Confused.. Help please!

Hi guys - wondering if you could please give your advise / thoughts on sudden chages to my bolus ratio at lunch. Currently on a pump with 2 basal profiles .. one for work and one for weekends where i need less basal dues to activity / stress levels etc but bolus has always been the same whatever day of the week. At lunch i normally have a tin of John West tuna pasta, 2 small tins of mackrel in tom sauce, small bag of crisps and a banana totaling between 67 - 71 grams of carb. Usually eat the pasta, mackrel and crisps immediatley following my bolus and wait for my BS to trend down (use dexcom G4) before eating my banana - this is usually 1 and a quater to 1 and a half hours after bolusing - this has worked well. For past two days though have bolussed for all my lunch but have not eaten the banana as BS levels have been almost a flat line meaning for the past couple of days my insulin needs have approximately doubled at lunch time!! there has been no change to the time i eat or with activity/stress levels at work other than the office being a bit warmer than normal (there has been no change to my IC ratios for breakfast or dinner). I initially thought of the temperature but dismissed this as warm weather usually means a reduction in basal.. not an increase in bolus... Im at a loss... not too keen on the idea of just doubling my basal at lunch... just wondered on your thoughts and what could be the potential cause of this.

Many thanks in advance

helensaramay said:

Is your starting BG the same?
I ask because I wonder if you are starting to come down with something which is raising your BG and increasing your insulin requirements.

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GrantGam said:

Have you done a recent basal rate test over lunch time, to gauge your basal requirements for that part of the day? Maybe 10am to 2pm for example?

What do you mean when you say your BG has almost been a flat line? Surely that's not an issue?

If I were to take an advance bolus of 90 minutes, I'd be hypo long before I started eating. Although I appreciate that we are all different, to me that would imply that my bolus was compensating for some sort of BG rise seen around lunch. Implying a lack of basal. A basal rate test would confirm or dismiss that.

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Hi GrantGam - thanks for the responce - yes last basal test over lunch perod was about a month back... and BS seem to be quite stable. Regarding the 90 mins pre bolus - I dont in a sence do that.. i have been bolusing and eating straight away... just postponing eating the banana until the bolus peaks - as with me a banana can quicky rise my bloods within 15 - 20 mins. This approach has been great.. very slowly rising from bolus to about no more than 2 mmols then at about the 90 min mark start dropping where then i eat my banana. Levels then remain almst on an even keel..... other than since yesterday where i have not needed the banana and bs have been almost flat... just verty slowly rising but to a level of no more than an aditional 1 mmol. For example today bs at 7.1 at 11:30 bolused for full lunch (including banana) at 14:00 BS was 6.7 at 14:30 bs at 7.4 (not yet eaten banana!?!) totally confused

helensaramay said:

Is your starting BG the same?
I ask because I wonder if you are starting to come down with something which is raising your BG and increasing your insulin requirements.

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Hi Helesaramay... No my bloods do rise slightly but not by much... feel ok in myself just been a little warm in the office... other time of the day my levels act as i would anticipate... at a total loss :-(

GrantGam said:

Okay, I think I get you

What is your I:C ratio out of curiosity?

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At Breakfast 1:15, Lunch 1:9 and dinner its 1:11 - carbs today were 71 given a correction of .25 u and carb bolus of 7.9... by my reckogning my IC ratio today at lunch should have been 1: 5.44 as only eaten 43 g carbs!?

BS now 6.6 with .12u IOB

GrantGam said:

Interesting how you are more sensitive to insulin in the mornings than lunch and dinner, amazing how we're all different isn't it?

So I make an average sized banana to be around 25g carbs? Going from what you've told me ratio and carb intake wise; I make your "new" lunch ratio to be 1:6 (rounding of convenience). So although you appear to now need more insulin at lunch, it's not a frightening amount more.

Ratios do chop and change from time to time, as they're far from static values for a lot of us. Do you think this might just be a case of "one of them things"?

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Cheers for that ... i know... basal in last 6 months has almost doubled and ratios dramatically changed.. think might keep an eye on it currently at lunch for further few days just to see if the past few days has been a bit of a 'blip'... if continues may then adjust my ratio at lunch to 1:6. Cheers again