Correction Bolus = Blood Sugar Go DOWN

Generally speaking, when you give a correction bolus, your blood sugar goes down.

I usually operate with that in mind. You know, blood sugar is higher than target, you take an appropriate amount of insulin, and your blood sugar starts going down.

Of course there are all of the scenarios that we know all too well. Being sick, fighting ketones, infusion set or site problems, bad insulin, whatever. Those are (hopefully) rare encounters, and they are easily explained away once we get to the bottom of it.

Here is how my morning went today:

  • Wake up, test blood sugar. Time is 7:40 am.
  • 142 mg/dl
  • Not too bad. Three digit number starting with “1”.
  • Enter that number into pump and deliver a 1.20 unit bolus
  • Get ready for work, drive to work, get to work (as in “arrive”, not like “yay! I get to work”)
  • Do some work stuff, walk down to the cafeteria and get breakfast
  • Get back to my desk, ready to eat my english muffin & peanut butter
  • Test blood sugar. Time is 8:58 am.
  • 142 mg/dl

Um… Ok.

aiga_stairs_down_bgBut wait – I did deliver a correction bolus right? You know, that one that is supposed to make your blood sugar go down? Yep, I sure did!

And typically when you take insulin, particularly a bolus it’s job is to make your blood sugar go down, right? Yep, I thought so.

So what happened to that 1.20 units of insulin that I took? Did it just magically disappear? Did it wha..?

Well, I do realize that it had only been a tad short of an hour and a half, but on that note, IT HAD BEEN A FRICKIN’ HOUR AND A HALF!!! All things considered, I would expect to be at least lower than what it was when I took the insulin.

Just one of those things.

I didn’t really have the time this morning to sit back and see what would have happened given another hour or two – but I’m really curious now.

Stepping back a little bit, it makes me wonder if I don’t need a different correction factor for a certain time period in the morning? You know, that I might be a little more resistant to my insulin for some time after I wake up.

But is it a “time of day” thing or a “waking up and moving around” thing?

And if I do come to the conclusion that my correction factor needs to be different for some period in the morning, how the hell do you figure what time you go back to your regular correction factor?

A lot of testing. A whole lot of testing. Then some more testing. And yet more testing.

And the presence of mind to watch and see if it worked or not. Sometimes I feel like my attention span is really bad when I can’t keep track of something a short two or three hours later.

Or if I get distracted and forget to keep the variables out of the mix during that time.

I feel that there is a shortage of days that I can really take the time to eliminate those variables. So many days where something is going on that I need to take care of. Days where I just don’t have the hours to really watch and see what’s happening. Maybe two a week, excluding weekends.

With that in mind, it seems like such a big job to work through. Something that takes so much trial and error – and the daunting task of trying to keep track of it all over such a long time span.

I know, I know. I have to do it, and I just have to start. And it’s not really as hard as my overly complicated self talk makes it seem.

But still.

Never do today what you can put off until next week.

Wake me up when things are easier.

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16 Comments on "Correction Bolus = Blood Sugar Go DOWN"

8 years 11 months ago

Hey Scott,
I had to check your site out. Very cool!! Now that I know your here I’ll have to check you out more often. See ya round the water cooler.

8 years 11 months ago

Just to comment on Ryan’s comment. This isn’t about testing twice in a row and comparing the numbers in the same meter, it’s about testing on two separate occasions and seeing the same number twice. The number you get on test #2 could be different than if you had done test #2 with another meter. That’s why if you see two numbers in a row that are the same, that doesn’t necessarily mean that you are even that exact number. You could be somewhere between 5-20 pts. away from that number. This is why you need to study trends and patterns, and not just whatever number happens to pop up on your screen. That is only part of the problem.

I hope that explains my original statement a bit better.

8 years 11 months ago

Of course, one sample isn’t enough to really diagnose a cause, but my first thought isn’t that the correction bolus is wrong…but that your basal rate is wrong for the morning.

Personally, I’d test for several days without eating (and without bolusing) to see if your BGL actually rises in that time period. The fact that the numbers matched after 1.5 hours and a 1.2 unit bolus could mean your basal rate is too low.

My nighttime/early morning basal rate (until about 9:00 am) is 1.1 or 1.0 units per hours. Starting at 9:00 it drops to .7 u/h. Over the course of 4 hours, you have a difference of 1.2 units!

Something to think about. Then again, it could be a one-off tied to something you ate the previous night, etc.

Variability in meters isn’t likely an issue as you shouldn’t see 15-20% variability within the SAME METER…but there is that much variable between any given meter and the “true” reading.

Oh, and Scott…BTW…You’ve been tagged!

8 years 11 months ago

I have this happen all the time. I can end up 30 points by the time i get to work having consumed nothing.

I hate testing but I know it has to be done. What sucks is the last few times I have tried to work all this crap out, something comes up and I have to scrap that fasting test or I get all stressed out and wonder if that is screwing things up too.

Hmm, I wonder if I should figure in a Road Rage bolus amount?

8 years 11 months ago

I can’t tell you how many times this has happened to me! I have two different correction factors and I have them set for four different time ranges. 12am – 3am, 7am-2pm, & 7pm-Midnight I am set one unit bringing me down 35. Then from 3am-7am & 2pm – 7pm one unit brings me down 50. It took a lot of testing and a LOT of low lows and high highs to figure this one out. Sometimes though, I think things don’t work exactly, but this is around what I need. My correction factor changes the higher I get, as well. So anything over 250, I take my correction and multiply it by 1.5. I know, all that math in my head, but how do I program my pump to take a 250 blood sugar and recognize I need a different correction factor? It doesn’t have that capability!

I also wanted to respond to a comment you had on Aiming For Grace about how diabetes is always work for you. I know sometimes it feels like diabetes fades into the background for me, but recently as problems with Gracie have arisen, I have really been looking in the mirror and realizing although I may feel from time to time as though diabetes fades into the background, I dedicate huge amounts of time and energy to diabetes, and it IS a lot of work. I’ve been imagining myself doing what I do for me and also doing it for HER and it really becomes even MORE clear how much work this is. So I’m in total agreement about how much work it is…..I guess is my point!