Dealing with Stubborn Highs... followed by extreme lows

I am desperately trying to get out of the rollar coaster pattern! I will go high after meals and then stay there for several hours, despite several bolus dosages. I wil give myself more and more insulin every 30 min and then finally go really low. So frustrating! Has anyone else experienced this? Any advice??

I wonder how high fat the meals are? Does that seem to matter? High fat meals will cause the sugars to keep you higher longer. (I’m not explaining that well AT all but I hope you understand what I mean?) Chinese food, pizza, bagels and cream cheese…are all meals that are hard to manage the insulin on. It is often helpful to extend the bolus with meals like those. (or not eat them which my son isn’t on board with yet)

That happens to me when I eat steaks and high fat foods. You can’t go by the carbohydrates if you eat a lot of red meat because there’s hardly any but 2 hours later my BG is very high and I also have to inch it down. It’s not good to keep bolusing every 30 mins. because you still have a lot of insulin working in your body and that’s why you bottom out after a few hours. Like Dinah said, extending the bolus with high fat meals is better than constantly giving corrections. If it’s happening after very low carb, high protein meals I would discuss it with your doctor to adjust your bolus numbers. Good luck.

What could help is to bolus 20-30 mins prior to the meal to give the insulin a head start. Also do you find that when you are really high it takes more insulin to bring you down then just a mild high? If so you should increase your correction boluses the first time to avoid multiple boluses. I have found that when we are really high it could take as long as 1.5 hours before you start to see a drop. hope this helps.

I agree that you should try bolusing farther ahead before meals. That’s what many of us have learned to do to curb post-meal spikes. I don’t always remember, but it’s so helpful.



Secondly, my CDE makes me promise NEVER to correct a high after a meal until the 3 hour mark at the earliest. I had a habit of seeing a stubborn high at 2 hours postprandial and then correcting and then going low. That insulin is still active in your system, whether you think it’s doing its job or not.



Third, consider your portion sizes and your starting blood sugar. That more carbs you eat at that meal, the higher your post-prandial is going to be. Some people wait to begin eating until their blood sugar shows a downward trend or is under 140.

I have the same problem. I am trying to accumulate examples to show to my CDE the next time I see her and see if we can develop a course of action.

She (my CDE) did tell me that diabetics tend to become insulin resistant at high BG levels and recommended that I do a temporary increase on my basal. (That is not for highs after meals, but for persistent highs).

Thanks for the comments! My persistent highs are not after high fat meals – usually after high carb meals like cereal with a banana. I just started on a Dexcom Monitor so maybe that will also help my CDE pinpoint the problem. Interesting comment to bolus 20-30 min b4 eating and waiting till I’m 140 and going down to eat. That will take extra planning, but it’s certainly worth a try.

I only eat cereal with a banana once in a while. Seems no matter how much I bolus for it, my BG goes extremely high and very hard to get down so I try to stay away from that combination. I’ve found that if I exercise for a half hour after eating my BG is more stable when I have a very high carb meal. Sometimes I’d rather bring it down by exercising then taking a lot more insulin. But that’s just me.

I have had the same issue in the past. I found it depended on the meals I was eating, and on how carefully I carb counted and bolused. I also have differing needs for insulin depending on my activity level in a normal week. At work I don’t need as much but at night when I am lazy and sitting around I need more. It took me a little while to tweak my settings on the PDM but lately it has been spot on.

What really worked for me was checking my trends for BG and insulin delivery, tweaking the settings and basal programs accordingly, and making better food choices. I felt like at first the OmniPod didn’t have a lot of room for mistakes in insulin delivery. If I was off a tiny in my carb count or ate too many carbs it cost me. I also see the difference activity levels have with insulin needs way more than when I was doing MDI. One thing that I was frustrated with and still work on is what I call the “BG sling shot effect” or like you said “roller coaster pattern” but as I have used the PDM more I have learned how to even out more.

Also try a 20/30% basal increse on top of your pre-meal bolus (preferably 15-30 min before a meal… a longer time before the meal is really good when you know you can eat and food is ready within the 30 minutes (dont try this at a restraunt) (if its a meal you know you have issues with (i.e. higher carb meals or things that tend to shoot you high quickly)… set the temp for 3-4 hours AND DONT TEST untill the 3rd hour… This will help you from stacking boluses…(your wanting to stop the stacking which will stop the lows, and will also help level out the yo-yoing a bit)… Also remember steak has carbs… (check out the TAG forum for a bit of an explanation… the body does convert protein to carbs but its about half the protean number and its over a longer period of time (so your BG increase is usually a bit slower)… As always YDMV

I usually do a 60/40 split on my son to help with the highs after eating. Bolus 60 % with the meal and extend the other 40% for usually a couple of hours. This is only for the insulin covering the carbs, not for the correction. This has helped us.

