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Should Corrections take 2.5-3 hours to complete?

Discussion in 'Parents of Children with Type 1' started by mamattorney, Jul 5, 2013.

  1. mamattorney

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    I know this is kind of a basic question, and I thought that the answer was insulin works at the same rate regardless as to whether it's a correction or given to cover food, but either we are way off with her correction factor or maybe I am wrong and insulin works faster when there is no food involved.

    I've been wondering lately if we are WAY off with our correction factor with my daughter. I think her honeymoon is coming to a close because we are seeing higher numbers than usual. We haven't done a ton of corrections since her honeymoon started, so we never changed her correction factor since she left the hospital. However, she seems to come down really quickly with correction doses.

    Tonight - she was 241 at bed (4th of July BBQ, lots of grazing and guessing and all) and her correction factor is supposed to be 1 unit for 50 points. I gave her 1.5 units, which mathematically should have brought her down 75 points over some time frame (1 hour? 2 hours? 3 hours?).

    But, an hour later she tested and she was 69. This is not uncommon, I can't seem to correct her these days without her becoming low and having to eat. Because she ate some carbs to bring her back up to an OK place for bed, I can't tell how the situation would have played out if the insulin had just worked its way through her system.

    Would she have kept going down or does correction insulin finish up in an hour or so? Using this time as an example, if we used an hour as the cycle for the insulin, her correction factor would be 1 unit for 114 points, but if it's three hours, then maybe it should be 1 unit for upwards of 275 points - which would make giving a correction really hard since we switched to pens and the minimum dose is a 1/2 unit.

    I know I need to change her correction factor; it's just that her having to eat every time I correct her is making it hard for me to figure out what her real factor is.
     
  2. Sarah Maddie's Mom

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    Short answer is that I think a 1unit for 50 pts is a very aggressive correction factor for a 10 year old either in or just coming out of honeymoon.

    The problem is that you don't know if her 241 was the peak # or a trending high or beginning to crash number. Without a cgm it's really impossible to know.

    In terms of time frame most folks will say that at the 1 hr mark, assuming that the high bg for which you correcting was not aggressively trending up, you will begin to see the peak of the correction, or near peak so the 69 might have come down to s 50 or a 55 but it's very hard to say.

    If you are often following a correction with food then I would seriously consider decreasing the correction factor. My gut says 1:90 or 1:100 might be more on target.

    As for how long a correction will take, well, that's also impossible to say. What you can know is when the insulin duration is spent and look then at the number to get some understanding of what happened. If at the 3 hour mark a correction has not worked it means 1. the factor id off, or 2. the bg was rising and the correcting was made for an incomplete rise or 3. some fat was involved in the high and you had a resistant high, not a rising high, just a stuck one that needed a 125% or 150% or more dose to get down.

    It's as much art as science :rolleyes: Sorry I can't offer a cut and dried reply.
     
  3. Lee

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    If a correction is bringing her low, then it is to aggressive. Just like if a correction doesn't bring her back into range in 3 hours (give or take), it is not aggressive enough. Of course, you would change it based on one off #, but if I see a few corrections in a row being off, then I know it is time to change.

    I also want to add, she could not be coming off of her honeymoon, rather, she may just need some insulin tweaks. When we came off our honeymoon, we saw our first 30's and our first Hi's - it was more of a rollercoaster, rather then just needing a bit more insulin.
     
  4. shannong

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    For my son, I find that I know if the correction is going well if at the 1hr. mark, I see his bg coming down slightly, by the 1.5 hour mark he should be in range (but more near the upper end) and by the 2hr. mark he should be at a good number and stays there.

    If at the 1hr mark, he is already back in range or low (or if there has been a huge drop), then I have been too aggressive with the correction. However, if we have been having subborn highs, sometimes I do get aggressive with the corrections and feed him if he drops too much/too fast.
     
  5. redheadmom

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    I agree the correction factor sounds too aggressive, especially for such a young child who probably isn't dealing with insulin resistance from puberty hormones yet.

    Personally, one unit of insulin will lower my blood glucose by about 100 points over the next three hours; and yes, I have to give it the full three hours to finish working. If I don't, and I correct again before three hours, then I will go low.
     
  6. Helenmomofsporty13yearold

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    "An Accurate DIA Prevents Excessive Insulin Stacking

    By John Walsh, PA, CDE and Ruth Roberts, MA

    Once a bolus or injection of rapid insulins like Humalog, Novolog, or Apidra is given, its impact on the glucose can be seen over the next 5.5 to 6 hours. Little effect is seen in the first 15 to 20 minutes, about half its activity is gone at just over 2 hours, and the other half of its activity gradually decreases over the next 4 hours, giving a total DIA of about 6 hours.......The use of a realistic DIA in children is especially important. Because children eat so often, the action time of a bolus or injection often overlaps two, three, or four meals or snacks, and complicates BOB calculations. It is essential not to stack or hide bolus insulin in children, even though the small insulin doses that children require often convinces parents that their child's insulin works fast rather than that they might have received a half unit too much of it."

    http://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time/duration-insulin-action
     
  7. Sarah Maddie's Mom

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    Can't say that I've ever seem a bolus of NovoLog or Humalog ever, ever have any meaningful impact beyond four hours max. I think a DIA of 6 hours is silly. But then I'm a parent and perhaps Walsh thinks I'm silly.:rolleyes:
     
  8. Helenmomofsporty13yearold

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    I heard Gary Scheiner say that 60% of a bolus works in the first 2 hours and 40% in the next 2 hours and I find that is how it seems to works in our house. The amount of insulin working out to 6 hours would be tiny, but if one is stacking boluses, it could add up and be more significant. It appears that Walsh thinks stacking is a huge issue and recommends DIA times of 4.5 to 6 hours.

    My goal was to drive home the point that short acting insulin is not finished working in 2 hours, (though we have also seen lots of times it appears that way).
     
  9. virgo39

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    Our DD's dia seems to be a bit over 4 hours and it wouldn't surprise me if it continued for 5-6 at a very small rate. We would expect, at the 2 hour mark to be half way to her target.
     
  10. Sarah Maddie's Mom

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    I'll agree that 2 hrs is most likely not the full DIA for most people, but I think 6 hrs is not a workable DIA for anything but a lab rat, or an "expert" :p
     
  11. mamattorney

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    Thanks everyone - although I just read that article and now have even more thoughts running through my head.

    I think everyone, including me, agrees that her correction factor is too aggressive. I agree that without a CGM, my testing of her is just a snippet in time and it's hard to tell exactly what's going on. So, I think next time I will start with at least 1 for 100; maybe 1 for 150 and see what happens over a longer period of time.

    I hope she is still honeymooning and just needs some tweaking. I know that you all know what I'm talking about, but with summer (between vacation, sports, and just recreational activity - swimming, etc) it seems I can't get an "average" week to really work out some patterns to help me make some adjustments.
     

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