I use the tandem control iq and am frustrated with myself as I tend to spike up to the 200s when I have more than 20 grams of carb. I don’t seem to be able to time the prebolus correctly. I am open to any tips or advice.I will admit to being impatient as well as having a bed habit of overcorrecting highs caused by this lack of sufficient prebolus but it sure seems a lot of people have it down cold. NOt me and I do desire to do this well. Just really discouraged about it right now.
Are you eating things with just carbs, or do you include fats and proteins?
Many carbs will digest quickly, but additional fats and proteins can slow down hitting BG quickly.
How long do you wait after bolus to eat?
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I suggest using your CGM to identify the optimal pre-bolus time. Stephen Ponder of Sugar Surfing fame, calls this, “waiting for the bend.” That “bend” is the downward inflection of the glucose line following a meal bolus.
Other factors also influence this, however. Your other pump settings, such as insulin to carb ratio, must be set well for this to work.
If your meal contains portions that are distinctly protein, fat, and carbs, try eating the fat and protein first and finally the carbs. And don’t, for goodness sakes, drink any carbs!
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I wait 15 min and mostly carb fat protein combo.
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If you are getting quick spikes, you can try 20-30 minutes. Which insulin do you use? Some are faster than others.
With tandem pump, also look if your basal first drops your bg, and check if pump has reduced basal just before meal.
When i see a low/zero basal at mealtime, i will bump up my meal bolus.
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You are NOT alone!!
Many struggle with this I think.
I go with 20 minutes when I can. Which isn’t always. Like in restaurants. Who knows when the food will come? Don’t bolus too early! ( done that). When the food arrives? D’oh!
One method is to take some insulin at time ordered, and remainder when food arrives. Having snacks with you, or ordering appetizers can help too.
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I have a love/hate relationship with Control IQ. IMO it is great at preventing lows but poor at preventing highs.
Mealtimes can be problematic for a couple of reasons.
One thing to consider is have you had basal reductions and/or suspensions in the hours leading up to a meal? Although those suspensions/reductions prevent lows in the present, they often set you up for basal deficits and therefore highs in the future. And that can coincide with a meal.
One way to measure that is after you take your meal bolus, does the IOB (Insulin on board) reflect the total amount of the bolus? If I bolus 2 units for my lunch and the IOB only shows 1.5 units afterwards, then I know I have a basal deficit of 0.5 that shorts my meal bolus. So I often take another .5 bolus to make up that deficit.
A very knowledgeable person on Facebook told me that was a bad thing to do because it messes up the Control IQ algorithm. I disagree. Yeah, I didn’t need that .5 basal previously and that reduction in basal prevented a low. But I am eating now and I know I need the full 2 units for my meal.
Or some people just have stronger carb ratios for meals to make up for Control IQ basal adjustments.
And if you are at a good BG and pre-bolus for a meal, Control IQ often shuts off your basal because it thinks you will go low. Some people estimate what the missed basal will be (for example if your basal rate is 1.0 per hour, 20 minutes of a pre-bolus would be about .35 units) and they add that to their bolus.
None of these things above are a complete magic fix, but they all suggest that you may need to feel free increasing your mealtime insulin. Sometimes I do that with an extended bolus so it doesn’t all hit as a pre-bolus.
And one more thing to consider is that Control IQ is really easy to turn off and turn back on again. Sometimes I just turn it off so I can do things like temporary basal rates or have my BG drop in the 80’s and 90’s before meals without Control IQ reducing my insulin. Just remember that when you turn it back on, you need to turn back on Sleep whether you use it all of the time (which I do) or have a Sleep Schedule.
I think that the biggest problem with Control IQ and probably all insulin regimens is that our insulins are just not fast enough to combat highs after basal reductions and suspensions.
And we also don’t know “how good” do we have to be. Are we driving ourselves crazy trying to combat the limitations of Control IQ?
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I wish it would take into account that the meal bolus means don’t adjust basal, food is coming !!!
But i do same when i see zero or reduced basal prior to bolus, but its still tricky to get it right.
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I agree Laddie. It’s kind of crazy making trying to out think the algorithm. I also wish it could react faster.
My issue is that when I run high, I believe I get some insulin resistance, making me need even more insulin. I’m not sure control iq can handle that change.
Sometimes I go high like 180 and it just stays there I can’t get it down even while my basal is being increased.
I have battled this by taking a small dose of lantus each morning. I’ve been experimenting but I think 10 units works best. It keeps me from those stubborn highs and it also keeps me from dropping low from reactive highs.
I just got my a1c at 5.8 which is kind of the same as it was without the lantus, but I think I’m in range longer so I’m still continuing it.
But it also keeps me lower at night in the high 90 s instead of 112.
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I haven’t added Lantus to Control IQ in quite a while, but I have definitely experimented with the Untethered approach. I take the long-acting insulin in the evening because I only want to do 1 injection a day and I want my strongest action overnight and into the morning. But then I get tired of the phone alarms to take the injection and eventually abandon it.
But over the next month, I’ll be having vacation time with grandchildren and will do a lot of swimming. It always helps to be untethered for that so I can have pump-free time.
So maybe today I’ll take some time and figure out a new Untethered profile for my pump.
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I usually wait until im trending down and then start eating. The amount of time usually depends on how high i was when i bolused.
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When I was on Novolog I would pre-bolus 15 minutes prior to food. When my insurance switched me to Humalog, my doctor said it takes longer to activate so now I inject 20-25 minutes prior. Or I overdose the insulin so I have an excuse to binge donuts. Depends on my mood.
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I use 20 minutes usually but make minor adjustments depending upon BG. However, I lower my Humalog dose by 2 units and take Afrezza when I start to eat. If you can get Afrezza, it’s like a miracle drug IMO - acts in minutes and quits completely by 2 hours. Check out more info for this and tons of other issues at TCOYD: http://tcoyd.org.