Okay d-moms. I need some help here. Warning....this is a bit long. Sorry about that! I always try to keep posts short and sweet. Ummm....not today!
Right up front, I'll tell you that we see the endo next week and I'll ask about this. But I'm trying to do some research first so I understand what they tell me.
Matthew was diagnosed in March 2010. At that time, we were given told his correction factor was 1:100. Meaning 1 unit or insulin drops him 100 points.
We started pumping in December and left the correction factor alone. (Though at night, we usually only give half corrections to avoid lows...)
After basal testing recently, I'm seeing some patterns that point to making a change in the correction factor. I think. Here goes....
In the morning, corrections usually don't work.
At dinner, corrections usually work too well and he goes lower than I want.
I'm thinking we need to lower the correction factor in the morning and raise it at night. Is that right?
I'm having trouble wrapping my brain around this for some reason. And where do you start....
I did find a calculation somewhere(CWD forums??) that talked about taking the meal ratio and multplying it by the # points one carbs raises your sugar. (Whatever that is called.)
If I do that...it would change his morning correction from 1-100 to 1-70.
Evening correction would change from 1-100 to 1-154.
Ever heard of this?? Oh, and I'm not planning on making these changes until after the appoinment, just trying to understand better.
Any advice on correction factor is appreciated. A lot. : )
7 comments:
Oh correction factor! Gary Scheiner, our CDE, has a way of figuring out what the correction factor is based on your TDD (Total Daily Dose of insulin) that is, how much you average every day. He calls it the rule of 1800 (though he does use 1500 and 1600 at times to do this same rule). You divide your TDD into 1600 and that should give what 1 unit of insulin will lower your blood sugar. For example, if your son uses on average 20 units of insulin a day, it would look like this: 1600 divided by 20 = 80. So, 1 unit of insulin should lower your son's blood sugar 80 mg/dl. That would be the starting point from which you figure out how to fine tune for your child, as we are all different.
Gary always tells me that kids and human beings alike are more sensitive to insulin at night, so at night your son's, from the example above, insulin sensitivity factor may lower his blood sugar by 100.
To verify it, check 3-4 hours after the correction dose is given, and your son should be around his target number.
I have not heard of the calculation involving the meal ratio, though it's possible. Gary has a lot in his book Think Like A Pancreas and John Walsh has some really good information and charts in his Pumping Insulin book.
You are on the right track though, he needs to lower the correction factor in the morning so he gets more insulin to bring down a high blood sugar and likewise, he needs less insulin, so a higher correction factor at night so he comes down slower and doesn't crash.
Is your head hurting yet? :0) Your endo should be able to help with this too. Good luck!
Oy CF are the worst for us. Justice is insulin resistant at night, but when the moons full he's not ;)
I have hard of Garys way but never anything else. I do know corrections don't work if basals are off. Id basal test a few more times in the morning before assuming its the CF. Good luck! :)
Yep, you are on the right track. He needs a lower CF in the morning (meaning MORE insulin) AND a higher CF at night (meaning less insulin).
Alexis is right...YOU.ARE.ONLY.AS.GOOD.AS.YOUR.BASAL when adjusting everything else. When I tweak Joe's CFs I calculate out how much of a change the new CF would be from the old CF using a BG of 240. With Joe's sensitivity to insulin I feel a 1/4 to a 1/3 of a unit change is a good place to start (whether going up or down).
Good luck. You are WONDERFUL.
You got great advice! : ) I would also say that you have to isolate basal before you attack bolus or correction ratios. And also practice corrections under 240. Over that, and you are messing with ketones-whole other story. Then you have to add extra no matter what!
I would only drop his correction by maybe 1-125 or 1-130, and see how he does. If he still needs more, then jump to 1-154. I get nervous making big changes! : )
Praying you get answers!! Hugs!
dd has different correction factors at different times of the day.
Can't help you with specifics as we use different units here.
Be very careful applying Gary's formula or any other formula for Insulin Sensitivity for a child. We have used Gary in the past but I know if I followed his formula for sensitivity she would be on the floor. I used to double-check sensitivity with our endo who advised us to adjust in increments, going up and down by ten points. So, for us, 80 to 70, etc. And I am positive she will give a different adjustment factor for each child. So ask the endo how to adjust in your case. Easy to test if you have correct basals overnight, can test correction factor either when high or just give some excarbs to make child high enough to test the factor. Sensitivity changes a LOT, if the child is active and exercises. Just be careful about this adjustment.
SERIOUSLY, my fried brain just exploded when I started reading the comments.
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