Can You Help Me Troubleshoot?

Type 1 and LADA
#1

I need some help with my 670G. I’m running auto mode. My blood sugar is running high long after it should come down post-meal. The last week it’s been staying at or increasing to around 200 between 10-11:30 am and then again at 3-4 pm. Unacceptable. So I’ve reduced carb ratios and over estimated my carbs (based on my reasonable guesses by reading labels) also today I took a bolus by going out of auto mode and then back in about 15 minutes later.

The durn thing quit giving me micro boluses for 45 minutes after I took than manual correction, so now it’s only 150. I only ate a max of 35 carbs today but bolused for 50, just to catch phantom carbs and any extra carbs floating in my fats/condiments.

I’m at 1:8.5 carbs during the day, I’m afraid to go much lower because I don’t want to crash and my 1-2 hr post meal #s aren’t bad. My active insulin time is 2 hours. And my bolus/basal ratio is 52% v 48%. So pretty optimal there.

What else can I do to make it run at 120 instead of averaging 160?

I do have an endo appointment on 9/25, so if it’s not solved with us, I can always ask for more help. Maybe auto mode doesn’t work for me…

#2

Sorry youre having these issues…it can be frustrating. Did you change your duration time when you went into auto mode? For example, on all other pumps Ive used a duration time of 3 hours (YMMV of course) but in auto mode its set at 2 hours. Its a widely known issue having to do this, so just asking.

#3

check your insulin sensitivity. It may be set too long. Many of us have found that 4 hour sensitivity is just way over estimated. Think about backing it down with your doctors help of course by 15 minute segments. In my area we start people on 3 hours and often see them go up or down by 15 minutes. however some folks have found they are as high as 5 or 6 hours while other in the 2.00 range.

Note: I am a Medtronic ambassador. No I did not get anything for this honor. OK, I confess I got a shirt and a cup but even I have a bigger price than that.

#4

Rick, I think you meant insulin duration. :wink:

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#5

My AIT is set at the minimum. 2 hours. I wish there was some other factor to play with… :flushed:

#6

Maybe your food is digesting faster than the insulin is being absorbed since your post meal BG’s are OK. Have you tried pre-bolusing?

#7

That was my experience with it. Bottomed out the AIT and still couldn’t get back to where I was before automode. AIT is the most powerful parameter of the two (!) that you’re allowed to adjust, and generally it makes the most difference. But I also played around with setting different I:C ratios. The lore on that–whether it makes any difference to microbolusing as well as bolusing–is mixed, but since it was the only other thing I could adjust it seemed worth a try. It seemed like maybe it was helping a bit with DP, which was my biggest frustration, but when my a.m. BGs started drifting back the other way again I finally said to heck with it. The delay between making an adjustment and seeing the effect when it’s integrated into the algorithm was a big part of the problem: was it because I:C didn’t really matter and the marginal improvement was just a coincidence? Or had the algorithm changed its mind about something and I just had to give it more time? Or… or… or…

I don’t mind a bit of wait-and-see, but after six months of waiting and seeing I figured I’d pretty much plateaued and it wasn’t at a level I was happy with.

ETA: when they do the next release, if they would just allow a leeeetle more leeway with AIT it might make a huge difference to those of us who finally gave up on the thing. Of course that won’t be a mere software update, since only Tandem has that very modest but very obvious capability. You’ll have to buy a whole new chunk of hardware, and in my case wait another three years for the privilege. Meanwhile I’ve got a very expensive paper weight, having gone back to my old Paradigm which has far fewer annoyances as a manual pump. Ridiculous.

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#8

Guess what? I think I fixed it!!! I lowered all my carb ratios by at least .5 carbs so from 8.5 to 8 or 9 to 8.5 and I think it just might be aggressive enough now.

I didn’t think about this, but autocorrect stops the severe lows that I was afraid of. So I’m doing well. It gives me more at meals and then kicks off for a bit. (I prebolus by at least 10 minutes, sometimes 20) So it’s steadier, but not crashing. And it’s more aggressive…

I think it might work! Thanks for suggestive getting agressive with changes!

