Im a T1, on dexcom G7 and Tandem pump, x2. The last several months have been particularly frustrating as my post meal BG always seems to rise about 2 hours after my meal. I’ve been careful to bolus accurately, wait for 15-20minutes before eating, and try to account for fat/protein. Lately, my BG spikes way after the actual meal. Would appreciate any help. Thanks.
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Are you using ControlIQ? Any chance your basal is reduced/shut off for some time before the meal (like the pump sees you are low so adjusts your rate)?
Thanks for replying, I am on Control IQ but basal has remained the same. Kind of wondering if that’s the problem and it needs adjusting.
Maybe your food is fat/protein heavy, so causes delayed digestion and late highs?
I wondered that too, thanks for the reminder, I’ll do a better job of watching that.
It’s unlikely the pump settings or control iq because that handles long term sugars. This issue is likely that you didn’t bolus enough.
Of more likely , your infusion set has stopped absorbing correctly.
When I was on Tandem I had a slight allergy to my sets and likely the adhesive. If I pumped more than. 50 units a day, it would just not absorb.
The sites were often red inflamed and sometimes hard to the touch. That’s a sure sign that you aren’t absorbing insulin.
I lost my pump on an airplane and I had to switch to omnipod until I could figure out a new pump.
I found that I wasn’t allergic to omnipod and I had no issues with absorption. 7 months later I’m still on pods.
The AID algorithm is better on tandem, but the absorbtion issue is gone so my control is much better. From 85% in range to 95% in range in average.
I still think Tandem is a great pump, but for me, pods are better.
A couple of things can help, use Flonase on your skin before putting in your set, and use some oil based ointment right at the spot of insertion, I used to use neosporin, but it’s the oil that blocks the adhesive from getting into your skin, not the antiobiotic.
You can even use Vaseline, but a tiny bit so it won’t spoil the stickiness of the tape.
I was using varisoft and just put a tiny drop on the needle before inserting and it helped a lot. .
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I often add a temp rate when I eat to prevent my glucose levels from surging. I also have several personal profiles with different basal rates which I can utilize depending on what I’m eating.
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I had no success with either Control IQ or Omnipod. What does work for highs is the inhaled insulin Afrezza. It works much faster than any injected insulin, but does not stay
active as long so is less likely to contribute to lows.
I can’t recommend it highly enough.
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Great ideas, thank you so much. Didn’t consider the infusion sites so will give that a try.
Thank you, I haven’t felt confident experimenting with temp rates yet but it’s something i’m going to look into.
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Thank you, I asked my endo a while ago about Afrezza and she didn’t like the potential for lung issues, but I don’t like persistent highs so I’m going to ask again.
Diane,
I’ve been using for 3 years now with no lung issues. Not all endocrinologists are familiar with Afrezza.
Sue
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Diane, I started with Affrezza a few months ago and agree that it is a great tool to have in our Type 1 toolkits. Because it’s inhaled I try not to overuse it.
The main reason I started using it was trouble with insulin absorption using Omnipods. I was finding that any bolus larger than about 3 units was frustratingly ineffective. The symptoms were high BG peaks after meals that seemed to have no rhyme or reason and lasted too long, almost impossible to bring down using the Omnipod, etc.
So I use a syringe bolus for many protein/fat rich meals or an Affrezza bolus for selected “faster” meals or snacks. But for a correction bolus, correcting a high BG, Affrezza works quickly and reliably for me and is my usual go to insulin for that purpose.
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Dunno if any of this will help, but in my experience with T1D, diagnosed five years ago now, I have always had spikes four-six hours after various meals. It took me a while to just realize this is how my body digests/processes carbs w/ certain foods, and that the whole “spikes always happen two hours after a meal” was just not accurate a lot of the time, for me personally. The main causes of delayed spikes are bread, pasta, mixed complex carbs (like beans with corn flour products or flour tortillas), or a high amount of simple carbs. It has nothing to do with fat or protein content (for me). It also is not an issue of not giving enough bolus up front. What I have to do in these scenarios is do a maybe 60-70% bolus up front, then spread the rest of the bolus out for one or two injections (I’m on mdi) maybe 1-3 hours post-meal. In these scenarios, if I gave all of this insulin up front, I would have a signficant low in the short-term (say in the two hours following the meal). Then of course there is always the possibility of needing correction later on many hours after a meal depending on how well I did my bolusing. Anyway I hope that helps, though maybe doesn’t have anything to do w/ your scenario. Best of luck—
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Thank you!
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There was a failed trial of another inhaled insulin that caused respiratory problems. A friend of mine did his masters thesis working on it.
Some doctors get something in their heads that is no longer true.
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@Diane_Bejcek a question, have any new medications been added to you?
Thanks, that’s a good observation.
There are some really good comments here that probably address your problem, but here’s one other possibility – bodies can slowly become increasingly insulin-resistant. This happened to me, with BG highs I didn’t use to have.
One solution is simply to increase bolus insulin for a given amount of carbs. I have also just cut back on carbs at meals, allowing me to bolus less.
What’s good is you are being proactive. That is most important for us T1Ds.
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No new meds. That’s what makes it more puzzling.