snacking and corrections

The rules for snacking are quite clear in terms of what you are doing in future. But what about existing. If I am 15.4mmol and want a snack of 1CP in theory I don't need to inject, but that just seems silly when already high. If I have a snack of 2CP then I can inject 2 units if my meal isn't due soon.... but can I also do a correction dose of 2 (my target is 7-9mmol at the moment) or is that only with meals rather than snacks? Pre-DAFNE I would simply avoid a snack if I was that high, but DAFNE suggests I can have the freedom to snack when I like, but doesn't mention about what your blood is already doing, I feel wrong snacking when that high but I'm hungry so still want to!

Hi Gemsa,
The main point is why your BG is at 14mmol/l when you have the snack. If it's because you had a meal and some QA a couple of hours before you wouldn't want to add in a correction dose because the meal QA is still working and there'd be a danger of you going hypo.
So just have your snack and QA according to your ratio at that time.
If it's been say 4 hours since your last QA dose then you could safely add in a correction on top of the dose to cover the CPs.
Hope that helps?
Carolin

Thanks. That does make sense to tie it in with previous food and QA times. But surely 14 is just too high whether or not its soon after a meal? 'normal' people only go as high as 7 or 8 after a meal so we shouldn't be peaking really high and then dropping in once insulin has taken effect?

Hi Gemsa, sorry bad news you are no longer 'normal'. What happens to 'normal' people no longer applies to you. What Carolin was trying to say was say you eat at 6pm, inject 12 units and have 120carbs ( where you are on 1:1 and 10carbs = 1 unit). If you test 1 hour later your body is still digesting the food and your BG will be higher than normal. If its 14 and you decide to correct and give yourself 3 units to bring you back to 5 ( generalising a lot about the exact
effect of insulin), you now potentially have 15 units working on 12CP's which may be too much and will force you too low. Your QA insulin will generally keep working for upto 5 hours, this is the danger of injecting between meals.
In an ideal world our BG stays within range after meals, but its not an ideal world so we are trying to make the best we can of it. If your BG is back in range before the next meal then generally you are doing ok. You can try to get better control than this but is very difficult. You don't have the feedback mechanism that a normal person has. You cannot secreet insulin at just the right time to balance the sugar in your blood, All you can do is put it into your body fat and let it be absorbed into your system at roughly the rate required. This is not precise but its as good as it gets with technology as it is at the moment. Maybe one day this will change but not in the immediate future.

Thanks. (my mum would disagree, she has spend all my life trying unsuccessfully to make me feel I'm normal and not stick-out-like-sore-thumb)

I guess I'm thinking about my worktime pattern. Eat at 6:30am, 10/11am I want a snack but am high... it's on the edge of when the QA should have stopped acting but my brain thinks its should have finished as breakfast seemed so long ago. I don't want a bad score at lunch time. My lantus seems to take 5 days to adjust rather than the 72 hrs so I guess my system just takes a bit longer so I should err on the side of caution with the 5hr rule even though brain says "it's 4hrs, what little can be left in the system you must have had your peak and it clearly didn't work, go on, go on, get the bloods down". I just don't have much patience and trust.

Thanks

hi, sorry maybe that came across a bit wrong. What I meant was your control of Blood Sugar is not normal, as people we are no different from anyone else
and DAFNE makes you able to eat 'normally' ( not what you want, thats not normal even for non-diabetics ).
I guess with you its really your decision, the DAFNE 'rules' provide guidelines to what you should do however we are ALL different and react differently. It
may be that the previous QA dose in your case has stopped having an effect it may not. There is also the fact that if you are like me when you are at 15 correction doses don't follow a linear pattern and you can pump in 5 units with little apparent effect. So maybe try experimenting with corrections but
make sure you start off cautiously and make sure you consider any correction the next time you inject i.e if you correct at 11am then eat at 12, the previous
insulin is still working....

Just adding my tuppence..........

When I snack I use my InuslinX meter to work out my dose, this provides the insulin due for the carbs by using my ratio at that time, the correction I need for my blood reading and then the amount of units that are still working in my system......

The on board insulin is subtracted from the carb count and the correction...........


I often find that the correction is cancelled out by the on board insulin, then it simply gives you the carb insulin......this also confirms my previous carb count was successful....

this can be done manually though, you just need to decide on how long your insulin lasts for on average, for me its 4hours 25minutes, you can then work out how many units your using up by the hour, you can then work out how many units are left at the time of the snack and subtract it from your calculation....

sounds easy written down..........lol

All makes sense both Marke and Novorapidboi. Sorry to sound a dunce though... how do I find out how long my insulin lasts on average? (particularly if my BI isn't right yet and therefore my QA:CP ratio may be wrong too) 15 minutely blood tests?!

You really need to get your BI dose correct first before attempting any advanced dose adjustment.....

I just made sure my BI was correct and that my carb count and ratios were right then tested every Half hour, it won't be exact but you can get it pretty close....I done that a few times to make sure

Novorapid is on average 4-5 hours long