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forgetting to bolus and its impact on i/c ratio

Discussion in 'Parents of Children with Type 1' started by momof2here, Oct 29, 2012.

  1. momof2here

    momof2here Approved members

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    It doesn't happen often but, with more independence does come 'forgetting to bolus' - even after I asked, "did you bolus for that?" so.... about 1.5 hours later and checking reveals 415 bg.

    I have him bolus for the item that he previously ate, pre-bolus for 80 carbs that he was going to eat and, from experience, (this is a rare experience) I felt that this situation brings on a stubborn high that the traditional bolus will not cure. So, I had him do an extra bolus for the high that we would have to counter.

    At bedtime he was at 201 so I corrected it and did so more strongly since he had previously corrected (40 or so minutes before) and yet his number was still high.

    That, apparently didn't even do the trick because at 6:00a.m. this morning he was at 180 which is a real rarity.

    The question is, when your child forgets to bolus and you find yourself in a similar situation, do you find that you need a much stronger bolus (so a different i/c ratio or a strong correction, whichever way you want to think about it) simply because this occurrence?

    What do you do about it? I still feel as though I handled it partially wrong because of the wake up number and the cgm sensor went bad yesterday so there was no cgm (which is also rare).
     
  2. nanhsot

    nanhsot Approved members

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    Definitely, with highs comes insulin resistance, for lack of a better word. The higher the blood glucose, the less well insulin seems to work. This is particularly true for us when he wakes high, it often takes all day to bring it down, and it takes HUGE amounts of insulin sometimes.

    I guess I don't really view it as a change in the I/C ratio but more that the normal correction factor isn't accurate. I can't say we have a formula for it, but my son is aggressive with his corrections during times like this.

    I don't really think you did anything wrong. Waking at 180 seems reasonable, certainly not desirable but starting from there wouldn't be hard to bring down, where starting from over 200 makes for a bad day. Since you had corrected upon a correction (which is what I would have done too) I probably would have woken and checked around 2 or 3a and done another correction at that time.
     
  3. hawkeyegirl

    hawkeyegirl Approved members

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    Yep. For us, it would probably take a double bolus and an aggressive temp basal to bring that down.
     
  4. virgo39

    virgo39 Approved members

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    We find highs like that require more insulin. We'd be checking and correcting every two hors as well as increasing the basal.
     

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