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Confused

Discussion in 'Insulin Pump Forum' started by steveo4, Apr 28, 2022.

  1. steveo4

    steveo4 · Well-Known Member

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    Can somebody advise me what I'm doing wrong because I can't seem to get it right. At 5.40 today I was 14.3 so gave myself 3 units to get back in range. Then before breakfast at 7.20 I was 8.7 and slightly dropping. I had 30g of carbs so normally give myself 3 units but the pump was saying I still had 2.5 units on board so only gave myself 0.5 units instead to prevent going hypo. Have just scanned again now and I'm 12.6 and slowly rising. Did I do the right thing by not giving myself the full amount for breakfast or should I have done. I'm just getting so confused.
     
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  2. Soplewis12

    Soplewis12 Type 1 · Well-Known Member

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    Hi Steve, I only know onnipod dash pump which takes in to account IOB when working out the Insulin you need. I would input carb & BG reading & the pump does the calculation for me. Are you overriding the pump calculation?
     
  3. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Hello - pumps aren't magical (well mine is as I've got a closed loop one) and are designed to take account of your active insulin when correcting a blood sugar. They will assume the life of this dosage to be 4 hours so your dose at 5.40 will have expired by 9.40 so your pump is designed to avoid panicked over stacking of correction doses which would lead you to a hypo.
    Firstly I would say don't panic if you've gone to a 12 unless this persists for more than 2 hours?
    If this happens then you'd need to look at 2 things:
    Bolus to carb ratio
    Correction dose ratio
    If you've got the first thing right then the 2nd should not be necessary unless your background basal is off.
    I am assuming that the ratio s etc were set up on your pump and that you know how to edit them if necessary?
    At the end of the day the pump is a mechanical device and just does what you've told it to do and some days your body isn't going to behave as expected.
    Also why did you wake up to test yourself at 5.40? If you've got an fsl alarm for highs it may be better to disable this at night time unless your blood sugars are very wild! Just the stress of waking up that early would spike me!!
     
  4. steveo4

    steveo4 · Well-Known Member

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    Yes my blood sugars can be very erratic at times. I seem to get a lot of insulin stacking up which I don't really understand why this happens.
     
  5. In Response

    In Response Type 1 · Well-Known Member

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    As @NicoleC1971 said, pumps are not magic.
    They are also not mind readers. They have no clue why you took the correction dose earlier or why you are taking more now.
    I don't believe it treats correction doses and food boluses any different (even though you told it about your BG and carbs) so it didn't know whether the earlier dose was for some food which has not yet digested. Yo need to apply this intelligence and override the calculation if you feel comfortable to do so. If not, don't panic about the 12 and correct later.
     
  6. StewM

    StewM Type 1 · Well-Known Member

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    What do you have your Insulin Duration set to?

    The fact your Pump believes you still had 2.5 of 3 units on aboard suggests you have the Insulin really high*. If it is high was that something that you changed, intentionally?

    *Like just doing a quick calculation that implies your Insulation Duration is set to 8 hours.
     
  7. steveo4

    steveo4 · Well-Known Member

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    My insulin duration is set to 4 hrs and the speed is set to standard. Do you think I need to change that to stop insulin on board?
     
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  8. StewM

    StewM Type 1 · Well-Known Member

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    I'm not entirely sure what you mean by your question.

    If your Duration is set to 4 that doesn't quite match with the scenario you've outlined, as you've outlined it. Did you take any additional Insulin as well as the 3 units mentioned at 5:40am? If not, have you seen signs of your Pump failing to calculate Insulin on Board correctly, because I don't believe there's any algorithm that would calculate Insulin On Board, by assuming only a tiny fraction of the Insulin was used after 100 minutes?
     
  9. Juicyj

    Juicyj Type 1 · Expert
    Retired Moderator

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    How are you sites looking too - any lumps ? Bad sites can delay the insulin performance so it's good to make sure sites are ok, in your shoes i'd look at changing my site, as this will rules out a bad set/insulin and site at the same time, but also using novorapid via a pen to bring down high levels too. Also are you coming down with anything such an infection/illness as this has this same effect for me.
     
  10. steveo4

    steveo4 · Well-Known Member

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    My pump doesn't seem to take into consideration the insulin on board as you can see from this photo below. 20220428_130152.jpg
     
  11. steveo4

    steveo4 · Well-Known Member

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    My sites are good I think I may need to adjust my insulin sensitivity maybe the current setting is too high
     
  12. Rokaab

    Rokaab Type 1 · Well-Known Member

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    Without a blood test value they generally don't afaik.

    Also note that just because you have insulin on board doesn't mean its all free.
    For example if I eat a 50carb meal at lunch and take 8 units for it (based on my carb ratio) and then have something else of 20 carbs to eat 1-2 hours later, I will obviously still have insulin on board but I still need insulin for that meal/snack of 20 carbs
     
    #12 Rokaab, Apr 28, 2022 at 2:35 PM
    Last edited: Apr 28, 2022
  13. steveo4

    steveo4 · Well-Known Member

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    Oh I see now I never realised that the thing is if I have insulin on board and if I'm 6.2 in range and have a snack of 30g then I wouldn't bolus because I thought if I did I'd go low but you're saying that's not the case?
     
  14. Rokaab

    Rokaab Type 1 · Well-Known Member

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    Well think of it this way:

    If you have 80 carbs in one go you take the insulin for that 80 carbs

    And if you have 80 carbs but split into 60 and then another 20 carbs an hour or so later, that still totals 80 carbs so you would still need enough insulin to cover that 80 carbs (though split into doses for 60 and 20 at the relevant time)

    Obviously some things get digested at different rates, sometimes insulin can seemingly get absorbed at a different rate so you may need to experiment on timing
     
  15. megan

    megan Type 1 · Well-Known Member

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    I've had this happen before. MySugr app would tell me how much insulin I needed and I'd follow it. But on some occasions it would tell me I still had insulin on board so it took it into account for my bolus. I'm fully aware of insulin stacking and didn't agree with the app but I thought to prove a point I'd follow its instructions. As I suspected I went high and eventually it was obvious a correctional was needed. MySugr app eventually completely crashed earlier this year and I've gone back to working out my own doses
    It's erratic too which is frustrating with how hard I try but I'm learning some is definitely hormonal.
     
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