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Correction factor varies with BG?

Discussion in 'Parents of Children with Type 1' started by scarral, Mar 7, 2016.

  1. scarral

    scarral Approved members

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    My DS is turning 4 in a month, and was diagnosed with DMT1 in mid October. He wears a Medtronic Minimed pump and an Enlite sensor. His correction factor is (since October) 200 (one insulin unit brings BG down 200mg/dl). He takes Humalog (100 IU per ml).

    Last week I observed whether this correction factor was adequate for him. One time his BG was 180 three hours after eating, so I gave him 0.4IU (we correct to 100). After about one hour his BG was already coming down, and after two hours he was already close to 100.

    However I have observed several times in the past that when his BG is above 250 one correction alone doesn't seem to do anything. For instance, today his BG was almost 300 1.5 hours after eating (he usually doesn't go above 250 one hour after eating), so the pump calculated the bolus as 1IU minus 0.3 IOB, and pumped 0.7 IU. One hour 15 minutes later the sensor hadn't dropped at all and his BG was 270. I pumped again, this time the pump calculated 0.85 IU minus 0.4 IOB and pumped 0.45 IU. We keep having these situations over and over again, and in our experience if he hasn't come down from the first correction, the second rarely works, so I also put a temporary basal of 125% (increasing his basal from 0.1 IU/h to 0.125) for one hour. One and a half hours later his BG was 56.

    Do you find that when BG is so high, they need more insulin than what you'd put if it wasn't so high? Is this behaviour normal? How do you go around it? Do you have a lower correction factor for bringing down those high numbers? If so, how much higher? Is there some sort of insulin resistance that is somehow triggered by high BG? It would be nice to know what I can do in such a situation without having to wait for the BG to go down without knowing whether it will come down at all, or how long it will take!

    Thanks for any insights you might have.
     
  2. Sarah Maddie's Mom

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    A "stuck" high or a high from either an under bolus or inadequate basal will all require extra insulin above and beyond a usual correction. Obviously, YDMV, but this is a pretty common occurrence. You'll probably want to try and figure out the cause of the high first, so does this happen with higher fat meals? Or could there be some meals for which you are inadvertently underbolusing? Or do you think it could be that the basal rate at that time of day is a smudge too low. Knowing the cause will help you decide if you want to extend the bolus, increase the carb count slightly above what you believe it to actually be or to run a lightly increased basal for an hour.

    Long story short, managing Type 1 is as much art as it is science and yes, once the numbers get up into the high 200s it can very often take a larger than normal correction to get things right. Hope that helps.
     
  3. scarral

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    Yeah knowing the cause would be nice, unfortunately this is not always possible. He ate in Kindergarten, and it will be difficult to know if they did everything right. For instance I've seen a couple of times that they sometimes don't weigh things properly, as in not standing the scale flat leading to inaccurate measures. The meal was definitely not fatty, if any it would have had a high GI (some kind of polenta made with wheat and fruit mousse). This is the first time in a few weeks that we have this issue, so to see if the bolus or basal are too low we'll have to wait to see a pattern, right?

    I guess next time we see his BG close or above 300 we will give him a higher correction bolus, see how that works out.
     
  4. quiltinmom

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    We see this a lot. There are times when he takes a full correction and he doesn't even budge. It's hard to know why all the time.

    Corrections are tricky sometimes because you don't know if they have hit the peak already, or if they will continue to rise, requiring more insulin than the cf suggests. There are so many factors to consider that sometimes you make your best guess and hope it all comes out ok in the end.

    It is ok to experiment a little bit with adjusting corrections when bgs are super high. Especially if there's a meal coming in an hour or two, it shouldn't cause big problems, as long as you're careful.

    Another easy help is having him drink extra water. Obviously it won't fix it completely but it can help dilute the blood some, helping to bring down a high a little faster. At the very least, it will do no harm. You can try it if you're not sure about giving more insulin. Plus they tend to be more dehydrated when they're high anyway.
     
  5. mikegl31

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    We see this when he gets high. Just yesterday afternoon we were at his cousin's baptism. I think from the excitement of the day, to the foods that he ate at the party, he shot up into the 350s and was basically stuck there. I tripled the basal on the pump and corrected every 1.5 hours, and he didn't budge for 4 hours. What I do find that helps with us is getting him active. When we got home, I ran around the backyard with him for about 20 mins. About 20 mins later, the Dexcom started showing a down arrow and he began his drop. I know at school, if he is unreasonably high, the nurse will have him ride up and down the hallway on a scooter for about 10 mins and that also seems to assist in getting his BG to drop.
     
  6. Mimikins

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    I also experience stickier highs (and having to play around with either decreasing my SF, temp basaling, or exercising to improve my insulin sensitivity) under certain situations. It seems like highs are more troublesome to correct the higher they are (it's harder for me to correct a 300 than a 150 because of associated insulin resistance from the high) and the longer I've been high without getting any extra corrections (being at 300 the entire night is more of a PITA than being at 300 all night while correcting every 3-4 hours vs only being at 300 for 2 hours).

    Most of the time, I correct with no more than an additional 15-25% added for the insulin resistance (either through an override on my pump's suggested bolus or a temp basal increase), or I bolus normally and do 15-60 minutes of exercising (I had a morning last week where I woke up at 300, corrected, and tanked to 90 in 25-30 minutes -that was a doozy tying to fight off the extra IOB).
     
  7. funnygrl

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    Back in the day, the Cozmo's pump bolus calculator let you pick BG limits above which, a certain percentage of insulin was added onto corrections. So this is a well known issue that as blood sugars go up, as does insulin resistance. It's too bad no other pump manufacturer as adopted this.
     
  8. jenm999

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    This is like the 5th thing I've heard about the Cozmo that makes me think it must have been the best pump EVAH! Whatever happened to it?

    Yes, we add insulin when he's 250+. We had to experiment and had some overshooting but usually extra .5u when 250ish and 1.0u over 300. All depends on your ISF though.
     
  9. Sarah Maddie's Mom

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    If I recall correctly, MM sued it to death. It was a great pump. We still have one that I can't bring myself to toss.
     
  10. mmgirls

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    Tslim / tandem has bought the patends for Cozmo. But in the past I heard that that does not mean that they will bring any of the features to market.
     
  11. funnygrl

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    Yep, that's my understanding of what happened, too. Smith's medical, Deltec's parent company, is alive and well. It just wasn't worth it for them to make pumps any more with Medtronic beating them down. I still have my purple Cozmo 1800 in my closet. It's sad to think what the Cozmo would be like now if it were still around.
     
  12. Sarah Maddie's Mom

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    We've used it on and off when we didn't have a better back-up pump handy. Still makes me smile when it does that warm-up, "beep, beep, beep...beep, beep, ba, beep" :)
     

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