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How Soon After Meal Insulin Can You Correct?

Discussion in 'Parents of Children with Type 1' started by danielsmom, Feb 22, 2012.

  1. danielsmom

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    Within how many hours should BG be at its "ideal" number after the meal?..I ask because with Baseball season starting and late games Daniel's dinner time will start being a little off...He gets his levimir between 8:30-9pm...If he eats around 5 or 6, its not an issue...But there may be nights he eats as late as 7 and since he will be checked again by 8:30(although I can push it a little later if necessary...I want to make sure if I have to correct that the insulin has had its full effect oh him...if thats possible?).. Also he gets a snack around 3 or 3:30..if he has a game right now they are at 4:15/ but will be moving to 5....he really won't have a chance to eat until after the game, around 7 maybe later...that is a long time without food...do I just snack him again?..I know with soccer it was every 30minutes of active exercise...obviously baseball is not that hard on the body...but still I don't know how he will do without food that long...

    Any opinions?
     
  2. Mrs. Russman

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    Novalog usually lasts around 4 hrs. Most people wont correct any sooner than 4 hrs. His levemir dose should keep his blood sugar steady without eating (but he may need extra carbs for the activity)
    What I would do (YDMV) is give him a snack before game, then if dinner is at 7, I would check him around 11 pm and correct then if needed. If there is a problem with lows during the game, give him more carbs beforehand, or sports drink during.

    Ben played baseball, the season started the week he was diagnosed. I would check his blood sugar about 4th inning.
    Good luck
     
  3. Flutterby

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    I wouldn't necessarily check before giving levermir.. checking an hour and a half after a dinner bolus is going to give you an inaccurate number, one that you can't base any decision off of, so I'm not sure there is a reason to test. I wouldn't do any correction until you are at the end of his active insulin time, otherwise you run the risk of stacking insulin. For example, if you check him 1.5hours after dinner and he's 356, his active insulin time is 3 hours, he's still got an hour and half left of active insulin that would pull that number down. If you go and correct that 356 using your correction factor you are doubling the insulin needed for that 356, therefor stacking insulin.
     
  4. nanhsot

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    When on MDI we never correcting anything within 4 hours of mealtime bolus insulin. I always set my alarm to do the checks at the 4 hour mark. Lantus is given at the same time no matter what's happening.

    We never check on a set schedule in any way, we check when needed. I'd lose the idea of an 8:30 check if he eats at 7, he will be high but it's too soon to correct.

    As far as foods, my son pretty much ate when he wanted, and we bolused for what he ate. We were never on a snack regimen so I really can't comment on that part. My advice is to feed when hungry, covering all carbs with appropriate insulin. If he eats at 7, then do your check at 11p.

    If a correction is done at 11p, I would then do another check at the 3 hour mark from that to make sure there is no low happening.
     
  5. danielsmom

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    hmm then maybe I've been doing it wrong...He always gets checked at bedtime because he gets a snack...I correct when needed..and it is usually within the 2 to 3 hour mark of dinner that he has gotten correction...So its a good thing we haven't had any problems with lows because of it..But I will talk to my CDE...I wasn't very clear on that..
     
  6. nanhsot

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    I have corrected at the 3 hour mark, but only if pretty high. YDMV of course but for my son novolog has a pretty sharp tail, meaning it will drag him low at the very end of it's run. So we did have to be careful about correcting too soon. 2 hours is, IMO, much too soon to correct, you've still got a lot of insulin action left from the bolus at that point, not to mention food digestion going on.

    I know it's been discussed, but for me the snack is what really confuses things! Do you now give full insulin for the snack or is it still free? I would only give the snack if he's hungry, not because it's scheduled. If he's now not eating until 7p or later due to baseball, that snack is really not needed.
     
    Last edited: Feb 22, 2012
  7. danielsmom

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    He gets bolused for the snack..no freebie.....since we've been doing that his fasting numbers are much better.....Daniel has no problem with the snack...'
    30c is really not much, and usually it is a small bowl of cereal and he is happy with that...the freebie snack is in the am and after school...I don't have to correct often at all after dinner...Daniel's insulin peaks within 1 1/2 hours.. so if he has a low it is at that time it will hit him...But I will discuss this with endo....and its not a problem doing the night check much later if he does have a late dinner....
     
