What is a correction bolus?
• Corrections can be given at bedtime if the
A correction bolus is an additional dose of rapid
acting insulin, like NovoRapid or Humalog,
injected to immediately correct a high blood
glucose level (above 8 mmols/l). A correction
ratio is calculated for each child following a
multiple daily injection regimen.
Why do I need to correct’ high glucose levels?
Even if occasional high glucose levels do not
make you feel unwell, over time they can
contribute to worsening your HbA1C (glycated
haemoglobin). Complications are rarely seen in
children but we know that good diabetes control
reduces the risk, even into adult life. There is
good evidence to suggest that taking action
to correct high glucose levels helps to improve
diabetes control.
What is glycated haemaglobin?/What is good
control?
Glycated haemoglobin / HbA1C is a longer term
measure of your blood glucose control; over
about 2 months. Sometimes day-to-day blood
glucose levels can fluctuate and this measure
should give you a better idea of how well
controlled your diabetes is.
The units of measurement changed in 2011, for
good diabetes control you are aiming for an
HbA1C 48-58 mmol/mol .
Day-to-day you are aiming for blood glucose
levels tested at home to be between 4-8 mmols/l
How is my correction ratio calculated?
Each child has a sensitivity to insulin (that is how
insulin affects their blood glucose level) based
on age, weight, total daily insulin needs and
how long they have had diabetes. The Children’s
Diabetes Specialist Nurses or Doctor calculate this
for you. It is expressed in the following way;
1unit (rapid acting insulin) = ……..mmols/l (drop
in blood glucose level)
What is my correction ratio?
1 unit……… : …………..mmols/l
How do I use my correction ratio?
Correction boluses are used when you are
‘well’, but have a high blood glucose level. It is
important to know that there is special advice for
managing diabetes during illness.
• Corrections are recommended if your glucose
level is above 8mmols/l when you test at
main meal times. You correct down to the
mid-point of the normal range eg 6mmols/l.
(Children with diabetes under the age of
5 years, children using different insulin
regimens and insulin pumps will receive
specialist advice about their correction targets
from the Children’s Diabetes Team).
• When you eat a meal, you are due to
have a dose of rapid acting insulin, so the
correction should be added to the dose you
are planning to have with that meal – if you
add the meal dose and the correction dose
together it means it can be given as one
injection at that time.
blood glucose level is high, but you must re-
check the glucose level after about 2 hours
to ensure it has not dropped too low. This is
especially important for young children
Example:
Correction ratio 1 unit:5mmols/l
Glucose level before lunch 11.9 mmols/l
11.9 (actual level) – 6 (desired level) = 5.9
5.9 ÷ 5 (correction factor / ratio) = 1.1
= 1 unit correction dose.
Round up or down to the nearest half unit (if
using ½ unit pens, otherwise to the nearest
whole unit).
Additional information
• Corrections can be given with every meal, on
a daily basis, if necessary.
• If you notice a pattern of always having
high blood glucose levels / correcting at
a particular time of day, the usual dose
of insulin affecting that time may need
adjustment. Contact your Diabetes Nurse or
Doctor for advice if you are unsure.
• Corrections should not be given more
frequently than 2 hourly due to the risk of
insulin ‘stacking’ and causing hypos (low
glucose levels) several hours later.
• Recently available ‘smart’ blood glucose
meters can help with these calculations
when programmed with individual patients
settings. If you are interested in this, please
talk to your Diabetes Nurse or Doctor about
it.
Where do I get further advice?

Children’s Diabetes Nurses

01823 343666
(Monday – Friday, office hours + answer phone facility -
*Please note same day response cannot be guaranteed)

Email: Diabetes.Centre@tst.nhs.uk
Fax: 01823 343777

If unable to contact the Children’s Diabetes Nurses

and you need urgent advice OR….
Evenings and weekends – urgent advice

01823 342016 Oak Ward

Ask for the on-call paediatric registrar Correction
Boluses for high
blood glucose
levels

Children’s Diabetes

PIL11045/M Gardiner/Jan13/review Jan15