Basal vs. Bolus increase?

Diabetes Technology Insulin Pumps
1

Hi,

I'm wondering if anyone can offer some help on determining if a high is coming from needing a higher bolus ratio, or a higher basal level. i've never really had to chage my bolus/food ratios, which is why i'm a little perplexed.

this morning, pre-breakfast i was at 80 bg. one hour after eating i was at 165, and then 194 after another 45 minues.

this afternoon, pre-lunch i was at 122. one hour after eating i was at 233.

normally if i start under 100 my 1-hour post-prandial is 145 and then curves downward. i'm used to adjusting basals, but usually see this need arise when my 2, 3, and 4 hour post meal is high, not the one hour.

Does anyone have insight into this?

Thanks for your help!

2

How old was the infusion site? Sometimes I see both basal and bolus insensitivity issues if the infusion site is going bad, or has been in place for too long. I assume you were not fighting an infection or anything, right?

3

i changed the set yesterday evening, and have no infections. it may be worth it though to change the set again, to be safe…

4

But to answer your question, I’d always adjust bolus size before tweaking basals. It sounds like you are really diligent about testing and making necessary adjustments, especially when something odd seems to be happening. My tendency is to get frustrated when the tried-and-true ratios seem to get out of whack. Usually, changing the set is a good place to start. But sometimes, it’s just a temporary condition such as stress or hormones that can cause ratios to be temporarily wrong. Does your pump have a “combo-bolus” feature where you can spread out a bolus over a specified period of time?

5

According to your sugars, it looks like you need to change your bolus rates. It is always recommended to check your sugars before you eat and two hours after you eat. Also, if you are eating a high carbohydrate meal, I would recommend using TAG meal counting. You can research more about that on this forum, just type it in the search box. TAG show you how to do two things:

1.) It shows you how to not only count carbohydrates, but also protein and fat. All 3 of these things turn into sugar once digested, therefore, they too need to be accounted and bolused for.

2.) TAG shows you how to do a combo bolus. This is important beacause meals high in carbohydrates take longer to digest thus increasing your blood sugar later on down the road, like 2 to 4 hours instead of immediately after you eat. Pizza is one a good example and food item that I always use TAG on. Example: If I wanted to eat a personal pan pepperoni pizza from pizza hut and my sugars go out of wack hours after eating, I would use TAG.

Total fat 29.0g = You take the total grams of fat and times it by 40% or sometimes 10% depending on your need. 29 * .40 = 11.6 units

Protein 28.0g = You take the total grams of protein and times it by 10%. 28*.10 = 2.8 units

Carbohydrates 67.0g = You do your normal carb to insulin ratio. Mine is 1 unit for every 5 carbs. So, I would get 13.4 units

Then next, you would add them all together = 27.8 units.

Next, you would use a combo bolus on your insulin pump. you would get 13.4 units right away and get the other 14.4 units over a time frame of about 2 hours. The time needed to extend the second portion of the bolus depends on your needs.

Next, I would recommend checking your blood sugar every 30 minutes to an hour or so after you eat to see how the TAG is reacting with your bolus and food. This technique has worked wonders for me!

As far as seeing about your basal rates, i would do a block blood sugar test. This is where you set aside blocks of your day (24 hour time frame) and do not eat or drink. During this time, you would test your sugar every 30 minutes or so to see what they are.

For instance, from 8am to 4pm, I do not eat anything. Check my sugar and write it down.

The next day, do not eat from 4pm to 12am. check sugar and write it down.

The next day, do not eat from 12am to 8am. Check sugar and write it down.

You can take those results and discuss them with your doctor or make your own tweaks depending on your results. I usually tweak mine myself.

It’s a lot of info, I apologize, but I’ve been in your shoes and this has worked for me! When in doubt, just call the Endo! Good Luck!

6

I’d want to see a pattern over a number of days, not just a one-off before I’d be thinking about making changes. You might just have been having a totally off day for any number of reasons.

Some suggestions on what to look for have been made, including basal testing. If it was me, I wouldn’t bother unless I saw a pattern over a few days and after another site change.

I have to adjust my basal seasonally, and usually just at certain times of the day. Unless you’re eating the exact same thing every single day for a few days and doing the same activity, and getting the same results, you can’t assume it’s the bolus either. Even then, is your carb counting accurate? Know what I mean about the many variables?

How’s it been for you today?

7

There is also an exercise in the Animas user workbook. Look at that also. It helped me but is a little too complex to explain.