Little Changes, Big Difference - Part 5: Mastering the Correction Bolus
Over the past few weeks, Kelsey's implemented a system of working smarter, rather than harder, to maintain her blood sugars. Follow along here to find out what she's learned!Little Changes, Big Difference
The final reminder that has helped me to tighten my blood sugar control, without a lot of additional effort, has to do with correction boluses. If you are trying to achieve normal blood glucose levels you have to deliver correction boluses regularly. Anytime your blood sugar is higher than the range you're shooting for (under 140 mg/dl when you're pregnant or trying to conceive) you should bolus additional insulin.
Correction boluses can be tricky, however, because there are many variables that contribute to rising or lowering blood glucose levels. You have to take into consideration how recently you've eaten, your activity level, and the composition of any food consumed before you go off and "rage bolus" for a high blood glucose number. For instance, if you eat something with a high GI figure such as most breakfast cereals and test your blood about an hour later, you're likely to see a result that's out of range. However, adding a correction bolus at that time will probably send your blood sugar too low because of how quickly the cereal will spike your blood sugar in relation to the efficiency of the meal bolus you'd already delivered.
Giving a correction bolus too early is a common mistake; I'm willing to bet it's happened to all of us. But, correction boluses are very helpful in maintaining tight blood glucose levels, if you give careful consideration to when you use them.
One of my favorite techniques is called the "super bolus." Basically, you test your blood sugar about an hour or so before a planned meal. If your blood sugar is high, you deliver both a moderate correction bolus and your meal bolus simultaneously. This will lower your blood sugar efficiently before you eat again. Or, if you know you're going to eat soon but you're not sure what the content of the meal will be, you can deliver a more aggressive correction bolus and wait to take your meal bolus once you've settled on what you're consuming. This will keep you from having a subsequent episode of hypoglycemia if you end up having less carbs than you planned for.
The trick with correction boluses is having a good idea of when you're planning to eat again. The little reminder note in my meter case says: "Correction bolus: When will I eat again?" Since eating with an already high blood glucose level is a sure way to keep your blood sugar high constantly, it's important that those pre-meal levels are as normal as possible. Thus, your correction bolus should be directly proportional to when you plan to eat next, and what you're planning to eat, for that matter.
The other night, Dennis and I boarded the San Diego trolley to go catch one of the Chargers' preseason football games. I tested as we left and saw that my blood sugar was 156 mg/dl. Typically I'd give a correction bolus of .50 to .60 unit for that number. However, since it was early evening (the time of day when I need less insulin) and we weren't necessarily planning to eat at the game, I decided to just correct with .35 of a unit. An hour later my blood sugar was 148 mg/dl and it slowly trended downward until it landed at 94 mg/dl and we finally ate dinner around 9:00 p.m.
So, I could've given myself a more aggressive correction bolus before the game, and my blood sugar would've gotten back to normal faster. However, that would have required me to eat sooner. Part of the gloriousness of an insulin pump is the freedom it gives you to eat when and what you want (within reason). We chose to skip the fatty, sugary stadium food and enjoy one of our first dinners out since Sienna was born. We ate late, but it was wonderful!
Correction boluses, then, have their place. I like to use them in conjunction with my meal planning so that I don't have to treat unnecessary lows throughout the day, but on the other hand, I do get those pre-meal numbers down quickly.