There is a downside to every huge upside — something you can prove in life, money and diabetes. It’s called opportunity cost. Diabetes is a math game. A really annoying one where the rules always change.
I wrote about feeding the basal with enthusiasm. However, I forgot to mention a very key downside that hit me recently. Basically, I take more basal (currently Lantus) than I need to keep my BGsat 115 (my target, not my goal). Therefore, if I do not eat, I will go low. Not a problem with exercising (exacerbating the lower need of insulin), I eat and want to eat constantly.
Got home late last night at 8pm with a BG of 80, I proceeded to eat 90g, bolused correctly. I continued to feel hungry, and therefore continued to eat (an unknown amount via blind eating for an hour plus). Falling asleep with a BG under 100, I felt good. However, bolusing for blind eating is tricky, especially so close to bed time – so I made a guess. The guess was wrong — by a long shot. I woke up very early and was very thirsty — the cue to know instantly I am running very high.
The worst part about being high is how difficult it can be to come down. The usual ratios do not work. If you are 1u:60 points when you are 200-275, everything over 275 may take more insulin to bring down. So from 275-350 you may need 1u:40 points, and anything above that may need 1u:30 points. Basically, the higher you get, the harder it is to fall. In my experience, I really hate to do this kind of math when realizing a high BG and just do a normal 1:60 correction. However, in an hour I will see that I am not coming down fast enough.
Given the above situation, let’s say I was 400 and want to get down to 115. I would need 1.6u to get me to 350 (1:30), 1.9u (1:40) to get to 275 and 2.6u (1:60) to get to 115. For a total of about 6.1u — versus about 4.75 that I would take using my 1:60 baseline approach. The difference? 1.35u or about 80 BG points.
Guess what happens when I used 1u:60 this morning instead of my more complicated formula? I was 260 3.5hours after the correction. Makes sense, since 80 points higher 3+ hours ago can easily translate into an additional 65 points over a few hours of higher BG.
Moral of the story
1. Watch what you eat before bedtime. It can really mangle your morning.
2. Feeding your basal has the side effect of giving you lower BGs right now (as does increased metabolism from exercise) but Carbs on Board may not appear till later in your BG. Must have enough insulin to cover.
Nb. These are my numbers — that work for me. Your numbers will not be the same as my numbers.
Nb. Blind eating is a curse for diabetics. It’s something I know I should never do, but I do it. It causes havoc to my numbers, but I doubt this will be the last time I ever do it.
Blind eating is something I struggle with too. It’s human to do it, and inhumane for us not to be able to.
I too really fight with highs and having my normal correction factor not do the trick. Another problem that gives me is that I tend to over-correct when I’m high, then crash. I get so frustrated when I’ve corrected a couple times and am still not where I want to be. Like you say, the rules are always changing.
Good point about over-correcting and crashing. I only ever had that problem when correcting a BG under 180 or 200 — that is mainly because of the inaccuracy of the meters. So I stopped correcting until I am over 200 (and let it come down naturally) — something I know many other athletes are doing because it is pretty easy to bring a 200 down to 100 in a short amount of exertion.
One other scenario of correcting BGs is time of day. Early in the mornings and late in the evenings the body really isn’t running at peak performance and it can take a lot more insulin to get you down. What range of times is another very personal thing too. When truely accurate BG readings comes to market we might be able to make some better guesses.