Back on it

After being off the CGMS for a few months, I decided to give it another try yesterday, and what do you know, numbers have been right on, but what is freaking me out is to see how high I can spike just after a meal.

Does this bother anyone else and I know that I can try to alleviate this by bolusing earlier, which I always, always forget to do, I am a shoot and eat type?

What I am also doing is correcting these spikes too soon which is causing lows, wow 2 days and a lot has happened ;).

Soooo does seeing these spikes bother others on the CGMS?

Bolusing before eating really does help smooth out the spikes. I’ve been trying very hard to do that even if my BG is already on the low side to begin with. I can see on the sensor that I peak anywhere from 45-75 minutes after eating. I’ve managed to stay almost flat on the graph by bolusing at least 15 minutes in advance. Sometimes I worry that the sensor has died so I check with the meter, even if it’s only been 50 minutes since I ate, and the meter backs it up.

I always used to shoot & eat and I’d be fine at the two hour mark, but I know my spikes must have been much higher and happened sooner.

Do you watch your trends before you eat? If my trend before I eat is going up, no matter what the number is, I will give myself 10% more insulin. Same with the trend going down. I also notice that I spike more with breakfast than any other meal, and I think that it is due to no fat, all carbs. I especially make sure I bolus about 20 minutes early for that meal.

I don’t have a CGMS, but I was also noticing the spikes with regular testing.

Along the lines of what Liz and Toni recommended, here is what I’m trying now.

I use a dual wave bolus on the pump and give 50% of the insulin up front, 50% over 30-60 minutes.

If I’m <80, I eat after 10-15 minutes
If I’m 80-100, I eat after 30 minutes
If I’m >100 (most of the time), I eat after 1 HOUR!!!

I don’t do this all the time, but when I do, I notice that the spike is much less, BUT since i don’t have a CGMS, it could be that this is not the best, but it seems to be working for now. This article, which was posted by Scott convinced me that I should use dual wave boluses all the time.

I had peaks UNTIL I started this system. I don’t completely understand WHY it works, but I have found that it does work. Here is my best attempt at explaining it.

If I took all the insulin an hour before eating, I would have terrible lows. If I take it as a dual wave bolus with only half the insulin upfront, then my blood sugar already starts to drop while I am eating. Then the rise of blood sugar from the food is immediately counteracted by the insulin without ever needing to go above 120.

It is all about timing the insulin and the food correctly. By splitting up the insulin and using the dual wave bolus, I also prevent such dramatic swings in my blood sugar. If I go low, I don’t go low as quickly as if I had given it all in a single bolus.

I would love to try this with a CGMS so that I can figure out the right timing. Perhaps I should be giving the dual wave over 15 minutes, or 30 minutes, not one hour. Some day perhaps I will get to try this out with CGMS.

There are several other people in this community that use dual wave boluses to avoid post-meal spikes. I couldn’t understand the logic of it at first either. BUT trying it showed me that it does make a difference and the real advantage is being able to wait til your blood sugar is dropping to eat without it dropping too low.

Perhaps someone else can offer insights on this, as I am new to the dual wave bolus!

Here is a link to an old discussion, where we discussed similar issues. This was the discussion that encouraged me to start experimenting with early bolusing and dual wave boluses.

Click here

I found this out too when I started my CGMS…I had been told by the CDE at the endo I fired to shoot and eat right away to prevent a low as I am very insulin sensitive…however—I didn’t recheck this with my current CDE at new endo—when she trained me for my CGMS she was walking through my pump and said why aren’t you dual waving—and a few other tidbits—anyway… now since the CGMS dose 15min b4 eating use a dual wave 60% plus any correction upfront (as long as not over 3 units–rarely) and the rest over an hour…amazingly flat (well–wiggly,but no spikes) lines now and have all but gotten rid of my lows (an occasional sneaky one-but not several times daily.)

I no longer feel like I am on a roller coaster–and I was on a serious roller coaster before the changes that I have been able to make with the CGMS–best thing I have fought the insurance hard for in a long time!

Also been able to reduce my basal from 12 to 10.5/day–5 different settings during the day

I have very accurate readings with CGMS–except if I get dehydrated