You stated that you can avoid the spike with more insulin. This means your I:C for the morning is incorrect. You may also need to up the basal for that time. Don’t think you can stick with one I:C and be fine all day. There’s some who can, and there’s some who can’t. I have a particular I:C for breakfast, one for lunch and one for dinner. Then I have a series of snack ones.
As Dave mentioned, when you state that you “think” you already know the answer, it makes it less likely for someone to want to assist.
I have 4 different basal rates, and several I:C ratios. Something with your setup is obviously not right if you are spiking.
Since you have been on the pump, have you done a basal test for the morning without a high carb breakfast? As in, does your BG stay exactly where you want it to be during those breakfast and after breakfast hours EVEN if you don’t eat those carbs? I know you say your basal rate is correct, but it’s possible this could be one of those complicated high BGs that are caused not JUST from incorrect I:C ratio but from slightly off basal rates as well.
What I would suggest is doing a basal test for these morning hours. I need substantially more basal insulin in the morning around breakfast in addition to a higher I:C ratio. 4 hours after breakfast my basal needs drop dramatically. Sometimes the difficult thing about highs and pumping is that the high bgs are often solved with a tweaking of a lot of different areas, not just one.
Theodore, I know how much insulin I must take to avoid the spike and keep my bg below 130 at all times. However, the dose is so high that eventually I have to eat something to avoid a low. This is what I used to do. My difficulty is with switching to the new paradigm of injecting the exact amount that covers my breakfast. Given my desire to stay below 130 at all times I see only 2 choices:
Eat less carbs.
Inject twice the amount needed to cover the half bagel and eat something later to avoid the low.
I know that option 1 is the more sensible choice. I am close to declaring defeat. Or should I say victory?
“Something with your setup is obviously not right if you are spiking.”
I would like to find the problem with my setup. After the PDM is done with all it’s calculations it injects a certain amount of units. I can lower the spike by increasing the units. When I increase the amount of units so that I spike at 130 then I will go low an hour later. What do you think is wrong?
I skipped breakfast only once so far and my bg stayed in range. I will repeat this test a couple of times. Maybe something was off that day. I varied the amount of insulin for breakfast. Does it make a difference whether the insulin comes from basal or bolus? I don’t expect my basal rate to be off by more than 0.1 units/hour. I use 8 units for breakfast.
A bagel is 40 gr carb and you call half of that a high carb breakfast ?? my breakfast is generally 100 gr carbs ! Is this uncommon for type 1’s should i chang my diet?
Either way, i too go up during the hours after my meal if i don’t take my insulin well in advance (up untill around 200 mg/dl) . For my 200 gr bread breakfast i need to inject 30 min in advance.
I agree that in my opinion this has noting to do with I/C but only with timing.
To address your question: “Does it make a difference whether the insulin comes from basal or bolus?”
You want to cover your meal only with bolus insulin. It sounds like your basal rate is likely on target, but yes, I would suggest repeating the basal test a few times and seeing if your bg stays in range. It’s a process of elimination! Once you are sure your basal rate is NOT affecting any highs (or lows, too!) then you should start tweaking your I:C ratio.
Are you finding that you get high after breakfast with the SAME amount of bolus insulin you used when you were on injections? IF SO, What it sounds like to me is that it’s possible that when you were on MDIs your basal insulin was kicking in a little if you never experienced any highs with the same amount of bolus insulin you are using now.
You sound like you are on the right track with deciding to adjust your I:C ratio for the morning. What I would suggest before adding more insulin upfront or even adjusting your I:C ratio, why don’t you try a dual wave or combo bolus (whatever it’s called on the pod) to see if that makes a difference. Maybe what was happening when you were on MDIs was that your basal insulin sort of acting as a second wave of insulin to cover your carbs. Additionally try bolusing 15 minutes before you start eating.
I had this EXACT same problem when I went on the pump and for me, it was just trial and error with a combination of (1) bolusing earlier, and (2) using the dual wave. Everybody has different results with the dual wave, but for me, what works best for most normal meals is 15-20 minutes before eating I use the dual wave bolus, 50% upfront, 50% over 30 minutes (only if my bg is normal at the time).
That is so interesting that you use the dual wave bolus, 50% upfront, 50% over 30 minutes. Before I read your post I did just that this morning. Everything seemed to be smoother and I was able to wait 30 minutes instead of the usual 20 minutes before eating.
I never did MDI. I used one shot with 30 units of 70/30 to cover my day.
Yes, the dual wave is a wonderful thing. I wasn’t sure if it was available with Omnipod. I am a MM user you can tweak the dual wave to do 75 and so on depending on what you eat. I tweak mine for pizza and chinese
100-200 carbs for breakfast is quite a lot. The recommended daily carbs for non-diabetic people (on the recommended daily 2500 calorie intake) is 375-400 carbs.
I scanned through the responses, so I apologize if I am being redundant.
Caleb typically eats about 50 carbs for breakfast. I have found, since using DexCom, that bolusing 15 minutes before he eats is the magic number to avoid a spike. This has helped tremendously.
Caleb’s IC ratio is the most aggressive at breakfast - he needs twice as much insulin for breakfast than lunch and three times as much insulin for breakfast than dinner. Because of this, I have found the “tail” of insulin to be greater with such a big bolus and thus the likelihood for him to go low greater. I have handled this a couple of ways over the last couple of years. Because Caleb typically eats at the same time every day, there was a period where I would decrease his basal rate about two hours after his breakfast bolus time. This would prevent the low from that tail. Right now, his snack schedule at school allows for a snack just about the time when that tail kicks in, so it actually helps Caleb because he can partake in his snack with the other students and not have to interrupt his schedule with an extra nurse visit/bolus.
Sounds like you have a lot of great advice here and several alternatives on how to proceed. Good luck as to experiment and figure it all out!
Thanks for creating this spreadsheet for me. I share your concern that my basal rate is not correct. I only did one test and the responses in this thread make me suspicious. I will skip breakfast every other day until I am confident that my morning basal rate is correct.
The bagel that I am eating weighs 135 grams. I buy the bagel at a bagel store and it does not come with a nutrition label. When consulting bagel nutrition labels on the web I came up with the guess of 35 grams of carbs per half bagel. With 5 grams of carbs for condiments I end up with 40 grams of carbs.
Until I have confidence in my basal rates I will ‘overdose’ on insulin and correct the low with high GI food. I am good at that. This is what I did for many, many years. Then I will move to the second round and use your spreadsheet to tailor the dual wave bolus. The investment will be well worth it. I eat the same breakfast every day without exception.
you can tweak the dual wave to do 75 and so on depending on what you eat. I tweak mine for pizza and chinese