Insulin Backed Up

[StewM]

Hi, I've only been on a pump for a week so I'm not sure if this is a common issue or not, but it's not one I've experienced using MDI.

My Bolus seems to be getting "backed up" when I inject. What do I mean by this? I take the Bolus and about 60% activates (based on the spike I get compared the Carb Intake and my sensitivity to Carbs). The other 40% just doesn't do anything for hours and then at about hour 4/5 that 40% all acts at once very quickly* (e.g. dropping from 12.2 to 4.9 in twenty minutes, where I just sat on the couch). This seems to be happening with my Breakfast, Morning Snacks, and Dinner (not Lunch and/or Afternoon Snacks curiously enough). It happens with everyone of these meals.

Now, it's almost certain my Basal patterns are not right yet, but even after adjusting my morning Basal (due to what I saw in a Basal Test), I'm still experiencing this phenomenon.

I'm on Fiasp on the Pump, all Basal Tests are showing that my Basal's being delivered without error, even if my Basal Program isn't fully optimised yet.

Has anyone experienced this issue, or have a theory about why this might be happening?

*This scares the **** out of my Libre, so I get an alarm pretty quickly when this happens.

 

[searley]

Unless it's an extended bolus then it should not be backed up like that.. the peak would be about 50 minutes after injecting and almost noting after 4/5 hours

I'm going to guess it's more likely that you basal is incorrect...

You need to do basal testing to get the basal right throughout the day.. when this is right you can work on the bolus levels

 

[searley]

Unless it's an extended bolus then it should not be backed up like that.. the peak would be about 50 minutes after injecting and almost noting after 4/5 hours

I'm going to guess it's more likely that you basal is incorrect...

You need to do basal testing to get the basal right throughout the day.. when this is right you can work on the bolus levels

Having read that you are on fiasp which is not tested or approved for most pumps.. and is know in some cases to cause issues... tandem claim that bolus are OK.. but basal causes issues then this could also be a factor...

I know there are many using fiasp in pumps but I also know from my hospital that they have had many fiasp issues


I'd be tempted to talk to your hospital or pump manufacturer

 

[StewM]

Unless it's an extended bolus then it should not be backed up like that.. the peak would be about 50 minutes after injecting and almost noting after 4/5 hours

I'm going to guess it's more likely that you basal is incorrect...

You need to do basal testing to get the basal right throughout the day.. when this is right you can work on the bolus levels

Thanks!

Yeah, I'd be doing that anyway as I definitely haven't optimised the Basal, but like I say my first Basal adjustment had zero impact on this phenomenon (whereas my first adjustment to my overnight Basal had immediate results).

Having read that you are on fiasp which is not tested or approved for most pumps.. and is know in some cases to cause issues... tandem claim that bolus are OK.. but basal causes issues then this could also be a factor...

I know there are many using fiasp in pumps but I also know from my hospital that they have had many fiasp issues


I'd be tempted to talk to your hospital or pump manufacturer

What might lend credence to Fiasp being the issue is the phenomenon is very similar to what I experienced with Corrections on MDI, i.e. I'd need to take a correction and very patiently wait for it to come down, as it could seem like Fiasp was doing nothing for hours before suddenly dropping towards the end of its activity cycle.

When I was given a choice of Pump, I was told some Pumps wouldn't take Fiasp (which wasn't a problem as I wasn't attached to Fiasp at all) but they kept me on Fiasp because it was "okay with this Pump*", which in light of what you've said, I'm not really sure what that means.

*That Pump being the Omnipod Dash

 

[searley]

Thanks!

Yeah, I'd be doing that anyway as I definitely haven't optimised the Basal, but like I say my first Basal adjustment had zero impact on this phenomenon (whereas my first adjustment to my overnight Basal had immediate results).



What might lend credence to Fiasp being the issue is the phenomenon is very similar to what I experienced with Corrections on MDI, i.e. I'd need to take a correction and very patiently wait for it to come down, as it could seem like Fiasp was doing nothing for hours before suddenly dropping towards the end of its activity cycle.

When I was given a choice of Pump, I was told some Pumps wouldn't take Fiasp (which wasn't a problem as I wasn't attached to Fiasp at all) but they kept me on Fiasp because it was "okay with this Pump*", which in light of what you've said, I'm not really sure what that means.

*That Pump being the Omnipod Dash

You said you had not experienced on mdi....


If you had the same issue on mdi then I would say you are not suited to fiasp... fiasp should peak at about 50 minutes and the tail off over the next few hours... if its holding back for several hours you really need to try another insulin

I can't use fiasp doesn't suit me.. I use humalog no issue

 

[StewM]

You said you had not experienced on mdi....


If you had the same issue on mdi then I would say you are not suited to fiasp... fiasp should peak at about 50 minutes and the tail off over the next few hours... if its holding back for several hours you really need to try another insulin

I can't use fiasp doesn't suit me.. I use humalog no issue

Sorry, may have explained this poorly. I've not experienced the issue with my meal-time Boluses "backing up" on MDI. This exclusively occurred with corrections on MDI.

The Doctors in my health board push Fiasp very aggressively. So much as mention a small issue with non-Fiasp Bolus and they immediately push Fiasp on you as the solution and are extremely reluctant to take anyone off Fiasp if they experience issues.

 

[Soplewis12]

Sorry, may have explained this poorly. I've not experienced the issue with my meal-time Boluses "backing up" on MDI. This exclusively occurred with corrections on MDI.

The Doctors in my health board push Fiasp very aggressively. So much as mention a small issue with non-Fiasp Bolus and they immediately push Fiasp on you as the solution and are extremely reluctant to take anyone off Fiasp if they experience issues.