Extend! Extend! Extend!

It really works!!

Marty

Agreeing with the other advice. I used to notice this and changed a few things.

If you’re going to have a large carb meal, try to take some insulin before hand. I recommend this half heartily as changes in that meal aren’t really an option after taking the insulin.

Second, as marty suggests, extend! I’ve recently started using it and it really helps!

Plus the most important thing that was suggested and I saw from your post, the repeated delivery of insulin, every 30 minutes! I’ve done this in the past for the exact reason you describe, but the problem is that when you test and you’re high (within 3 hours of your last bolus), there is still insulin active in your system. As such, it’s extra on top of what you’re bolusing to bring down the “high.” This results in extreme lows as you finally reach the goal blood sugar level, but can have countless amounts of insulin still working in your body.

A suggestion I would make is that you may want to check if your ratios are correct. I guess, ideally one would want to take one bolus for a meal. If that bolus brings you to where you should be after about 3 hours, then you’ve got the correct ratios; if not, you probably aren’t taking enough insulin. However if you’re low after those three hours, then you’re probably taking too much.

But again, to avoid the extreme lows, really try not to layer your boluses.

I can’t tell you how appreciative I am for your suggestions! Thank you sincerely. Great ideas. I can’t wait to try extending my bolus, bolusing further in advance of my high carb meals, etc…

Just to be sure I understand: I think you are saying that if I need 10 units total for a meal, I’d do 6 on regular release (2.5 hours), and 4 units on extend (3.5 hours)? Sorry, this is a new area for me.

The cereal and banana are pretty high glycemic for us, meaning they affect your blood sugar pretty darn fast. Pre-Bolusing 15-20 minutes before the meal should help with this.

Some people have good luck extending most of their meal insulin over 30 minutes. Sounds strange, but it really works for some people. Personally for us, extending out insulin for cereal would be disasterous, but everyone is different. We do extend for high protein/high fat meals and it is extremely helpful. There is a great discussion group here called TAG that explains the concept really well.

Happened to me all the time I would test and wow a large high so I would do a correction and retest in an hour and bam still high. Another correction and still high after an too high and then while waiting I feel my sugars dropping rapidly from a 200 average high to less than 60 which really makes you feel rotten, at least me. After an episode(s) with 3 bad pods in a row I got mad and pulled out my old cosmo (which I had just had replaced before going on the pod) and started to use it again and lo and behold sugars are becoming normal after 4 months back on it, no weird highs or lows and stable. Don’t know if it is the angled insert or what but I like the 90 degree mush better than the angle and also no bad pods, occlusions or any of the issues with the pod. This is my story others will tell you different as we each have our own choices.

My sons new CDE doesn’t want him to check his BG between meals unless he feels low (of course) or extremely high due to a suspected pod error. The reason being that he was on a correction roller coaster by correctlng between meals and then would be low. You should be getting a BG rise peaking at two hours of so but then be back in range in four hours or so at the next meal. She just has him correct at the next meal which the pod does automatically. She also has him pre-bolus which he was not doing but only just before he has the meal in hand.

His numbers were not very good to start but by adjusting his ratios for each meal based on his data on the pod (we did several weekly meetings including a DEX trial for a week), she now has him in perfect range by the next meal without mid meal corrections. If he eats a snack in between meals, she showed him how to “not correct” because the Omnipod Insulin on Board is a little different than most pumps.

His 7 day average this week was 91 - a big improvement over the 158 when we first started to work with her (the 158 included hockey playoffs and we are on hockey vacation between seasons for the month of April so that also helps).

Your experience has also been mine highs after meals and then corrections then lows. This is what has helped me.



My minimed 722 has the option of what they call “duel bolus” I calculate carbs then use their bolus wizard to determine amount needed, then take that amount and using the duel bolus option divide it 60/40 with 60% of bolus given right away and 40% spread out over a set time. I was using one hour for the 40% portion and it was helping, but with some continued spiking after meals. My vendors rep that i ran into at the dr’s office suggested I set the residual 40% to be spread over 90 min. I have done so over this weekend and what an improvement it has been.



I was splitting 60/40 sometimes 70/30 but doing the reverse, with the lesser amount first and dividing the larger over only 60 min.

This has worked out better so far then trying to bolus B4 meals. I am just not that well organized :slight_smile:

The extention of the delay seems to be the answer for the time being at least