On Novorapid and Medtronic 640 pump

[Jeannie3]

@Jeannie3 a jump from 9.9 to 13 is a little bit much but there's too much going on here to make any suggestions.

Did you have lunch at 1.30pm, so were 13 two hours later?

Did Bolus Wizard give a correction at lunch? (It should have, unless you still had active insulin from earlier).

You say your bolus ratio is 7g carbs to 1 unit of insulin. You say this is 1:13 but it is actually 1:7. (You can check by going to Menu, Insulin Settings, Bolus Wizard Setup, Carb Ratio).

Not everyone has the same carb ratio throughout the day. Perhaps you could ask your DSN if she thinks a change is necessary at lunchtime.

Also, if you did have a correction this morning and it didn't bring you within target, it could be your Insulin Sensitivity Factor needs to be changed. (We can also have different sensitivity factors for different times of day.)

I presume you have done a basal test by fasting at lunchtime. If not, check that before anything else.

If there's anything you're not sure of, check with your DSN.

Insulin sensitivity interesting ...will ask at my review in December ta ... Also say this morning was 6.7 BG before drive to work ...had no food ...got 2 work and was 9.6???? Basal goes up from 6am ...6.7 BG at 7 am then 9.6 BG at 7.45...ate nothing ...you start to think how do you control random problems ???

 

[Jeannie3]

I also "suffer" dawn phenomenon and used to be on Novorapid until almost a year ago
Asked my diabetologist to switch me from it to Fiasp (which is Novorapid with an added vitamin which makes it work much more quickly from 2 mins right up to 5 hours).
I can't understand why people who are on Novorapid aren't changed to Fiasp.
Maybe a change to Fiasp after consulting your diabetologist might help you get the effects of dawn phenomenon back into target range more quickly

Thank you so much for your advice ..will ask Consultant in April

 

[Jeannie3]

When I was working, my BG used to jump to high teens 2 hours after breakfast but when I increased bolus I would go hypo later in morning. My DSN suggested using an increased temporary basal for 30 minutes at breakfast, instead of the increased bolus. It took a bit of trial and error (starting low and working up) but eventually I found a level that worked for me. Maybe you need something like this at lunchtime.

Can i ask what you increased basal by at lunchtime and was it only 30 min blast?

 

[dancer]

Thank you ...not sure if im replying to you ...wanted to follow your advice but not sure how i can do this ...will have to try n find info

@Jeannie3 do you mean you don't know how to do a lunchtime basal test or how to adjust your Insulin Sensitivity Factor?

I presume it's the 2nd one. The insulin sensitivity factor is found in Bolus Wizard (Menu, Insulin Settings, Bolus Wizard Setup, Insulin Sensitivity Factor,)

you will have at least one entered there (I have 3). This is the number of mmol/l that 1 unit of insulin will reduce your blood glucose. For instance, if you have 4 entered, this means that one unit of insulin will reduce your blood sugar by 4. If you consistently find that you are still high hours after correcting, then maybe you need a higher correction, maybe 3.5 (that's 1 unit of insulin will reduce your blood sugar by 3.5) or lower.
You will notice there is a time section, so you can, if necessary, have a different correction factor for different times of day.

 

[dancer]

Can i ask what you increased basal by at lunchtime and was it only 30 min blast?

Everyone is different. I started with a temporary basal of 120% for 30 minutes and worked up. I kept it at 30 minutes, though tried an hour once and went hypo . . . but I am insulin sensitive, so have to be very careful.

 

[Jeannie3]

@Jeannie3 do you mean you don't know how to do a lunchtime basal test or how to adjust your Insulin Sensitivity Factor?

I presume it's the 2nd one. The insulin sensitivity factor is found in Bolus Wizard (Menu, Insulin Settings, Bolus Wizard Setup, Insulin Sensitivity Factor,)

you will have at least one entered there (I have 3). This is the number of mmol/l that 1 unit of insulin will reduce your blood glucose. For instance, if you have 4 entered, this means that one unit of insulin will reduce your blood sugar by 4. If you consistently find that you are still high hours after correcting, then maybe you need a higher correction, maybe 3.5 (that's 1 unit of insulin will reduce your blood sugar by 3.5) or lower.
You will notice there is a time section, so you can, if necessary, have a different correction factor for different times of day.

Thanks for that ...see what u mean ...used it this morning as 9.5 BG was 6Bg at 12.00 noon so ok in morning ...think my probs are always lunch time ....will try 30 min basal increase slightly n note thinks ...thank you for your help

 

[Jeannie3]

Everyone is different. I started with a temporary basal of 120% for 30 minutes and worked up. I kept it at 30 minutes, though tried an hour once and went hypo . . . but I am insulin sensitive, so have to be very careful.

