STICKY Post-meal Highs... Needs some help

Type 1 and LADA
#1

Ok smart ppl… I’m having trouble with sticky highs post meal and cant figure out what is going on… Thoughts would be appreciated:
This morning for instance I entered 20g of carb into my wizard. I overrode my ratios and ISF (currently at 7 and 67) and I took 4U for 20g – ate 1/2 piece of Matzah . I’m pumping Fiasp and gave insulin 20Min before (note that same thing is happening when I use Novalog or Humalog).

@7:40 – 111 @ time of meal.

  1. @ 8:20 I was 160 and APS (artificial pancreas) super micro bolused .3

@8:50 I got a cold-brew coffee and ~8g of carbs - mostly skim milk with a dash of regular

  1. Gave 2U @ 8:32 - calculated IOB is 5.3
    3/ Between 9:23 and 9:49 APS micro-bolused .2 .2. .1 and .3
  2. @ 10:02 I bolused 3U
  3. @10:11 bolused another 2 - yes, I know I’m stacking
  4. At @ 10:44 Calibrated - Meter BG was 199
  5. @10:59 bolused 1U
  6. @11:42 APS micro-bolused .3
  7. @ From 8:19 to 12:22 the APS has had me on a 0 basal rate
  8. @ noon I started a sqaure wave bolus of 3.0 for 90 minutes to simulate basal rate.

So I have CURRENTLY have 4.7U on board… and had easy bolused 8U plus the additional micro-boluses and square wave. Site was changed last nite. My sugars are also going up after a meal and instead of coming down to normal just SIT where they went to – for instance, if it goes to 175 – it stays at 175 for 2-3 hours. Its such a sticky high – i’ve never seen anything like this before.
beginnning to drop now but this is crazy?

I completely disregarded my ISF and this still happened. I am at a complete loss.

Help would be appreciated.

#2

Oh my gosh, I can so identify with this! I went through almost the same kind of day a couple days ago. Had no idea what was causing my BG to keep rising! Was I getting a cold, did I exercise too little, too much. I try to figure out what caused this but sometimes you just don’t know! I try to focus on the biggest variables in all this, which is food choice, carb counting, medications and obtaining accurate BG readings.

This is a quote from an excellent book by Adam Brown, Bright Spots and Landmines and it looks like you’re trying to get the insulin to work faster than insulin does. I try to always remember this quote cause it takes a good 3 hours for your BG to move downward into the range you want. You’re not alone in this frustration. Hang in there. Tomorrow will be better.

" Imagine a car with a 60-90 minute lag between steering the wheel and the car meaningfully changing direction, and a full 3 hours or more before the car stops turning. It would be ridiculously difficult to drive safely. But that is the SAME delay we have with current injected rapid-acting insulins: a 60-90 minute delay before they peak, and a duration of action that lasts 3 hours or more. Keeping the car on the road-my BG in range-is tough with that kind of steering wheel!"

Sticky high? Yup it will stay sticky for 3 or more hours!

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#3

This seems like a major problem to me. I don’t use APS though, so maybe I don’t understand that dynamic. Seems like there’s no point in bolusing if the basal gets suspended regardless of how high your bs is.

Have you been on this system for very long?

#4

I have been wrestling with persistent highs myself – one thing I can say is that Matzo has a tendency to digest weirdly – both quickly and slowly, as I’ve been seeing it. Depending on the type, I suppose (I’m eating only hand-backed Matzo for the moment), there’s a fair amount on non-digestible “fiber” as well as just difficult-to-digest carbs in it - so it can act like more than it is…

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#5

I this the 670G system? I have zero hands-on experience with the 670, so I’ll keep my remarks more general.

The easy answer is that you’re not getting enough insulin. But you didn’t need me to tell you that! Since you just changed your infusion site last night, I would put the possibility of a bad or compromised site high on the list of possible explanations for high BGs.

When these kind of mysteries present themselves to me, I just change the site or at least add corrections with a syringe. That way, if your BG improves, then you’ll know it was site absorption and not the formulas you’ve programmed into your system.

Are you eating the Matzah by itself? This is bread, right? For me, eating bread by itself in the morning is equivalent to drinking several ounces of orange juice – it rockets my BG. I would avoid bread and other fast acting carbs in the morning. Save them for later in the day when your body becomes more sensitive to insulin.

How is your system performing during the balance of the day? Is morning the only problem time?

#6

Yeah, what do you mean by APS? Medtronic’s 670?

If so, are you still “training” it or have you ever achieved good control with it? If the former, there is little advice anyone can probably give you as the official advice is “stop messing around with it (i.e., doing overrides) and let it ‘learn’ you properly”.

(From personal experience, I could not abide by this advice for more than a week and being pretty much constantly high during that short-lived attempt made me give up on Auto-mode completely.)

#7

I’m using OpenAPS – brilliant piece of machinery but don’t think this is the cause - could be a contributing factor though.

#8

Thanks – good insight. It could be the sight but I’m not sure since this has been happening on other days with other sites…its been persistent these last two weeks. I also thought as @Jane22 that I was getting sick… allergies yes, sick no - Definitely not getting enough insulin but 10U for a half of piece of matza with a tiny (and I mean tiny) bit of butter. The only other thing I can think of is that its the caffeine… wonder if I have to start treating it like a high glycemic load carb? Thoughts?

#9

If your basal is set too low, the accumulated basal deficiency can make it look like you need way more bolus than actually needed. Then your matzah bolus first needs to backfill for the missing basal before it can metabolize the food.

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#10

Allergies can make my BG’s stubborn.

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#11

Interesting… I had no idea… can you provide me some background on this? Thank you.

#12

Just my own experience. If I am coughing, sneezing or itching then I need extra insulin to get my BG’s to cooperate. Putting an air purifier in my bedroom makes a significant difference to my allergies and by extension my BG’s.

#13

Firenza, I did not know that about allergies either EXCEPT I do know when my eczema acts up I do need more insulin too.

I thought it was due to inflammation. I don’t know but are allergies ‘inflammation’ caused too?