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!


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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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,


Most welcome @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 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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That’s a great book. So is Think Like a Pancreas. The website contains some excerpts from the book.

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Bolusing for fat and protein is new to me! I use a t-slim which calculates bolus using carb of course, so how do you calculate for fat/protein as well?

This older post may be helpful, related to using T-A-G, Total Available Glucose, to include fats and proteins.

Like Richard I don’t like to eat unless I am around 80 or less, and I won’t eat if I am over 100. I give my pre dinner shot usually about 10 minutes before I eat. I rarely go off my meal plan which is low fat and vegan so it eliminates my need to count carbs. I eat about 275 to 300 carbs a day. I am usually back down to 14O two hrs after I eat. I rarely go high.

I went out to dinner the other night and really went off my eating plan. I ate some salad with sweetened nuts, a portobello burger without cheese but with a bun, and I ate friend’s sweet potato fries. Oh, I also had a couple of bites of a dessert. I upped my dinner shot from 4 to 5 units. I dropped rapidly after dinner. Go figure. I don’t understand why I didn’t need a lot more insulin to cover that meal.

My insulin resistance is really dropping with the low fat vegan diet.

The reason I stick to an eating plan is because it makes my diabetes so much easier to handle. Over the 60 yrs, I have eaten every way imaginable.

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@Suz4. I use a weight to carb formula. 16oz fat\protein equals 30 g carbs for me.

I am really uncertain how these strategies will work with Loop.
I am uncertain how well Loop will be able to deal with postpranials.
I am hopeful about the new fast acting insulin.

I will have to try this list of strategies one by one and see what works. Thanks everybody

Hi, I started the omnipod a few weeks ago and am really struggling with postprandials that I just can’t understand. Just to give an example, I started lunch at 140, had an apple and pepper with hummus today for lunch, counted at 30 g carbs, which led to 3.8 units for my bolus (I:C currently set at 7 g/u). I then promptly skyrocketed to 260. When I see myself headed up that fast, I try to do extra boluses because if I don’t I just hang out in the stratosphere for hours. Even with extra boluses (3 units total), I was stuck in the 200s for 3 hours. But then of course I crashed from overcorrecting.

I like to call overcorrecting “revenge bolusing” because I feel like it comes from trying to get even with these pesky highs. But I can’t figure out how to address them. I’ve tried taking insulin earlier to have carbs hit when the insulin takes effect, but so far that hasn’t worked.

This is the first time I’ve been on a pump where I don’t have absorption problems! I can tell because my basal rates seem spot on, I stay level if I’m not eating. But the second food passes my lips, it’s sky’s the limit and I’m worried about increasing the I:C ratio again. My boluses weren’t so big before the pump?

I’m a bit lost as to how to figure out what I’m doing wrong with the pump. Can someone suggest something very simple as a starting point?

Hi @Karen_in_Michigan! I use OmniPod too. I had similar problems. I now use the OmniPod only for basal and I bolus via injection. Why not try that with your next pod change and see if it makes any difference.

I use an Omnipod and love it!

I like to start out eating at a lower number. Under 110 say? Even lower is nicer. I like to not go over 150 after eating. I do not low carb, I eat what I want, but I do prebolus. I take half my dose a half hour before I eat and the other half when I eat for a normal meal. If I have higher fat I do change what I am doing. And if I start out with a really low number I won’t prebolus as early.

I’m not sure why the pump is causing a difference? But we all have different places we prefer. When I gave myself shots, I used my lower stomach the most. But that doesn’t work as well for my pump. Maybe more scar tissue there that inhibits absorption? I also can’t put my pump on my lower back/buttocks or love handles, really bad absorption areas for me. So maybe try some different areas, a pod can go so many different areas!!! Make sure you pinch up the fat when you start the insertion process too. That is suppose to help it seat properly.

I hope this helps!

hahahahahahaha - “revenge bolus”

After being on Omnipod a long time, sometimes my meal bolus works like a charm and sometimes it just doesn’t work. I’m in a doesn’t work phase right now. I attribute failure to my body, not to the tech. But, everyone kinda agrees that smaller boluses get absorbed better than large ones.

Iv’e been taking more insulin than I need and then just eating when it inevitably starts to drop. Helps stave off the highs, but I eventually plummet post-meal.

I had some luck yesterday eating a bagel and delivering 7 units - extended 20% bolus for one hour. When I dropped, it wasn’t a real severe drop, but I dropped for a couple hours straight and had to keep eating.

Anytime in the past when my sugars have been stubborn about not responding as well, there is a reason? Like getting sick, or a tooth infection has gotten me a couple of times. Sometimes placement of my pod for a couple of days. I am quicker to switch them out now.

But it really starts to get to you when it happens, my solution is usually to cut way back on eating period. I always have some extra pounds I can lose so it seems to work well for me.

Maybe try some afrezza?? There seems to be a bunch of people that just use it off and on to bring down their BG’s when needed. So many people say it has helped solve their issues.

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