Until a week ago I was on conventional insulin therapy and had no problems with my high carb breakfast (half a bagel). I got an OmniPod and now my bg is way too high after breakfast. My bg spikes at 180 and stays above 140 for 2 hours. After 4 hours my bg is back where it started and stays flat. This means that basal rate and I:C ratio are correct. What do you do? Eat less carbs, use more insulin or tolerate the high bg? This question is not for pumpers only. MDIers must face the same dilemma.
How long has this been happening?
Your basal rate sounds right, but your I:C isn’t if you’re high at 180 & taking that long to come down.
I need a lot more insulin at breakfast because of dawn phenonmenon & eat basically an all protein breakfast to keep things as level as possible. I also eat & inject almost immediately after waking. Seen BG spiral ever upwards if I don’t eat or delay eating in the morning.
Eat less carbs or increase your insulin. Not good to tolerate high BG.
Perhaps you could add fiber or protein to the meal to delay the onset of the carbs. I have the same problem, and I get frustrated, as well.
They say at 1 hour, 30% of the insulin has been used. At 2 hours, 70% and at 3 hours, 90% has been used. It seems like you are peaking too soon.
Hey Helmut:) Sounds like you need a little higher I:C for breakfast. I do what Gerri does…eat a low CHO breakfast…have a higher I:C and give my insulin (via pump) a little extra time to work before eating. I use NovoLog…using Apidra may be different. I watched a presentation online from an international diabetes conference held last year…this doc was talking about how even non-diabetics have notable insulin resistance at breakfast…his recommendation was that persons w/ diabetes were better off avoiding high carb breakfasts…and even suggested for some…skipping breakfast may be an idea. I will try to find the link. I know…there are those who can eat whatever they want and still keep post-prandials low…but, he claimed many of us cannot…and I know, I am one of them. Half the battle is acknowledging we are all a little different and need individualized plans of care:) Take care and hope you work it out…and benefit from pumping as much as many of us have:)
I thought that the basal rate is correct if bg stays level without eating and I:C is correct if with a correct basal rate bg comes down to where it started after the insulin wears off. Is this not correct?
I can limit the spike with more insulin. When I use twice the amount then I go up to only 130. Within an hour I have to eat some fast acting carbs to prevent a low. As long as I ignore the I:C ratio I am fine.
Dave, sorry for wasting your time. Please feel free not to volunteer.
I watch my bg on my Dex before eating. I wait until my bg comes down and time it so that it bottoms out at 70. If I waited 5 minutes more I would risk dropping below 60 which I try to avoid. Is your theory that using the extended bolus would make the timing less critical with almost the same benefit as taking the entire dose upfront?
I started with the OmniPod on Monday.
Gerri, I am dedicated to keep my bg between 70-130. My CDE urged me to follow her advice instead of doing what I always did. I broke down after 2 days and went back to my old ways. I increased my insulin which forces me to plan a breakfast after the breakfast in order not to go low. I am fighting the cutback to 1/4 of a bagel. Maybe I should not be so stubborn.
Remind me Helmut…what kind of insulin are you pumping? I used to have more issues w/ 1-2 hr postprandials because I use NovoLog. I switched to low carb so absorption of food better matches peak of insulin, but if I wanted to eat more faster acting carbs I might seriously look at Apidra. Not that one is better than the other…just profiles fit certain types of intake patterns. Hope this helps.
I switched to Apidra when I started with the OmniPod.
When I eat a high carb breakfast (especially one with very little fat), I bolus 30 minutes before. It’s the only way for me to avoid the spikes.
I’ve noticed that since I started with the Omnipod, I’ve had to lower my basals and bolus ratios. I have no idea why I’m getting better absorption, but I’m definitely not complaining 
Thanks to everybody for their feedback. I apologize for irritating some of you. I will try the extended bolus to make timing less critical. I was always wondering what the magic behind the ‘dual wave bolus’ was. Now I have a hunch and I cannot wait to experiment. If all fails I can still cut back to 1/4 bagel or an all protein breakfast. If the biggest problem in my life is not being able to eat half a bagel for breakfast I must be a lucky guy. I definitely feel this way.
It sounds as though you do need to either: Use an extended bolus over time, or take it earlier before you eat those carbs in order to allow the insulin to work sooner and then balance out those blood sugar increases that will inevitably follow once you eat the food. I must bolus about 15 minutes before eating in order to make sure there’s enough time for the insulin to START working before the carbs kick in, and then depending on the food/protein ratio I use a varying square way to keep pace with the carb impact. Usually works to balance out and keep pretty level sugars.
Helmut,
Yes, basal rate is correct for the reason you state.
I:C ratio is correct if your BG readings from pre-meal reading & postprandial reading are within target range. This means you took the right amount to cover your meal. It’s not after the insulin wears off. Of course, we don’t achieve the ideal of pre & post meal numbers being close, but you don’t want spikes after eating. So, it’s one of two things. Either your I:C isn’t right, or your bolus timing is off. We’re told to take rapid acting about 15 minutes before eating, but this doesn’t work for everyone & may take some experimentation with a lot of testing.
The problem with eating something like a bagel is that it effects BG fast & digests quickly. Those carbs start disgesting as soon as they hit saliva. Don’t know what you eat with your bagel, but try eating more protein/fat with it. Since slower at digesting, protein & fat should prevent the low afterwards.
What are you doing differently with timing or doses since using the OmniPod compared to MDI?
What did your CDE advise? Did she give you a higher ratio?
Great goal aiming for 70-130. It’s what Dr. Bernstein states in his book. Higher doses of insulin don’t act as predictably as lower doses. Bigger doses can lead to bigger errors. Smaller doses=smaller errors that are easier to correct.
you totally crack me up!
Cream cheese, a tiny bit no-sugar jelly, coffee. That’s it.
Why ignore the I:C ratio, seems you need to adjust it for that part of the day. This is normal for correcting the Dawn Phenomenon that happens to nearly everybody. Don’t think in terms of what you used to do before you got the OmniPod, since you are no longer taking multiple insulins the whole scheme is different.