I am using a 770 insulin pump and I am in automode in about 98% of the time. When I eat an eggsalad sandwich my sugar rises after most of the insulin is gone. My question is can I bolus for a carbohydrate to compensate for this rise? Automode isn’t aggressive enough to lower it.
You should be able to do a bolus by switching off auto mode , giving a bolus then switching it back on.
I have a tslim. It allows you to do a correction bolus at any time without messing around with any setting.
Yes. I often include protein and fat, plus carbs in my bolus.
But if this is the only time you’ve noticed this (not consistently), then just add what you did this time.
T-A-G is a way to estimate if you have higher than normal fat/protein, common with low carb dets.
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So far the last 3 or 4 days I have been adding in “phantom carbs” for high protein meals. It is working pretty good and I haven’t messed up the 770’s algorithm. It is basically like doing a dual wave in manual mode IMO. I find automode keeps me pretty level when not eating and curbs my highs when I am.
If you dose phantom carbs, it will appear as if you are eating a lot more carbs than you are. Your pump algorithm is going to adjust for carbs. I don’t know if your doctor looks at your numbers or if you do, but you won’t be able to make adjustments or corrections if your data is all wrong.
On all pumps there is an insulin sensitivity setting. When you are low carb you are less sensitive to insulin so it will give you more insulin when your setting is lower.
If you can tune that setting to be accurate in reflection to your diet, then you won’t have to make phantom corrections and the algorithm will work better.
I went from an average of 90-100 carbs a day to nearly 200 carbs and my daily insulin dose stayed the same because my insulin sensitivity became higher on a low fat diet.
So where I used to be 1 unit:15 carbs now it’s 1 unit for 25 carbs.
Of course that varies depending on what I eat, if I eat cheese or something like that I know it will increase my insulin requirement.
I try to keep a diet of whole food carbs and lower fat, and moderate lean protein.
I only do it this way because I’ve tried everything else and this seems to work best for me.
I also was fighting chronic low blood pressure, and that seems to have subsided, since I switched my diet.
And I don’t go as extreme as the mastering diabetes diet suggests, but I’m moving more in that direction.
I’m not a vegetarian so it makes it difficult to go all in
So is it bad to do phantom carbs when eating high protein or fat? Timothy thinks so.
I can only control my carb ratio and duration of active insulin. I cant control anything else.
I think of them as protein “carbs”.
It depends on proportion of carbs and protein.
Most meals are much higher carbs, so not counting fat, protien is usully ok.
But low carbers, (higher fat, protein), tend to find more insulin is required by trial and error. But pumps only allow carb input, so must enter a higher amount, depending on situation.
If fat, protein is much higher, using extended bolus that covers that portion will often work well.
From above article:
Current guidelines only focus on carbohydrates as the basis for calculating insulin doses; however, data indicates that other micronutrients—namely fat and protein—can affect insulin requirements, and the other issues depend on the type of carbohydrates ingested,
Automode only allows a normal bolus but protein carbs is a better way of thinking of it.
I would like to know how Timothy knows that as he is on a Tslim. I have been adding protein carbs for about the last 3 days and I haven’t noticed anything off just better numbers.
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Glad it is working for you.
Here is past discussions on T-A-G if interested.
It’s not about the protein or the carbs it’s about putting in information that is not accurate.
I mean I don’t really care that you are doing that, but it makes your data less useful.
You don’t know how many carbs you actually ate.
You don’t know how to adjust or fine tune your basal unless you know that stuff.
Don’t let me deter you from doing whatever you like doing.
The carb ratio that is in every pump will correct it so you don’t have to enter false carb numbers
What’s important is finding what works for our own situation.
There are so many variations in our meals, exercise, sleep, stress, etc, all which impact our BGs, insulin effectiveness, etc.
Glad you found what works for you.
Personally, I don’t track how many carbs, and not sure what I would use it for. I do track total daily insulin and basal/bolus ratio, along with cgm trends as key input for analysis.
I don’t test my basal rates. The 770 levels out my basal rates. There is no sensitivity factor. Only carb ratio and duration of active insulin in my body. I use automode 98% of the time.
Carb ratio and sensitivity are the same thing.
On my old Medtronic pump I had a carb ratio setting for bolus and another for basal. I need a lower ratio for bolus than I do normally. And my pump also corrects basal rates, but if your sensor fails you might want your default rates to be close to your needs
I run auto mode in my tandem 100% of the time. I switch into nighttime mode automatically
It’s a really shocking world when I don’t have my sensor running, It’s amazing how good it is keeping me in range
It’s always bothered me that manufacturers, doctors and patients use different names for the same thing.
I’m aware that some people refer to the the arithmetic used to correct a high blood sugar as an “insulin sensitivity factor” or ISF. It essentially means the amount of blood sugar drop one unit of insulin will cause. Another way to refer to this is with the term, “correction factor” or CF. Using two different terms when one is sufficient causes endless discussions like this.
The Insulin to Carb ratio or I:C is the number of carbs that can be successfully metabolized with one unit of insulin. A 1:10 carb ratio means that one unit of insulin can metabolize 10 grams of carbs.
To confuse things, some people started calling this the Carb ratio or even Carb Factor or CF. Wait, isn’t CF short for correction factor?!!
Basal rates have nothing to do with carbs. A well set basal rate is simply the amount of insulin per hour it takes to keep your blood sugar level (not necessarily in range) when not eating. The basal rate metabolizes the glucose released from the liver, nothing more, nothing less. Basal insulin, of course, can be delivered via an insulin pump or a long-acting basal insulin like Lantus, Levemir, or Tresiba.
When we all use different terms for the same things, it makes discussions difficult at best.
My basal bolus ratio is 80 /20. I know this is unusual. My DE knows this. It is because I use very little basal. I am small. 5ft and 91 lbs.
Did you mean 20% basal, 80% bolus?
If so, it’s possible you make some insulin, so low basal.
Or you do higher carbs or dx LADA?
Was your C-peptide ever tested?
I think that the terminology that frustrates/confuses me the most is ISF/CF. In a lot of the Control IQ groups there are discussions of increasing/decreasing ISF. But do they mean raising the ISF number and thus weakening it or lowering the number and thus making it stronger. I understand the mathematics of it, but I don’t always understand what others are saying. Because I don’t know whether they understand it or not. For sure this stuff is rocket science. 
Is the rise coming from the protein in the eggs and mayo or from the bread in the sandwich? Perhaps try a low carb or keto bread and see if same happens? Then work out if need to bonus?