Insulin sensitive ??? What is that...poor u

 

[leeweeks]

They are quite good in that only have to inject the cannula every 2 to 3 days ...however its a task to get your overall rates of insulin input right and get overall good BG control ...everyone is different tho im sure you will find it good

 

[leeweeks]

They are quite good in that only have to inject the cannula every 2 to 3 days ...however its a task to get your overall rates of insulin input right and get overall good BG control ...everyone is different tho im sure you will find it good

Thanks I know any change of meds will be trial and error at first as log as they are easy to use . I will not be frightened about giving them ago

 

[dancer]

Insulin sensitive ??? What is that...poor u

I use small amounts of insulin. Big changes to basal or bolus cause havoc. When on injections, I had to use a half unit pen, as increases of one unit sent me hypo. At the time they only made half unit pens for children, so I had a nicely patterned Novopen

 

[kitedoc]

Insulin sensitivity interesting ...will ask at my review in December ta ... Also say this morning was 6.7 BG before drive to work ...had no food ...got 2 work and was 9.6???? Basal goes up from 6am ...6.7 BG at 7 am then 9.6 BG at 7.45...ate nothing ...you start to think how do you control random problems ???

Hi @Jeannie3, It sounds like your basal in the morning may need adjustment. Mind you the stress of driving to work may increase BSLs. Most of us pumpers, whatever pump find that we need more insuin for boluses (and therefore lower carb g per unit than later in the day.
Regarding basal, there are several 'types' of ways to first work out basal doses when put onto a pump according to my endo.
Some doctors and nurses apparently only do several basal doses changes over the 24 hours and expect the patient to just alter these a bit. He calls this the cook-book method - note the patient's weight and what insulin they are supposed to need, bung the numbers in and job done.
Others, like my endo, take into account the person's past insulin use and factor in Dawn phenomenon and really 'sculpt out' an individual basal regime which has many changes in the dosage, not great variations but still variations, through the 24 hours.
He fine tunes this over time with my participation. It is like learning from a fine craftsperson. The variations in basal may be just 5 to 8 % at a time. I work on a 4 to 6 hour "trouble" slot at a time. Give it 2 days and reassess.
There are some who have had site reactions to Fiasp and others who find the Fiasp seems to lose its effect after 2 weeks from when an ampoule is moved out the the fridge. For others the initial quick effect seems to peter out after some months of its use and they feel like they may as well be back on Novorapid. This is with pumps as well as with those on MDI (multiple daily injections).
I am not doubting those that find it helps but whilst UK health authorities have accepted Fiasp, the US (and so far Australia) have not accepted Fiasp.
I am on a Tandem Slim x2 pump but what has worked best for me was to alter my diet rather than trying to alter the speed of my short-acting insulin.(currently Novorapid).
Just as another way to look at things, not as an absolute sure-fire answer: read the book or e-book: 'Dr Bernstein's Diabetes Solution". It is not something to undertake, if you do wish to try it, by one's self as insulin doses need to be adjusted.
The upshot is that less carbs and more protein means that BSL rises are delayed and fit in better with Novorapid's action.
Again just a thought. Best wishes !!

 

[leeweeks]

They are quite good in that only have to inject the cannula every 2 to 3 days ...however its a task to get your overall rates of insulin input right and get overall good BG control ...everyone is different tho im sure you will find it good

Thanks .. i know all meds a a bit hit and miss , in the beginning. Its the ease of use that i will need , I dont mind going thro the trial period .
If things are to complex i will not stick with it, if the results are up and down .

 

[horsingaround]

Have you tried the libre or another cgms? It has really helped me with watching the graph! I have discovered with the libre that I need to take my bolus 30-40 mins before I eat to not get super high by hour two. Then and temporary basal at 0% to stop the drop at hour 3. Without doing it that way I would go from 5.5 pre meal to 15 at hour two and 5.5 and lower at hour 4. It’s all about timings. I have the ultimate basal. When I eat or do nothing or got a bug it’s a very straight line!

 

[Jeannie3]

Not had the chance ...still on wait list 4 libra ...hey ho

 

[Jeannie3]

I use small amounts of insulin. Big changes to basal or bolus cause havoc. When on injections, I had to use a half unit pen, as increases of one unit sent me hypo. At the time they only made half unit pens for children, so I had a nicely patterned Novopen

Thats an added horror for you ...people dont realize how hard it is to control eh