Can you give me an idea of how you are delivering meal insulin? My postpranials suck, like 350,400. I’m not doing it correctly. I’ve been doing some aggressive insulin dosages with an extended delivery around 80% for 1 hour. But, I either go high or bottom out. I’m the worst at meals. My doc said he would expect 180 post meal for someone with my a1c.
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@mohe0001. For me it depends on what I’m eating. Simple carb food, I lead the insulin by up to 30 minutes before I eat, and bolus for the carb load. Increased fat and protein meals I bolus for carbs, fat and protein, plus run a +10 to 15 pct temp rate for up to 5 hrs…
Fat and protein in quantity for me equal out to roughly 30 carbs\lb.
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You just delivering a flat bolus? Thats what I typically do, but playing with extended bolus now. He wants some kinda square bolus.
I just had the most ridiculous diabetes nightmare while trying to sleep through 4 hours of high blood sugar. I dreamed that all my devices got wet, one by one, and my computer got hacked. I reinstalled an operating system in my nightmare. Its over the top. Paranoia self-destroyer! I need to stop going to sleep listening to police radio.
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What you NEED is bolus delivery based on your meal choices and timing ! This often means “dual” wave. Meaning “X” units immediately to cover carbs and correction if starting BG is high. Then additional bolus that is delivered over time (1-4 hours usually, except when grazing). This is the square part.
Some people count fats, protien and use formula to calculate. Search for TAG, total available glucose, there were many discussions on this.
The other method is sugar surfing, which I tend to use.
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square wave boluses only work for me when the carbs are simple. If I want pizza, I use the temp rate in addition to the bolus. I stay withing 30 points of starting if the timing is right.
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For me
Carb meal like whole wheat spaghetti, bowl of veggies, salad with fixins, 50% a half hour before I eat and the rest when I eat. That way I can also adjust if I don’t finish what I originally planned on eating.
But that changes as soon as there is any kind of significant fat content to the food. If it’s just nuts sprinkled into my veg bowl, no issues, but if it’s say an oil based sauce on my whole wheat pasta a very different tactic needs to be done.
So higher fat, high carb, I’ll take 25% when I eat, 50% a half hour later and then the last 25% an hour later. I have a pump so the first 2 doses are set on my pump, but it doesn’t allow the third extended so I have to remember to take that.
High fat, higher carb, I still will prebolus some. I will still prebolus some if I have a very simple carb item with it like fruit or?
And some people (I’m a vegan) bolus at 2-4 hours after things like pizza. There’s not too many things I eat that would cause me to do that unless it’s an adjustment because I had to “guess” what carbs I ate.
But being sick, very tired, etc sometimes will up the needs of the length or strength I need to bolus, just as exercise will shorten it.
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I’m also having postprandial highs and it’s driving me crazy although not 300’s. I’m having high 200’s every time after I eat and they are taking hours to come down. This is unusual for me but it’s been going on for the last month so I know it isn’t an illness. Without food there aren’t any problems, stable BG’s for hours at a time but the moment I eat I start soaring. I’m on Afrezza and Tresiba, prebolusing anywhere from 10-30 minutes and watching BG like a hawk but haven’t been able to stop it.
I’m going to try switching my Tresiba dose from 9am to 6pm to try and utilize the peak that I have at the 18-20 hour mark from Tresiba. That at least might take care of some of the lunch postprandial problem I’m having.
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Also, poor insulin absorption could play a role in causing high bgs. I went through this with placing the OmniPod on my arm. I just couldn’t get good absorption, despite having good success in the past.
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Holy cow, El_Ver, thats really good! I have never, in my life, come close to that, but I’ll try harder now that I know how off I am. I’ll have to read the posts in detail tomorrow. I was just helping my brother move a bunch of freight and he took me out to dinner. There was an Omnipod diabetic sitting outside next to me. She asked about my Omnipod because she was a Podder. She turned out to be a Looper. What the heck are the odds of that?!??!?!?!?! She was full of helpful information.
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@Firenza I know you are saying it’s been a month and that is a long time. But I know I’ve had a tooth infection in the past I didn’t know about and my BG’s were elevated for a while I think at least a few weeks, a couple of years ago.
i just had a tooth infection again a couple of months ago and it first showed up as elevated BG’s for a few days and a sort of a slight annoyance when I pressed on an area. But it never hurt, although it was a definite infection. I had an implant put in where I had a tooth pulled and it turns out a small sliver of the tooth was still there with the new implant and my body did not like that and started a rejection process of either the sliver of tooth or the implant and hence an infection.
But it never hurt. And I seem to remember that was the same case a few years ago too with a tooth infection. It’s really hard to know sometimes! But I would bolus to bring it down, so I would be okay when it was down, but it would go higher than usual and be more stubborn about dropping. But all told with the infection and going to the dentist and being on antibiotics, it was a few weeks of higher numbers. So it seems like if unknown it could be a while.
You might start wiggling teeth lol…such a hidden possibility. But just something to keep an eye out for.
