# High bg



## delb t (Apr 25, 2014)

OK so we have been having HIGH bg's for the last 2 weeks as soon as we got on a plane things went to pot!-we followed all changes discussed at clinic- altered lantus / ratios  altered lantus mid holiday changed vials it was driving us nuts.Numbers before bed were silly  20.9   19.2 etc-  so we used the correction sum given etc. I suddenly wondered maybe this correction sum may have changed as weight/height now different to 2 yrs ago!.I got a cancellation appt at clinic - and yes a different calculation now- Feel dim that it 2 weeks for me to think this! but thought it may be of use to mention


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## Hanmillmum (Apr 25, 2014)

There is far too much to consider though so don't be hard on yourself  It's a good point though with growing, we have had a recent increase in basal rates due to growth spurt - not easy


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## delb t (Apr 25, 2014)

Well Im pleased to say a 6.4 on waking -the best morning reading for 2 weeks!- Surely this correction dose sum should be reviewed at each clinic appt - its never been mentioned in over 2 yrs


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## Hanmillmum (Apr 25, 2014)

Hmm 2 years is a bit of a stretch isn't it ? - after all they stick them straight on the scales and measure height, which is charted by them - surely they are plotting the increase ?


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## Sally71 (Apr 25, 2014)

We just had annual review this week, consultant looked at all the records of BGs and declared that after every high BG (whether mealtime or otherwise) the next one is normal therefore our correction ratios are working well.  Were told the same thing 3 months ago too.  Would have thought that they should check that every time for everyone really.

We are now doing a basal review this morning - oh joy - sugar free jelly here we come!!


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## Redkite (Apr 25, 2014)

Just to say, don't wait for clinic and your consultant's input to change your correction ratios!  I keep an eye on my son's TDD and regularly alter the correction factors as and when needed, using a guideline of 100/TDD and adjusting for night times when he needs less of a correction to achieve the same result.  His correction factors are currently on 1 unit to 3mmol in the daytime (1:3.5 at night), but a couple of weeks ago he was only needing 1:4.  It varies all the time with growth and activity, so we'd have a terrible time if we only changed it every 3 months at clinic 

P.S. I look at the trend in his TDD over the past week or so, I don't change the correction factors for a one-off higher day.  This is easy with the info stored in the pump, but on injections you'd need to be a meticulous record keeper!


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## delb t (Apr 29, 2014)

Well we seem to be getting back on track- Redkite am I being dim-what does 100/TDD mean?- I rang on sat and now corrections are BG-9 divided by 4 night 
                                                            BG-7 divided by 1 1/2 day
Also now tweaking meals - which weve always done one by one
we have never felt that confident up to now tweaking corrections - but Im on the case!


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## Redkite (Apr 29, 2014)

TDD = total daily dose, ie. basal + bolus.  As this will vary depending on meals eaten, I look at the average TDD over the past 3 or 4 days.  As a guideline for a correction factor, use 100 divided by TDD.  For example, if basal+bolus over 24 hours is 20 units, the correction factor would be 100/20=5 (ie 1 unit of insulin should reduce BG by 5mmol).  We correct down to a target of 7mmol, so for example if the BG was 14.5, the correction would then be (14.5-7)/5 = 1.5U.

Whenever basal is going up or down, the correction factor will definitely need reviewing too.


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## delb t (Apr 29, 2014)

Thanks Redkite- will try to get my head round the maths!- to add they say H is on a relatively small amount of insulin both basal and bolus esp basal does that make a difference to any calculations- were dx 2 1/2 yrs now


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## Redkite (Apr 29, 2014)

Don't think so.  The 100/TDD is a guideline/starting point for calculating a correction factor.  If it doesn't work for him it can then be tweaked.  I think I may have got this originally from Ragnar Hanas


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## everydayupsanddowns (Apr 29, 2014)

There seem to be a bunch of those guidelines/starting points knocking about. 100 rule... 500 rule... 1200/1500/1800 rules. Walsh/Roberts use a number in pumpin insulin and often give options based on how aggressively you want to tackle things and/or basal:bolus splits.

I think they can be useful as a place to start - but as Redkite says you'll need to evaluate whether those number/ratios/correction factors are actually doing the job as hormones and growth spurts ebb and flow.

At the end of the day it boils down to basal testing and then if BGs are always out of range 4-5 hours after food, or corrections just don't do what you want them to (either too much or not enough) then you need to tweak and try again.

I find making % adjustments helpful so I don't overdo it. 5-10% if only a bit out 10-20% if more drastic action is needed.


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## Tina63 (Apr 30, 2014)

We were never even told to correct! Nor have we EVER been told to adjust ratios from 1u/10g carbs. How shocking is that?


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## delb t (Apr 30, 2014)

Shocking!!! Great to see you back- Hows it all going?


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