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#9

sure did , sorry !!!

#10

I have recently been told to use my temporary rates. My Endo did not like that I was adding carbs just to get the bolus.
Even keeping to ten carbs at mealtime, from salad and green veggies, my bg shoots up.
I’m experimenting with adding extra to my basal to keep it from going over 200 when I start from 86, and am only eating green veggies and protein. I even add for the protein. I have also been delaying eating after giving the bolus for 10-20 minutes.
The temp rate (I start at 115% of basal, and have gone as high as 150%) makes me feel slightly more in charge of it. The basal rate the Endo set keeps it level, but my problem has been bringing it down without crashing. It goes up, then doesn’t come back down.
I just keep adding percentage of basal until my bg starts coming down, and when it’s in the range I want, I cut off the temp rate.
So far, that’s been working. I just read that someone had a temp rate for drinking black coffee, instead of extra bolus… i an trying that approach now… raising the basal rate as well as bolusing for carbs. Otherwise, it seems I would be adjusting my carb rate for everything that I eat… plus, when I tried over estimating the carbs… I’d still get the highs, but then crash… and the Endo also didn’t like it, because it made it hard to figure out what I was eating… especially when I wasn’t, & it was just for adding insulin…
Don’t know if this helps… tonight is the first time on this forum…
This has been a great discovery!

#11

Allyson,
You should test your basal rate for one period. My basal rate is highest between breakfast and lunch. So don’t have breakfast one morning. Test you basal and see if it too high or too low.

If you have a CGM then I would skip breakfast and look at your BG readings. With Dexcom I can look at a report and see BG every five minutes. If you don’t have a CGM then you will have to test you blood every half hour. You can then determine what the basal should be for each hour. Hopefully the basal will be the same for several hours.

An example. If you BG keeps rising then your basal is too low, If it stays the same basal is just right. And if you BG is falling then your basal is too high.

One example. Suppose your insulin sensitivity is 50. That means 1 unit of insulin should lower your BG 50 points. Or .1 units should lower your BG by 5 points. So check your BG. If it is 140 to start and 160 after 1 hour than you have changed 20 points. I would say your basal if obviously too low. I would guess it is low by .4 units but I would test it by raising it only half that and testing it tomorrow.

Once you get your basal right, you can then increase or decrease your carb ratio via trial and error. Maybe this will help.

#12

BTW, I’m adjusting stuff for the micro-bolus rates to be more aggressive on a Minimed 670G, so temporary basal shouldn’t be the key because it will never adjust the algorithm that way. I bet Alyson is using a different pump model?

#13

Must be. “Temporary basal” isn’t a thing in Auto Mode, because microbolusing doesn’t work that way. It has a set target, not a set rate. You can set a temp target of 150 (usually intended for exercise) but that’s it.

#14

Go to options, then to active insulin time, and check the duration. CDE’s disagree on where this should be. But I had a similar issue to what you are having. I changed the duration to 3:45 and the promblem improved. I have been told that I can take it all the way down to 3 if needed. Right now 3:45 works for me so I’m keeping it there. I would make the change gradually - look at where you have it set now and take it down in :30 intervals until you seem to have licked the problem.

#15

You know, I finally went to my new endocrinologist last week. They were shocked at my active insulin time (NP and Dr.) and moved it back to 4 hours. They also moved my carb ratio to 1:10 all the time and said they don’t vary it hardly ever. And I was like whatever, you’ll see. But it hasn’t been horribly higher than it was before. I don’t know. This algorithm will worry me for the next 15 years, I’m sure. I hate losing control.

#16

That’s interesting. I have four different IC ratios - morning, lunch, supper, and late evening. I see a lot of posters mentioning they too have varying IC rations.

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#17

I know. My Minimed rep who trained me suggested setting it to match my basal/bonus rates from before so we did 4 to compliment my previous rates. I think because it was first appointment they were getting a baseline for me. I’m just going to ride it out. I’m meeting with the local Minimed rep and an RD very soon to get some more help and just meet local peeps.

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