I've been meaning to do a post about the mental process I use to determine my insulin doses. I thought it would be easy. Heh.
See, there are two primary inputs to use when calculating your bolus size - the amount of carb you're going to eat in the next couple of hours and your current blood sugar. If it's high, you need to take some extra insulin to bring it down again. (This is often called a corrective.)
The first two factors are close to determinate, but there's still some variability, especially the exact carb count. There's a little fudge factor there, and there are times when your guesses are off a little. So that will lead to extra Smarties/Lifesavers/juice (or whatever's handy) or corrections later.
But there's a third component that has to do with intuition more than anything else, and that's the hardest to quantify. If I'm feeling like I'm trending low, I may hold off on a unit to let myself go up a little. If I'm trending high, I may take an extra unit to come down.
It's not quite the same as basing the dose on the exact BG reading, it has to do with whether today's results have indicated a little extra resistance, or creeping up.
Historically, I've been very conservative about taking extra when I'm in the 80's or so. Today marked a little bit of a change in that for me. I've been worried about about going hypo due to too much insulin. Sometimes I get low, but I have always had plenty of warning since I am very sensitive those situations still, and it's not hard to find appropriate sugar sources if something comes up. (Or goes down; you know what I mean.) Sometimes those highs seem very "sticky" in that they don't respond well to correctives, or a little extra carb has more impact than it seems like it should.
The difference between handling this third factor well or not can mean 10-20 points difference on the machine average in a given day. (That's different from just blowing it and hitting 328 on the meter and fighting that.) Time will tell how much difference that makes in the long run. Of course, I'm looking forward to taking my first official post-diagnosis A1C, and we'll see how closely that correlates with the machine average.
I think this is what people mean when they talk about the "art" of bolusing and carb counting.
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A Thing to Remember
1 year ago
Interesting... we do the same for Elise when we determine her dose, using intuition + BG + carbs to be eaten. It's funny how many times we get it right on.
ReplyDeleteThen we moved to full strength insulin a few days ago and it's like we're fighting in the dark. It's been frustrating, so we're moving back to diluted.
Yeah, I've been reading about that. I hope it goes well for you. I take some comfort in the routine now, and breaking it (and seeing bad results) has got to be tough.
ReplyDeleteMy CDE taught me a lot about how to make these kinds of decisions. It's important to understand that it's OK to be wrong sometimes. :)
We're back on diluted and we've had great numbers today... You're so right, it IS hard to move outside your comfort zone and it sucks when it doesn't work. Worse, I feel like I failed my daughter somehow.
ReplyDeleteWe'll be sticking with diluted for awhile, I think. Or at least until we're giving her something like 30 units of DH!
Yeah, today was a crappy day for me - Training class during the day plus holiday party at night. I hit 48 in the morning and 232 at night - and this with 18 units of Novolog in me.
ReplyDeleteIt's easier for me, I think, because it's just me. I have three kids so I totally understand the burden of parenthood, and feeling that you're failing your child.
Best of luck with diluted. It's like several DOC writers say - no one understands the mechanics of insulin resistance, so if you've got something that's working you should have a really good reason to change it.