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Well I can tell you that my teeth aren’t any problem. In fact I’ve been exceptionally lucky in that regard, haven’t ever had a cavity, nothing that requires anything more than cleaning. I think that any sort of infection would come up in my blood work and I just got that done although I haven’t heard what those results are yet. However if something needed immediate attention then my Dr.s office would get a hold of me.
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Like all things dealing with diabetes, your results will vary! Unfortunately, I don’t think there is an answer for you, except to continue to experiment.
Pizza is a huge problem for many of us. And I finally stopped complaining about pizza and went on a mission to solve my post meal spikes with pizza. So for about 6 weeks, we ordered pizza from Costco ( that way I knew it was going to be the same weight every time), and started playing with my extended bolus feature. And while I have it figured out now, the starting point can also change the percentages and duration. And that starting point wil also change the prebolus length. Sometimes 15 minutes is all I need and sometimes it might be 45.
So sorry to say, no magic formula but as with all that is diabetes, each day is an experiment in the making. Good luck!
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I use prebolusing with great success. I want to have a number below 100 before eating meals and snacks. Sometimes I bolus as much as 90 minutes before eating. I prefer a number as low as 80 at mealtime.
Dr. Stephen Ponder wrote the book called Sugar Surfing. You can find it on Amazon. Many people have had great success with it. You would need to be using a pump and a CGM to get good results while using the book. I have not bought the book since I am doing rather well with my own tricks. lol
Stephen Ponder and I are both scheduled as speakers at the Friends For Life type 1 conference later this month. Our sessions are scheduled on July 17.
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Would like to understand more about your bolus plan for fat and protein. I do not know how to bolus to compensate for the high fat in meals and the 8 hour later spike. I usually keep my fat intake low but when eating out it is sometimes unavoidable. I did not think we needed to be concerned about protein? I am not new to diabetes or pumps and get really frustrated that the CDE’s won’t teach me how to effectively use the profiles, insulin sensitivity factor, carb ratio, etc. I am dedicated to good control and know it could be better with a little more knowledge.
I am on a new T:Slim pump, and Dexcom G5. Hopefully will get the G6 in 3 or 4 months. Thanks for the post and any further info you can offer.
Hi Nan, I’m not entirely sure that everyone metabolizes and protein the same way. The strategy I mentioned earlier is the method that seems to work best for my body.
On the pump, I bolus for carbs as normal and do an extended bolus for fat/protein. I calculate the fat/protein carbs if the fat/protein is larger than normal (say pizza, or a large steak). For my body 30 carbs /lb fat/protein seems to work. Then I do a Temp rate at 110-115% for an extended time - generally how long I think the fat/protein will take to digest. Pizza I set the temp rate for 4.5 hours. Steak 6 hours. This method has been working extremely well for me since I discovered it on another blog. I find that with a little trial and error I can keep my bgs tightly controlled for a larger or heavy protein/fat meal instead of the usual rollercoaster ride.
I hope this helps.
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El_Ver
Thank you for the most helpful information. I can work with that and am surprised that the CDE’s do not teach this. It is great that we can learn from each other.
Thank you so much,
Nan
El Ver,
Thank you again for the information you sent pertaining to how you bolus for carbs, fat, and protein. You obviously have a much better grasp for making your pump work for you than I do. I am hoping you will allow me to pick your brain for how to finally get the control I should have with my pump but do not.
This is not for lack of trying. I had one of the best Endocrinologist in the business until last December when he retired. His education department though is woefully lacking in patient care. I finally gave up trying to get enough appointments to fully learn how to get my settings correct. Though I am mathematically challenged I am determined to figure this out.
This year I had to go on Medicare coverage and was forced to change pumps in order to get my pump and CGM covered. I went from Medtronic (40 years) to Tandem T:Slim X2 and Dexcom G5 CGM. It is clear to me after a week on the new pump that my settings are way off and I am prepared to once again work toward fine tuning my pump. I purchased the Sixth Edition of Pumping Insulin and am working through it. I realized today that I need a coach, not to do the work for me, but to bounce ideas around with.
I will be starting tomorrow night to work on my basal rate testing. I will not bore you with any further information if you do not want to be a participant in my quest for better control. I promise to not be a pest and to keep my questions and information brief. If you cannot help; please advise me where else I might look for help.
Thank you so much,
Nan
@Nan I have frequently seen discussed both here and on other blogs the need for a basal adjustment as you transition to a Tandem pump. The best explanation I have heard is because of the reservoir mechanism, but that could all just be hokum.
Get your basals set so you can flatline on your cgm as bet as possible. Everything else follows. Make a basal adjustment, wait a week or so and see how different situations affect your setting. Don’t rush into a settings frenzy, go slow. It will pay off in the end, even though it’s frustrating now.
Once the basals are set, verify your I:C ratio with known foods/carb counts. Adjust your pump as necessary (I have 2 settings, one for after 7 pm, and one for after 4 am until 7 am). +
I’m here to helpto the extent of my limited knowledge capabilities if needed. Alternatively, I can point you towards some additional internet resources that might also help.
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