Digestion and Pump

Hi all, I am Type 1 and a pumper using Sure-T.

Recently I am facing some problem with my elevated BG. I estimated the carb correctly for my meal, my BG continue to remain skyhigh 2 hours after meal.

For example, I had chicken rice and gave myself 110carb for the meal. 2 hours later I was quite shock to see my BG went up to 16.2mmol. After which I have to correct it to bring my BG down.

My Endo said that it takes 2 - 3 hours for food to be digested... But I still don't understand why my BG is that high 2 hours after the meal.

May I know if anyone has faced such problem?

That is quite a big wallup of carbs all at once. I generally try to bolus a little earlier.
If your sugar is still high after 2 hours then You should bolus more too,

Sometimes big meals will delay the sugar spike. It is worth just experimenting the next time you eat it, with a little more insulin. Or change around the timing a bit until you get it right.

These kinds of problems are very common for me and most other diabetics from what I understand.

Thanks Timothy for your reply.

I am still relative new to pump. What do you mean changing around with timing?

1. timing: an early spike does indicate that the carbs have been digested faster than the insulin. The goal is too balance both reactions. This can be done by giving the insulin some time to be absorbed from the skin. In healthy people the pancreas will release the insulin directly into the portal vein. By waiting 10min after the injection you can help the insulin to get into the blood stream. Then you can start to eat.

2. amount of carbs: really 110g of carbs in one meal? To me this is far too much. Just imagine your I:C ratio is not totally correct. You use 1:12 and imagine the correct ration would be 1:10. You would have injected 9.1 units but with the correct ratio you would have calculated 11 units. This is 1.9 units off and can lead to a difference of 60mg/dl later. So the more carbs you eat the higher is the risk that minor flaws will scale to huge problems in control. Try to restrict yourself to 50g per meal at maximum. This will help you to find the correct I:C ratios first.

3. mode of delivery: as Timothy wrote the bigger the meal the longer the digestion. Thus a different mode of delivery might help too. Just imagine the spike just developed after 90min due to carbs that have then be absorbed. In this case there is only little insulin left to work against these carbs. Here the dual wave of the pump (60% first, 40% over 3 hours or something like this) can help. It really depends on the absorbtion profile of the food.

You've gotten good advice so far. Also, don't forget that your ratios may change somewhat over time too. Nothing remains constant with this disease. Try eating smaller quantities of carb and a solidly known amount (not estimated) and see if your ratios are still correct.

Best of luck.

Is 110g too much for a meal?

As an Asian with 1 bowl of rice that's typical.

I can understand that this is not a happy thought. I have my limits for carbs (not more than 70g with one meal) but this is my personal choice. You could just restrict yourself temporarily to fine-tune your I:C ratios. This in combination with a food scale to calculate the right amount of carbs.

Is this the first time you ate this meal, and took this bolus, with the pump? I.e. did it work before and stop working?

110g of carbs (mainly from rice) would cause me to have the same issue. Two things to try:

1. Eat fewer carbs. Hard I know, but I do find that this helps limit the spikes that can occur 3-4 hours after a large meal. Yes, 2-3 hours is typical digestion time, but there is variation within that depending on the individual and food consumed. I have noticed that when I try to eat bread, rice, pasta, and pizza and just use a REGULAR bolus I will have quite the spike 4-6 hours after I have eaten.

2. When I do want to eat some bread, rice, pasta, and pizza (which I try to limit to just a few times a month) I do a few things. First, I don't eat these foods if I'm already having a bad day. I only attempt to consume these foods if I've had an active day and have had no crazy food excursions. THEN, I use a dual-wave bolus. I do about a 60/40 split, with 60% of my bolus upfront followed by 40% delivered in square. If I eat a lot, I'll also increase my basal rate a bit. For me, this usually works out fairly well; if I follow these rules, I generally will not go over 150. Which is pretty cool!

not really. I tried with the same method week ago it was OK. But the problem started to appear recently.

oh i tried with that. But I seriously didn't know the workings of dual-waves and ended up having hypo for half an hour. Bad. :(

Then perhaps its a site or insulin problem and not something so fundamental like the amount of carbs. Sorry, I don't want to confuse you even more :)

No no you are not confusing me! I have to thank you for putting in that effort to help me!

You will have to experiment and find out what works best for you - don't count out a dual wave because it didn't work the first time for you. Pizza, rice and pasta are always dual wave boluses for me - these sigest slower for me and the insulin winds up hitting and working before the food is digested. A good book to get and read is Pumping Insulin by John Walsh - has many good tips to dual wave bolusing.