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Discussion Starter · #1 ·
Overview of problem:
using insulin pump (humalog insulin) normal levels prior to eating (80-120)
Give bolus good 20-30 minute before eating.
Give bolus of estimated carb intake

Eat food.

Notice level quickly goes up, often times 300+ with 30 minutes of eating.
I notice this because of using DEXCOM sensor. I also verify level using Blood meter, and level is same as Dexcom within a few points.

Often times level stays elevated for over 1.5 hrs, and I have to give corrective bolus to force it down.

I have tried adjusting my carb/insulin ratio and still unsure what to do..

I have tried to give insulin 45 minutes prior to eating, (when sugar levels are normal IE 80-120) but then level start dropping to 40-50 when I start eating, and even despite levels being this low, sugar levels spike up VERY RAPIDLY, from 40 up to 300...

Any ideas or suggestions on this?

I am open to any / all suggestions, as lately this has been a real problem.

I am in the process of discussing this with my doctor also..
 

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This sounds like a real problem for you. I have to take my insulin after I eat because I have gastroparesis and my digestion is slow. I knew I had a problem when I was taking my insulin before meals and I kept going low. After I switched to taking my insulin to after meals, those type of lows stopped. I hope your doctor has some ideas for you. Diabetes is really a very individualized disease. You have a really good tool, the CGM.
 

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Discussion Starter · #3 ·
I have an apt to see my doctor to discuss this, the good news is the doc can download the dexcom to the computer, as well as the pump and line up the time the insulin is given, and see the levels, and then make a determination after this...

I am hoping to get some better results. I did read just now, that after eating and giving insulin, to do something physcial, IE go on a walk, do something to get the heart pumping faster, as it speeds up the insulin and it works better, but in my opinion it should work regardless of doing physical activity after you eat.

I do exercise as this does help the management of the disease, but these spikes after I eat, is just abnormal, and I need to get this under control.

the solution of not eating just doesn't work for me.....

I will keep this thread updates after i visit the doc.
 

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Hello, c123, and welcome. Hope we'll be hearing good news from you soon . . . sounds like you have a good doc. There are several pumpers here too, so you may get some more input.
 

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Since you must use carb counting to determine your pre-meal dosages, you may need to decrease your ratio so you will be getting larger doses. I am assuming that your post meal spikes cause you to stay rather high even when the bolus is completely depleted (usually 4 hours). Taking an early bolus even 15 minutes before meals would help. There is also a faster acting insulin called Apidra, which takes effect more quickly, and lasts about 3 hours. I know some people have solved the problem you are having by switching to Apidra. You may want to ask your doctor about Apidra.

Have you done basal testing recently? Some of your basal rates may need to be increased for the times following your meals. Are you sure your insulin sensitivities are correct? I have carb ratios and insulin sensitivities that very throughout the day. Getting the correct programming for different times of the day has helped me very much.

Be sure to ask more questions, if needed.

Richard
 

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Since you must use carb counting to determine your pre-meal dosages, you may need to decrease your ratio so you will be getting larger doses. I am assuming that your post meal spikes cause you to stay rather high even when the bolus is completely depleted (usually 4 hours). Taking an early bolus even 15 minutes before meals would help. There is also a faster acting insulin called Apidra, which takes effect more quickly, and lasts about 3 hours. I know some people have solved the problem you are having by switching to Apidra. You may want to ask your doctor about Apidra.

Have you done basal testing recently? Some of your basal rates may need to be increased for the times following your meals. Are you sure your insulin sensitivities are correct? I have carb ratios and insulin sensitivities that very throughout the day. Getting the correct programming for different times of the day has helped me very much.

Be sure to ask more questions, if needed.

Richard
I know this is a little off topic but I am curious about something you mentioned. As some of you might remember, I tried to get a pump a few months ago and my insurance wouldn't cover it. It looks like after the first of the year the change in insurance will allow me to get a pump.
Right now I eat the same amount of carbs every day for the particular meal I'm eating. 30 grams at breakfast, 45 grams at lunch and 15 grams at dinner. However, I use much less insulin at breakfast. 10 units with breakfast, 12-14 units at lunch and 14-16 units at dinner.
My question is this, will my pump be able to recognize which meal/sensitivity I am currently consuming and does appropriately? I.E. Will it know that my ratio is roughly 5 units per 15 grams at breakfast, 6 or 7 at lunch and 14 at dinner?
I don't know if that makes any sense and I'm sure my doctor will train me but I was hoping to have a little information going in.
Thanks!
 

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Yes Josh, you enter those numbers int the pump memory and tell it what hours you want each ratio to work. You can also tell the pump your insulin sensitivities and the hours too. That will enable you to correct highs properly. You can even program basal rates and the hours. I am using about 16 different basal rates that vary throughout the day. That is how you can narrow your range significantly. I finally have my fasting 80-110 every morning.

If you order the book "Pumping Insulin" by John Walsh, you will see all that you will need to know. That and the pump manual can be used to program your pump and give you the best control you have ever had. It can take a long time to get it all going properly though. A lot of trial and error and tweaking is necessary.
 

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Hi!

Hello,

I have the same problem as you! I can easily wait one hour after my bolus before eating, especially in the morning. It is really tough to control. The only thing that helps is eating oatmeal (big flakes) for breakfast with no sugar. Hope this helps!
 

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c123,
You don't say how many carbs you are trying to cover, but I hope you understand you are not going to be able cover an unlimited amount. I personally found I could not cover many more than 10 grams without spiking above 140. Insulin takes more time to get to work then most carbs - that's just the way it is. Pumps can't do miracles. If they could, I'd get one.
 

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could it be the law of big numbers

a lot of carbs require a lit of insulin gives you a lot of high numbers if the match of carb and insulin is not perfect.

what happens if you eat fewer carbs and bolus for fewer carbs?
 

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c123 has not logged in here since 2010 so this thread is now :closed_2:
 
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