  8. TheFormerLantusFiend

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    How soon I'll correct after a meal depends on a few things. One is, does the high look like a mealtime spike? I don't have mealtime spikes if I enter the meal at a normal number and I prebolus, so I'll correct an hour later or two hours later because I know the mealtime insulin won't lower it.
    The other is, how predictable are my numbers at that time? Do I tend to see my insulin sensitivity going up right about then? I don't correct blood sugars below 250 between breakfast and lunch because I usually eat my lunch with no insulin- my Lantus covers it because of how insulin sensitive I am at that time. Or if I expect to go for a run, I don't correct.

    I don't think you should correct for highs on the evenings of baseball practice until you know that baseball practice doesn't cause lows a few hours later for your son.
     
  9. caspi

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    I think you are concentrating too much on food, to be totally honest. If he is eating at 7, there is no need for a snack before bed, unless he is hungry, of course. It should not be mandatory. Also if he is having a snack at 3 or 3:30, 7:00 isn't "that long of a time" without food. Keep it simple -- if he is hungry, let him eat (hopefully something healthy) and bolus accordingly. But don't plan his entire day around food. :cwds:
     
    Last edited: Feb 23, 2012
  10. hawkeyegirl

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    I agree. I know I've said this time and again, but it's time to move away from regimented meals and snacks and toward a normal eating pattern. I doubt this is how he ate before diagnosis. That should be your goal. Ask your endo team to help you get there. It's silly to have a bedtime snack when supper is at 7pm.

    If he goes low without constant snacks, reduce basal.

    As for correcting, you need to know how long Novalog acts in his system. For my son, it's 3 hours. For some kids, it's 4 or 5.
     
  11. emm142

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    I totally agree with this. It seems strange that 3.5 hours would be a long time without food. I often go 6 hours between meals if I'm not hungry. If he's being bolused for his bedtime snack, that suggests that he'd be okay without it.
     
  12. Connor's Mom

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    I am agreeing with the others. If he is having a snack before the games around 3/3:30 then 7 isn't that late. I would just make the snack something slow that will last so he isn't hungry 20 minutes later. My son liked a grilled half of a low carb pita with lunchmeat and cheese before soccer games with a drink and SF jello. He felt like it was a second lunch and it usually took him through the game without being hungry.
     
  13. Beach bum

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    This is what we do for our late dance night. It's at 6:15, and she doesn't want to dance with a meal eaten at 5 in her stomach, nor does she want to come home at 7:30 and eat a full meal either. So, we do something lite like stated above, and then when she comes home she has something like fruit and yogurt or if she's really hungry egg whites and a slice of toast.

    If we are having dinner at around 6:30-6:45, she will add a cookie or popsicle onto the end of the meal, but no snack is given. No need really.

    In addition, I wouldn't check BG for the Levimere shot. It seems like it would be an inaccurate number. I'd be more apt to check 2-2.5 hours after the meal.
     
  14. Rcj176

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    Goodness...seems like forever since we did MDI that I wouldn't know what advice to give. Except I do agree with others about the food thing.
     
  15. Deal

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    We check at the 2-2.5 hour mark and correct then if necessary. If his number is already in range we correct with some extra carbs, if he is too high (meaning higher than the insulin left to act will bring him down) we give more insulin. I never wait until the 4 hour mark to test and correct because by then if we gave him too few carbs he would be low and if he was high I would rather have caught that earlier too.

    I wouldn't differentiate actions based on MDI or pumping. That is just the delivery mechanism. Regardless of delivery method the insulin requirements are the same.
     
  16. hawkeyegirl

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    Right, but the pump will track IOB. You can do that on MDI too, but the OP is not there yet. For her, it's really not safe to correct before 3 hours.
     
  17. manda81

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    We were always told by our endo to not do any corrections unless it had been 4 hours since his last insulin.
     
  18. BittysMom

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    To figure the iob you first need to factor in the insulin action? For instance, my daughter seems to get most of the oomph between hours 2-3. That's what plays into the "dia" that you figure out and set on pumps? And you'd have to factor it here as well? During the day I'll correct at 3 hours but I don't have the math behind it. Just looking ahead to pump start.
     
  19. hawkeyegirl

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    Yep. I don't know if you have Think Like a Pancreas, but Gary Scheiner has a nice chart in there on duration of insulin action. I believe he shows the approximate "curve" for a DIA of 3 hours, 4 hours, and 5 hours. Insulin isn't "used up" at a constant rate, as you know. It's more like a standard deviation curve. Anyway, when we were on MDI, we used his chart if we wanted to correct early. I'd look to see what percentage of insulin (approximately) was left working at 2.5 hours, for example, and I'd subtract that from my correction. Same thing the pump does, really.
     
  20. BittysMom

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    I'll have to look again. I read it a few months ago and my eyes probably glazed over looking at that part back then. Thanks.
     

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