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Can someone explain a "negative correction" and the alternative?

Discussion in 'Parents of Children with Type 1' started by rutgers1, Apr 27, 2011.

  1. rutgers1

    rutgers1 Approved members

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    I saw the mention of a negative correction in this thread.

    My son is on injections, and I was wondering what a negative correction is, as well as what the alternative is. In other words, I was hoping someone could share a couple situations where a negative correction would occur and, since it was alluded to in that thread that a negative correction isn't always recommended, I'd like to see what the alternative is in those situations.

    Thank you!
     
  2. hawkeyegirl

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    Well, on the pump it will shave off some insulin for a meal dose if the BG is below a preset level. That's a "negative" correction. So if I program in that Jack's BG is 73, it might shave 0.3 of a unit off of his food dose so that theoretically he'll end up at 90 in three hours.

    I don't like the way the pump calculates negative corrections, so I generally just give him some free carbs and don't tell the pump his BG.
     
  3. rutgers1

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    Am I right in saying that the reason to avoid a negative correction is that - if you pre bolus - you are giving insulin to a person who is already low? Even if you are eating immediately, I could see that being a bit scary.....Is that the reason?

    If I am understanding it correctly, then the other method involves correcting the low first and then bolusing as normal. I guess this would be preferable because you have the peace of mind that the child is no longer hypoglycemic before you give insulin. Is that the reason?

    Thank you in advance for the continued explanations!!!
     
  4. hawkeyegirl

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    That's not my reason, but that is A reason to do it differently. ;)

    We have a CGM, so I can see if he's still heading down or not. Generally, the food acts much more quickly than the insulin, so if he's not plummeting, I don't worry too much about giving him the insulin even when he's borderline low. If he's lower than the high 60s, I would treat first, however.

    The most conservative course of action is to treat first, recheck, and then bolus and eat the meal. That's not always practical (or very acceptable to the kid ;)), however. But your understanding of the issue is spot on. :)
     
  5. TheFormerLantusFiend

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    A negative correction isn't necessarily when a person is low.

    Here's how I was doing them at one point:
    My target range was 65-155, which I figured meant that 110 was perfect. One unit of insulin lowered my bg by 40 mg/dl, and I was taking 1 unit of insulin per 8 grams of carbohydrate.

    Let's say it was mealtime and my bg was 88 mg/dl and I was eating 48 carbs. Instead of taking 48/8 = 6 units to hopefully bring my blood sugar back to 88, I would take 5 1/2 units to push my blood sugar up closer to 110.

    I don't currently do that mostly because I am currently aggressively avoiding lows, and because I'm way more insulin sensitive but still can't dose with any refinement better than half units.
     
  6. GinaB

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    Tonight Joseph was 68 before eating. His bedtime target is 120 so I calculated the meal carbs then shaved off one unit for the negative correction.

    I think this is what you're refering to? He wasn't low enough to treat but under target for the night. We are MDI so the negative correction works great
     
  7. NomadIvy

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    When we were on MDI our endo told us not to deduct from the insulin dose. However, our CDE did. (They're not from the same practice.)

    Basically, we had a formula to use to compute her insulin dose (some are given a chart with how much correction bolus to give depending on the BG).

    Here's an example of how we might computer for her lunch dose:

    A) BG - Target BG/ Insulin Sensitivity = Correction Factor

    73 mg/dL - 120 mg/dL
    __________________ = -.33
    140 mg/dL

    B) Let's say she's eating lunch, so her insulin to carb ratio would be 1:23
    So, if she' eating 50 grams carbs for lunch, it'll be 50/23 = 2.17

    What I would do is subtract .33 to 2.17, giving me 1.84 units
    I'd then round that up to 2 units (or make it 1.5 depending on what she did before lunch or what she's doing after lunch).

    Have you read "Type 1 Diabetes" by Dr. Ragnar Hanas? I believe he has a chart there on when to inject and eat depending on the BG.
     
  8. virgo39

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    We have found that negative corrections don't really work very well for us.

    Our DD's target is 100. So if her BG is over 100, we give insulin to "correct" the high BG. Originally, her correction factor was 1 u. for every 200 over the Target.

    So if she was 125 before dinner, according to that formula, she would get 0.125 as a correction in addition to whatever insulin she'd get for her meal. (BG-target /200 or 125-100/200)

    If she had been 75 before dinner, according to the same formula, the "reverse" correction would be - 0.125. That amount would be subtracted from her meal bolus.

    As I said, we've found that negative corrections don't seem to work well for us.

    As an alternative, if DD were 75 before dinner, I might simply not count a few carbs or shave a bit of insulin off her dosage.
     
  9. rutgers1

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    We have a chart that our doctor gave us that has two main sections -- a section for corrections, as well as a section for handling carbs at meals. For the majority of this past year, we just followed that for the most part. However, increasingly we have been getting to know how things work and adjusting as needed.

    Generally speaking, in a perfect situation we'd catch the low before the meal and give him some free carbs to raise him a bit. I have a general sense of how much he rises from different carb amounts (though it isn't always as easy to predict as I'd hope), so I can quickly get him back into range.....However, if we catch the low right at meal time, I shave some insulin off of the bolus. I figure that based off of how much a unit tends to lower him.

    What I don't do, though, is figure out the negative correction mathematically. When I saw the equation above, my brain started to hurt, lol. How necessary are those types of calculations? If I know that a half unit tends to lower him 40, isn't it ok for me to simply subtract a half unit from the bolus if his blood glucose is currently 40 below range? I realize that it won't always work out that neatly, but at some point you have to round anyway, so I always make a judgment call.
     
  10. TheFormerLantusFiend

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    Yes, but not 40 below the bottom of the range, but 40 below the middle of the range.
     
  11. Ali

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    I too find that with todays insulins a negative correction does not prevent an oncoming low and ends up not being enough insulin for the meal. So I like many others treat the low with a fast acting carb-glucose tabs and dose for the meal as usual. I may wait 5 to 10 minutes to dose or start eating and then dose. Depending on your insulin routine you may find different routines work better. If I am dropping fast I will treat and reduce my bolus insulin and or my basal for an hour to compensate. With MDI all you could do with what you think is a major low coming on is to treat and under bolus the meal a bit. A lot depends on how much IOB from the last meal is still around or if you had some unusual exercise. I know clear as mud:rolleyes:hope others chime in. ali
     
  12. Jacob'sDad

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    So with a borderline low at a meal you can either negatively correct or add fast acting carbs.

    Both methods do one thing the same: You end up with carbs that were not bolused for. The difference is, with a negative correction, the meal carbs might be slow acting, so the rise in BG would be slower. That could be good or bad depending on the starting BG and how fast you want BG to climb. For Jacob, it is usually a good thing. His stomach empties pretty fast, so the meal carbs are fast enough.

    If you look at that pre-meal BG and say "this is too low and needs to come up now", then fast acting is the way to go. Treat, then eat.
     

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