Negative correction factor

[twodoor2]

Our target blood glucose is 150. The endo said if she's between 80 and 150, don't give a correction factor, just give the food dose (carbs/carb ratio). I guess what I don't understand is that if she's 80, or some number between 80 and 100, I'm a bit afraid not to do a negative correction. At 80 to 100, she's already low, and if I don't account for the negative correction, the food dose might bring her lower to a number I don't want. Her ISF is 200, so she's very insulin sensitive. We're talking about 8 units of bolus a day at the most.

Am I anal, or being stupid and stubborn, let me know what you think and what is your take on the negative correction factor?

Thanks!!

[BrendaK]

Our pump will automatically do what you are saying. It would subtract the amount of insulin -- if she is at 80 and the ISF is 200, and target is 150, then you would subtract about 1/3 unit fromt the meal dose.

But that gets really complicated when you are manually having to calculate all of those numbers, so you endo may have just wanted to simplify things. You also have to consider when her last dose of insulin was. If it was less than 4 hours before, she probably still has some insulin on board as well, so you have to take that into account when calculating the dose.

When Carson was on shots, I never left the house without a calculator ;)

[twodoor2]

I'm currently writing a spreadsheet that automatically does the calculations for me. I know it's easier to do what the doctor wants, but I don't want to forsake simplicity for the health of my child. I'm going to abide by the doctor's wishes, but I will do a correction if she's 80 to 100. If she's 100 to 150, no correction, and if she's greater than 150, then a correction.

Common sense tells me tht 80 to 100 is just too low not to have a correction factor, especially for someone so insulin sensitve.

[Nancy in VA]

Its really just something that you'll have to see over time. Doing a negative correction is "erring on the side of caution" by backing off on the insulin. Just keep good track of it and if you find when you do a negative correction between 80 and 100 that she is running a little high, then stop doing the correction until she's under 80.

Our target range was bigger with MDI than it is with the pump - I think because we can be more precise and also have the concept of IOB taken into account for corrections.

[twodoor2]

Its really just something that you'll have to see over time. Doing a negative correction is "erring on the side of caution" by backing off on the insulin. Just keep good track of it and if you find when you do a negative correction between 80 and 100 that she is running a little high, then stop doing the correction until she's under 80.

Our target range was bigger with MDI than it is with the pump - I think because we can be more precise and also have the concept of IOB taken into account for corrections.

More acronyms I don't know. What is "IOB?"

Thanks!!!

[Nancy in VA]

I'm sorry - that's a pumping term but the concept is the same.

IOB is Insulin on Board. Its how much insulin is still working in your body at a certain time after an injection.

For Emma, she has Insulin on Board (or IOB) for almost 5 hours after breakfast - which means I could still count on seeing the effects of her breakfast bolus for almost 5 hours. We take that into account with any correction we might do at lunch - because if her body is still using the insulin that she has and it will get her in to range by the time its done working, we dont' want to correct her again and risk her low.

On the other hand, it only tends to work for 2 1/2 to 3 hours after dinner. So, if Emma is still high at 3 hours after dinner, I can tell you that we need to do a full correction because she isn't coming down anymore. She has no more IOB in her body.

Does that make sense?

With shots, you just have to watch the trends and know how your daughter's body reacts at certain times of day and to certain foods. Once you figure that out, you can put a setting on the pump that will calculate the IOB based on the time period you have set and help you determine the appropriate correction based on that.

[twodoor2]

I'm sorry - that's a pumping term but the concept is the same.

IOB is Insulin on Board. Its how much insulin is still working in your body at a certain time after an injection.

For Emma, she has Insulin on Board (or IOB) for almost 5 hours after breakfast - which means I could still count on seeing the effects of her breakfast bolus for almost 5 hours. We take that into account with any correction we might do at lunch - because if her body is still using the insulin that she has and it will get her in to range by the time its done working, we dont' want to correct her again and risk her low.

On the other hand, it only tends to work for 2 1/2 to 3 hours after dinner. So, if Emma is still high at 3 hours after dinner, I can tell you that we need to do a full correction because she isn't coming down anymore. She has no more IOB in her body.

Does that make sense?

With shots, you just have to watch the trends and know how your daughter's body reacts at certain times of day and to certain foods. Once you figure that out, you can put a setting on the pump that will calculate the IOB based on the time period you have set and help you determine the appropriate correction based on that.

That totally makes sense, and I don't see the magical peak in Novolog that is supposed to occur two hours after taking it. The peak in my child is more around 4 hours, kind of like yours. Thanks for the info!!

[Mary Lou]

Hi there -- how old is Elizabeth? I'm only asking because sometimes "low" is very different for the toddler crowd. In my opinion (bearing in mind how diabetes varies from child to child) 80 - 100 is not low at all.

If your child is very insulin sensitive, and you are on injections, you might inadvertently cause a lot of highs by correcting numbers in the 80 - 100 range.

