep track of it all over such a long time span.
I know, I know. I have to do it, and I just have to start. And it's not really as hard as my overly complicated self talk makes it seem.
But still.
Never do today what you can put off until next week.
Wake me up when things are easier.
posted by Scott K. Johnson | 9:06 PM
16 Comments:
Dude! I was rolling over this post. This is so true, the part that gets me is the variables. Daniel's emotional state is HUGE in his blood sugar reaction. I cannot control his adrenaline rushes anymore than I can predict them. This is how I felt last night with the Halloween high, I was giving corrections but it was tough getting it down. I know it is not funny but thanks for the laugh all the same, I needed it.
The only thing I could think of to explain the phenomenon of double readings (once in elementary school I was 109 mg/dl at breakfast, lunch and after school snack...too weird...) is the fact that meters are not always accurate. There's like a 15-20% variable, so in reality, if you tested on another meter, you may have registered at 125 mg/dl. That would be lower than 142 mg/dl and shown that you were coming down.
I honestly wouldn't get too worked up about a double reading after a correction. If you had gone up to say 160 mg/dl or 180 mg/dl, then you know your correction isn't working. If you do this little experiment again tomorrow and only move 5 or 10 pts. between readings, then maybe you need to change something.
Otherwise, I'd chalk it up to the gremlins inside the meter. That's what I do at least.
I agree with Allison. Hey man, I knew my correction factor may be off when it NEVER brought my bg down to target...not one single time!
But, it has taken me a month to change it. And funny thing, I just changed it about the same time you were posting this.
Watch yours, and see if this is a trend. Good luck!
Scott
Look on the bright side. You like your work so much, you didn't notice the time flying by! :-)
This post reminds me of a complaint about insulin though: why doesn't it work *instantly*? I don't want to wait out three hours when I do a correction with Humulog--I want my sugar corrected ASAP.
So
many
variables.........
That's my biggest frustration factor. When my dawn phenomenon is raging, I can trend upward sometimes for as long as 6-7 hours and I have to correct with 1 unit:20 mg/dl. If I'm high at bedtime, though, my ratio is l unit:120 mg/dl, and even then I might head south too fast (rebound plus d.p. makes for a most unpleasant scenario).
But still, Scott, 142 is not at all a bad average for those hours.
PS, I think we are all just absolutely damn brilliant to be able to figure half this stuff out...take that thought forward into the day!
I've had that same thing happen to me a few times too! While I like Allison's explanation, I concocted my own.
I've (perhaps incorrectly) rationalized that it has to do with the time off the pump during my shower. If I'm on-the-ball, I'll usually give myself a small bolus of 0.1u or 0.2u when I disconnect. I have a habit of then wrapping my tubing around my pump while I shower (which occassionally produces the weirdest knots).
And then I think that the wrapping and unwrapping of the tubing actually causes some insulin to dribble out of the end. So to compensate for that, I deliver a fixed prime of 0.5u BEFORE reconnecting. I've been amazed that I sometimes don't see any insulin coming out until it has delivered 0.4u of that prime. Which means, that if I didn't bolus before going off the pump and I lost 0.4u due to tube dribble, than I can have my blood sugars climb between waking up and sitting at my desk to eat breakfast.
"You may be right,
I may be crazy,
But it just may be a lunatic
You're looking for."
(I have no idea where that came from).
My two cents: Ugh.
Here's the other 98: Duplicate readings are strange because they make you feel like you're too stable. "What, I haven't budged a bit??" And I agree with Lyrehca - I want instant-ulin. But there is comfort to be found in the fact that you weren't resting neatly at 200 mg/dl. 142 mg/dl ain't half bad, my friend.
I just tested my bloodsugar. 188 mg/dl and I've yet to eat a thing. My body is crazy lately. I'll join you in the request to be woken when things are easier. :)
All of the above (your post and the comments to it. :-)
So. Many. Variables.
We test Joseph so frequently that we've been able to see how his correction factor works differently those mornings when his sugars are rising steeply. In the past, when his corrections haven't been terribly effective, we found that sometimes it was due to an early morning low (and the ensuing rebound)-- at other times, because, well, we just couldn't be sure.
Scott, I must say that when I saw the title to your post I thought immediately about our own more recent issue-- Joseph has been going DOWN a little too fast and far too low. Even with a modified, more conservative correction factor of 1: 300... sigh.
Wow, what a factor, Sandra...1:300...whoa.
Kevin...BILLY JOEL! Tubing-wrap dribble...hmm...of all the things to worry about now this!!
Scott,
I can’t tell you how many times this has happened to me! I have two different correction factors and I have them set for four different time ranges. 12am – 3am, 7am-2pm, & 7pm-Midnight I am set one unit bringing me down 35. Then from 3am-7am & 2pm – 7pm one unit brings me down 50. It took a lot of testing and a LOT of low lows and high highs to figure this one out. Sometimes though, I think things don’t work exactly, but this is around what I need. My correction factor changes the higher I get, as well. So anything over 250, I take my correction and multiply it by 1.5. I know, all that math in my head, but how do I program my pump to take a 250 blood sugar and recognize I need a different correction factor? It doesn’t have that capability!
I also wanted to respond to a comment you had on Aiming For Grace about how diabetes is always work for you. I know sometimes it feels like diabetes fades into the background for me, but recently as problems with Gracie have arisen, I have really been looking in the mirror and realizing although I may feel from time to time as though diabetes fades into the background, I dedicate huge amounts of time and energy to diabetes, and it IS a lot of work. I’ve been imagining myself doing what I do for me and also doing it for HER and it really becomes even MORE clear how much work this is. So I’m in total agreement about how much work it is…..I guess is my point!
I have this happen all the time. I can end up 30 points by the time i get to work having consumed nothing.
I hate testing but I know it has to be done. What sucks is the last few times I have tried to work all this crap out, something comes up and I have to scrap that fasting test or I get all stressed out and wonder if that is screwing things up too.
Hmm, I wonder if I should figure in a Road Rage bolus amount?
Of course, one sample isn't enough to really diagnose a cause, but my first thought isn't that the correction bolus is wrong...but that your basal rate is wrong for the morning.
Personally, I'd test for several days without eating (and without bolusing) to see if your BGL actually rises in that time period. The fact that the numbers matched after 1.5 hours and a 1.2 unit bolus could mean your basal rate is too low.
My nighttime/early morning basal rate (until about 9:00 am) is 1.1 or 1.0 units per hours. Starting at 9:00 it drops to .7 u/h. Over the course of 4 hours, you have a difference of 1.2 units!
Something to think about. Then again, it could be a one-off tied to something you ate the previous night, etc.
Variability in meters isn't likely an issue as you shouldn't see 15-20% variability within the SAME METER...but there is that much variable between any given meter and the "true" reading.
Oh, and Scott...BTW...You've been tagged!
Just to comment on Ryan's comment. This isn't about testing twice in a row and comparing the numbers in the same meter, it's about testing on two separate occasions and seeing the same number twice. The number you get on test #2 could be different than if you had done test #2 with another meter. That's why if you see two numbers in a row that are the same, that doesn't necessarily mean that you are even that exact number. You could be somewhere between 5-20 pts. away from that number. This is why you need to study trends and patterns, and not just whatever number happens to pop up on your screen. That is only part of the problem.
I hope that explains my original statement a bit better.
Hey Scott,
I had to check your site out. Very cool!! Now that I know your here I'll have to check you out more often. See ya round the water cooler.
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