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Stacking insulin?

Discussion in 'Parents of Children with Type 1' started by HanksMom, Dec 14, 2010.

  1. HanksMom

    HanksMom Approved members

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    Several times our endo and CDE have said to us that we can't/shouldn't give Novolog within 3 hours of eachother because it isn't effective to "stack" insulin doses. I've read threads where people have given corrections within that window though, or dosed for additional carbs during that 3 hour time span. I'm confused...

    I'm wondering specifically because of weird timing coming up with holiday meals and such.

    Thanks!
     
  2. Christopher

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    The way to remember it is there is a difference between giving insulin to correct a high and giving insulin to bolus for food. If someone is high and they receive a correction, and then are hungry a little bit later, if they eat something with carbs in it you need to bolus for it. The bolus for the food is not related to the correction.

    As for corrections, if you give an initial correction, most people here wait at least 2 or 3 hours to give a second correction because the initial correction is still working on the system. If you gave a second correction while the initial one was still peaking, that is what people mean by stacking.
     
  3. hawkeyegirl

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    "Stacking" insulin refers to giving more than one correction within the duration of insulin action. So if insulin takes 3 hours to work in your child, and you give a correction, you should be cautious about correcting again within that 3 hour time period, because the first correction is not done working yet.

    You can give multiple doses for food within really any time period. That's not "stacking."

    On the pump, the pump keeps track of insulin that's working from prior corrections so that if you want to correct again within the DIA, it will automatically shave some off to account for the insulin on board. You can do the same thing yourself on MDI. Gary Schenier has a chart in Think Like a Pancreas that shows you the approximate percentage of insulin still working after 1, 2, 3, 4, and 5 hours.

    There are times when we do another full correction within the DIA. If BG is 200 and I correct, and 1.5 hours later, BG is 250, I consider the first correction completely uneffective and give another full correction. That's sort of "advanced" diabetes, though, and I would not be as aggressive if we didn't have a CGM.
     
  4. Blue

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    Our endo has told my husband not to give insulin at all (even for carbs) within two hours of an injection because it would be "stacking". Pretty frustrating with a toddler that likes to snack. Also frustrating because my husband didn't bother to ask why . . . My theory is that the endo figured out that my stepson's mother was still using the sliding scale (with the correction built in) so he was mainly talking to her, not my husband since we were using a meal ratio and a separate correction formula at that time.

    I still can't talk my husband into giving a second bolus within two hours though . . .
     
  5. Amy C.

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    That is too bad the endo has it wrong. Stacking is correcting more than once within a certain time period. Hopefully, you misunderstood what was said. If you know the kid will eat a lot, you can give the insulin prior to his eating, even if all the eating doesn't occur for a couple of hours.
     
  6. Deal

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    There are perfectly valid reasons for stacking. Not stacking just keeps things simpler but doesn't mimic real life situations. I try real hard not to adjust my childs living any more then we absolutely have to based on diabetes. So if he wants an extra snack and I would allow it if he didn't have diabetes then I allow it but with a bolus. So for us stacking is necessary.
     
  7. mmgirls

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    Stacking is not multiple food boluses, stacking is mutiple correction boluses within the DIA of insulin for your child.
     
  8. frizzyrazzy

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    when we were on shots we used a basic "4 hour/25% each hour" rule for 'stacking' of corrections. It's not 100% accurate but it was a good easy way to do it without the benefit of complex pump algorithms. So if he got 1u then we 'assumed' .25 was used each hour. You can alter that however you like - if you think he has a long DIA then break it into 5 hours or a shorter, then go for 3 hours.
     
  9. HanksMom

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    Thanks for the clarification - this is of great help! In thinking back on it, she may have been talking about corrections only, and I didn't separate the two.

    So if he wants that frosted sugar cookie at 1:30 an hour after lunch on Christmas, he gets it! :)
     
  10. mmgirls

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    Another thing that allot of people do is over bolus for 10-20 carbs and have them have those additonal carbs between 1hr and 2hrs depending on their usual spike, or if going into a meal they were high to begin with.

    Saves one shot.

    Caution you to remeber that you overbolused and to know when your childs insulin peaks for them.
     
  11. frizzyrazzy

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    that's the spirit!
     
  12. zuzinka

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    I somehow consider stacking insulin also for bolusing the food. With us if I give lets say every hour food with the right bolus then the 3rd food, she will start falling. If we do give food one after the other, then we must reduce insulin a bit as well.
     
  13. wilf

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    If this is happening, then her carb ratios may not be quite right..
     
  14. frizzyrazzy

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    I had the same issues with Ian when he was smaller and taking less insulin. It was as if he had a threshold old insulin that he could handle at any one time (or in stacked boluses) and beyond that we had to modify.
     
  15. FloridaMom

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    We aren't supposed to give corrections within a 3-hour period, but if he eats something again, he definitely gets insulin in that time.
     
  16. Kimby

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    We had trouble on MDI with multiple shots within a short time period because Andrew seems to absorb insulin faster from multiple sites than just one. With the pump, it all goes in one place and we don't have that issue. If he is high on the pump (no ketones, site fine), we'll sometimes still do a shot correction somewhere else because of the faster action benefit. When we do, I usually bolus into air to keep the insulin on board numbers right in the pump.
     
  17. BKKT10

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    We did not correct earlier than 3 hours on MDI because of stacking insulin. This rule saved us more than once- we would check 2 hours after a meal and be 300, check an hour later and be 100.

    We correct earlier now because the pump will take into account IOB. So it will take insulin away based on the most recent bolus/correction.

    It is definetly safe to bolus for a snack within 3 hours of the last bolus- but I would just bolus for the snack, I wouldn't give a correction and dose for the snack in the same injection. That is why D management with toddlers that eat constently can be SO frustrated- insulin is constantly trying to catch up to snacks eaten throughout the day and BS numbers can be crazy as a result.
     

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