At my first pump review with pump specialist I was enquiring about alternative fast acting insulins & was told that fiasp was not an option with omnipod dash pump as it was gloopy. Not sure if this helps

 

[StewM]

At my first pump review with pump specialist I was enquiring about alternative fast acting insulins & was told that fiasp was not an option with omnipod dash pump as it was gloopy. Not sure if this helps

Do you know where that information came from? It's been said on the forum a few times, but the Pump Manufacturer's website clearly lists Fiasp as one of the suitable Insulins that works with it. So it doesn't give me much to prove my case if I decide to bring it up.

 

[Soplewis12]

Do you know where that information came from? It's been said on the forum a few times, but the Pump Manufacturer's website clearly lists Fiasp as one of the suitable Insulins that works with it. So it doesn't give me much to prove my case if I decide to bring it up.

Sorry I don't, it was my pump specialist consultant @ NHS Greater Glasgow & Clyde who told me.

 

[StewM]

Sorry I don't, it was my pump specialist consultant @ NHS Greater Glasgow & Clyde who told me.

You know what’s really weird about this? I’m also in NHS Greater Glasgow and Clyde.

 

[searley]

You know what’s really weird about this? I’m also in NHS Greater Glasgow and Clyde.

My pump team told me fiasp wasn't a recommended option as they had troubles with it in pumps.... it not recommended for mine at all

I'm also going to assume that as most pumps work on the same principle that there is a potential for issue on all pumps

Having said that there are plenty of people successfully using it in a pump too!

But what I have ready in most cases is where a set change would be every three days most have to do it every 2 as the fiasp can crysalise

 

[StewM]

So I did a Basal Test in the afternoon yesterday and saw some unusual stuff. My Blood Sugar descended for four hours, but it did so like this

Hour 1: 1.2 drop
Hour 2: 0.6 drop
Hour 3: 0.3 drop
Hour 4: 0.1 drop
Hour 5: 1.4 spike

So… Don’t know what you guys think, this looks to me like my morning Bolus was still trailing off (despite the fact I’d given it 5 hours to do so). And then the minute it stopped my Basal was insufficient hence the spike.

 

[searley]

So I did a Basal Test in the afternoon yesterday and saw some unusual stuff. My Blood Sugar descended for four hours, but it did so like this

Hour 1: 1.2 drop
Hour 2: 0.6 drop
Hour 3: 0.3 drop
Hour 4: 0.1 drop
Hour 5: 1.4 spike

So… Don’t know what you guys think, this looks to me like my morning Bolus was still trailing off (despite the fact I’d given it 5 hours to do so). And then the minute it stopped my Basal was insufficient hence the spike.

May not mean that..

Firstly fiasp can work for upto 5 hours.... so unless you started testing 5 hours plus from the bolus there would still be an effect..

0.anything drop is not much and could just be a fraction too much bolus but I wouldn't adjust on a 1 off basal test... as the same tomorrow may give different results

As for a 1.4 rise again that may mean nothing unless it continues to rise... it may mean that your basal needs rise at that time of day.. it could be a 1 off liver dump... again with a small rise like that I wouldn't change anything without confirming the results

I have 6 time periods set as my basal at 3pm is significantly different to my needs at 9am

 

[StewM]

May not mean that..

Firstly fiasp can work for upto 5 hours.... so unless you started testing 5 hours plus from the bolus there would still be an effect..

0.anything drop is not much and could just be a fraction too much bolus but I would adjust on a 1 off basal test... as the same tomorrow may give different results

As for a 1.4 rise again that may mean nothing unless it continues to rise... it may mean that your basal needs rise at that time of day.. it could be a 1 off liver dump... again with a small rise like that I wouldn't change anything without confirming the results

I have 6 time periods set as my basal at 3pm is significantly different to my needs at 9am

I did indeed start testing 5 hours after my breakfast.

Yeah, I've not changed anything yet, as it wasn't matching patterns I'd seen on days when I was eating a lunch.

 

[searley]

It's not massive changes so your in the right area... little more testing... took about 6 months for mine to be right and occasional tweaks thereafter

 

[Hopeful34]

0.anything drop is not much and could just be a fraction too much bolus but I would adjust on a 1 off basal test... as the same tomorrow may give different results

Did you mean you wouldn't adjust on a 1 off basal test?

 

[searley]

Did you mean you wouldn't adjust on a 1 off basal test?

Correct... I really need glasses have corrected

 

[StewM]

Correct... I really need glasses have corrected

I understood you

 

[Soplewis12]

You know what’s really weird about this? I’m also in NHS Greater Glasgow and Clyde.

LOL, small world indeed!
I'm under the care of the RAH, Dr Neil McGowan is my pump specialist. Which clinic do you attend?

 

[Soplewis12]

So I did a Basal Test in the afternoon yesterday and saw some unusual stuff. My Blood Sugar descended for four hours, but it did so like this

Hour 1: 1.2 drop
Hour 2: 0.6 drop
Hour 3: 0.3 drop
Hour 4: 0.1 drop
Hour 5: 1.4 spike

So… Don’t know what you guys think, this looks to me like my morning Bolus was still trailing off (despite the fact I’d given it 5 hours to do so). And then the minute it stopped my Basal was insufficient hence the spike.

Hi, once you've established a definite pattern I would only alter if range was 2.0 above your upper range or 2.0 below your lower range. Fluctuations will still occur even if your basal rate is tight.
I went Christmas shopping today, I used my normal temporary basal reduction for this but regardless I have been fighting low glucose warnings for the last 3 hours!