If I do a correction bolus it brings my bg back down to normal range, but when I bolus pre-meal even if I do it a little early it does not seem to cover it enough. I use u500 in my pump and my basal rate is set at 2.00 a hour and my ICR is 1 to 15 ISF is 1 to 40. I woke up with bg of 136 and 2 hours later after breakfast and eating 30 carbs it was 196.
I think Cynthia here (mommy-to-twin-monkeys) uses u500. It must be so hard using such a concentrated insulin. Our dear Kristin in administration boluses at least 15 min before eating, and more if also doing a correction.
There can be many factors that could explain your experience. The first one that comes to my mind is the possibility of an overnight low. While you tested at 136 after you woke up, you could have been below 70 during the early morning hours. The emergency sugar released from your liver could explain the 136 upon waking. Once you wake up and eat, the liver is still pumping out emergency sugar and your breakfast carbs drive your sugar to a higher than expected level.
To troubleshoot overnight lows you would need to set your alarm to wake up every two hours and test – you don’t need to do this every night, just when you suspect your overnight basal may need adjustment.
The other two possibilities are an inadequate basal rate during the post breakfast period and an insufficient insulin to carb ratio to cover breakfast. If it were me, I would do a morning basal rate test first. Once satisfied that the morning basal was correct then I would adjust the insulin to carb ratio, in other words, take more insulin for each gram of carb.
Keep in mind that the basal rate that you want to examine is the one in effect about one hour before you eat breakfast. You’ll need to check when your insulin peaks. I’m unfamiliar with u500 insulin. If you look at the package insert there will be a chart that shows when the insulin peaks. Also remember that every person responds differently and even the same person can respond differently at various times of day and under different conditions. The package insert peak time is a good place to start experimenting.
Gary Scheiner, a certified diabetes educator, writes in Diatribe a step-by-step process for conducting basal rate tests.
Good ideas guys. I also am thinking maybe my ICR may not be set right. My Dr. set this rate but every time I eat it does this not just at breakfast. It is always off more than it should be even if I count my carbs just right.
Not sure what you mean by bolusing a little early, but timing is everything. Sorry, don’t know if & how timing would be different with u500. Seems that if you’re consistently high after meals, it’s your ratio. Doctors start people on a standard ratio of 1:15, but you know how that goes. Lots of people need more or less.
Since u500 is basically regular (though I’ve read it can act more like an intermediate insulin?) it may just be that you need to bolus earlier. Even with rapid insulin and not needing very much of it, I find I have my best post-meal #'s when I can bolus early by 20-30 minutes.
If you are always high after meals though, and don’t come down without a correction, it could just be that your I:C needs to be adjusted.
Marie is correct, I do use U500 insulin. I bolus 15 mins prior to eating using a dual wave bolus stretched out. In this thread , you will see the following suggestion:
The STARTING guidelines that MM gives for squarewave bolus:
50/50 over 30 mins for all normal mixed meals
30/70 to 50/50 over 2-4 hours for high fat foods
30/70 over 30 min to 1 hour for higher fiber foods
75/25 over 30 min for all meals that include correction for high BG
This is exactly what I follow. Now while I have a MM pump, I believe your equivalent would be a combo bolus. Please correct me if I am wrong. If you find that on a constant basis that your blood sugar is consistently higher, you may want to check into your I:C - I am at 4:15 - Please let me know if I can be of any assistance to you
No Dave I think it takes like 30 to start taking effect. It is Humulin U500.
Now see this is what I think may be the problem. I think I may need to raise my I:C I am doing 1:15 right now and I don’t think that is sufficient. I am kind of a newby on the pump, 6 months into it. So I don’t know if I need my doc to approve or just do it myself.
That is definitely something I need to learn more about is the extended bolus feature. That helps that you listed it like that it gives me a idea about what the screen is talking about.
I would try the extended bolus prior to changing your ratio and see how it does, I will see if I can find my mother’s Animas manual to be able to help a bit more
Attached is the One Touch Ping Users Guide. Page 67 explains the Combo Bolus feature. I find the your use of u500 an interesting variation. Does the onset, peak, and duration vary that much from Humalog?
It stays with you longer but does not take effect as quick. I haven’t been on it to long, but I really like how it brings my sugars under control when I bolus. I brings them back down pretty good. Rapid did not do that for me.
I would suggest doing a test to see if you insulin to carb ratio is correct. John Walsh in his Pumping Insulin book described how to do that test. f you do not have that book, I certainly suggest getting a copy of the 4th edition.
Yeah I don’t have it yet but I really need to. I hear great things about it. Sounds like I do need to do some testing to find out too.