Many would disagree with me, but experience has taught me that it is a guessing game as to where tenths of units are on a syringe (unless you are diluting insulin), and that is likely the difference you are talking about when you are attempting to correct an 80 BG, especially with an ISF of 200.

In our house, we treat any number 70 or lower as a low, and I've met many people on the board here who don't treat until 60. That is beyond my comfort zone, but everyone is different.

I truly understand your concerns about your child going low. It is beyond scary. But there are dangers in continuous highs, too. It is a balance.

If your child is 80 and you would like to "correct" that, maybe it would be simpler to give her a few sips of juice or a couple of crackers (or something else very small) to bring her up into your comfort zone?

As you build your worksheet, please keep in mind how long insulin is active in your child. When we were "correcting" via syringe (as in a time when not eating) we never gave an injection within 3 hours of a previous injection.

I know this is long, and I'm sorry for that, but I just re-read your original post, what are your endo instructions for BG less than 80?

[zimbie45]

We DO NOT use the neg correction factor at all. It always seems to cause a high for charlize after.. We instead use food for the correction and we jsut choose not to correct for everything.. For us the pump does not correct an 80 fast enough, and i cant correct with the pump and food.. she will go high. here is what we do

bs 80.... we let her eat a snack.. lets say its 24 carbs.. we will recheck her bloodsugar to make sure she is over 100, then we correct for let say 20 carbs. the other 4 are " free' to her and keeps her above the 100 mark.

We only let her have free stuff mainly if she is under 100, WE DO put blood sugars in for everything over 150.

[twodoor2]

Hi there -- how old is Elizabeth? I'm only asking because sometimes "low" is very different for the toddler crowd. In my opinion (bearing in mind how diabetes varies from child to child) 80 - 100 is not low at all.

If your child is very insulin sensitive, and you are on injections, you might inadvertently cause a lot of highs by correcting numbers in the 80 - 100 range.

Many would disagree with me, but experience has taught me that it is a guessing game as to where tenths of units are on a syringe (unless you are diluting insulin), and that is likely the difference you are talking about when you are attempting to correct an 80 BG, especially with an ISF of 200.

In our house, we treat any number 70 or lower as a low, and I've met many people on the board here who don't treat until 60. That is beyond my comfort zone, but everyone is different.

I truly understand your concerns about your child going low. It is beyond scary. But there are dangers in continuous highs, too. It is a balance.

If your child is 80 and you would like to "correct" that, maybe it would be simpler to give her a few sips of juice or a couple of crackers (or something else very small) to bring her up into your comfort zone?

As you build your worksheet, please keep in mind how long insulin is active in your child. When we were "correcting" via syringe (as in a time when not eating) we never gave an injection within 3 hours of a previous injection.

I know this is long, and I'm sorry for that, but I just re-read your original post, what are your endo instructions for BG less than 80?


Thank you, that makes a lot of sense. While looking at her trends, I think I will opt not to correct if she's 80 to 150. The endo said if she's below 80, then correct with carbs (no insulin).

[D-Dad]

The other thing we consider is the type of food eaten in the past couple of hours. If one had a low GI food like pizza or milk, then I would let a 90 ride. But if it was apple juice or something which tend to "go through" the system faster, then we would be moer apt to negitively correct.

[LJS118]

It varies as to how I handle this. If he's been fighting low #s all day then I'd actually do the negative correction and food bolus but with a square wave bolus-lets say the bolus is 1.0 well instead of giving it to him all at once I may spread it over a half hour or an hour just to make sure he doesn't go low again. But if its one reading of say 85 I'll just give a negative correction and regular food bolus all at once.
If the question is do I always use a negative correction I'd have to say yes.
But I know this varies person to person, my friend's daughter goes so high if you do a negative correction-so she never does one.

[hold48398]

We DO NOT use the neg correction factor at all. It always seems to cause a high for charlize after.. We instead use food for the correction and we jsut choose not to correct for everything.. For us the pump does not correct an 80 fast enough, and i cant correct with the pump and food.. she will go high. here is what we do

bs 80.... we let her eat a snack.. lets say its 24 carbs.. we will recheck her bloodsugar to make sure she is over 100, then we correct for let say 20 carbs. the other 4 are " free' to her and keeps her above the 100 mark.

We only let her have free stuff mainly if she is under 100, WE DO put blood sugars in for everything over 150.

We too do not use negative corrections for the same reason. Instead of letting the pump subtract insulin for the lower-than-target number, I give Mia a couple of "free" carbs in her snack or meal to gently bring her into target by the next reading. For example, if she is at 80 (target is 110 +/- 20 points), I would give her 4 grams of carbs "free" (which is 30 points for us), so instead of inputting a 35gram lunch for example, I would only put it in at 31 grams and skip the entry of the BG.