Please sone help needed

[Sasha1!]

Hi
So this feels like I’ve been here before a bit with this post
Can someone please advise me - I am using the Medtronic 780g with guardian 4
Nights & mornings - great
My afternoons seem to be getting worse & worse
So today knowing how the last 5 days have been I tried something (I know it may have been a bit silly but bear with me) had my lunch of small sweet jacket potato (weighed it for the carbs) my numbers were 8 before lunch & pre bolused
Had tomato with it & grated cheese
Wasn’t having an overly active afternoon but had a 10 minute walk after lunch
So after I bolused - I went to fill canula option & basically input 5 units - I know I know but the reason why is because every **** time I eat at lunch my numbers are a so & so in the afternoon- high!!
My point in this is - they still went HIGH ‍ what the heck??? I am attaching my screen shot

Please anyone how can I sort this out

 

[Sasha1!]

My i

Hi
So this feels like I’ve been here before a bit with this post
Can someone please advise me - I am using the Medtronic 780g with guardian 4
Nights & mornings - great
My afternoons seem to be getting worse & worse
So today knowing how the last 5 days have been I tried something (I know it may have been a bit silly but bear with me) had my lunch of small sweet jacket potato (weighed it for the carbs) my numbers were 8 before lunch & pre bolused
Had tomato with it & grated cheese
Wasn’t having an overly active afternoon but had a 10 minute walk after lunch
So after I bolused - I went to fill canula option & basically input 5 units - I know I know but the reason why is because every **** time I eat at lunch my numbers are a so & so in the afternoon- high!!
My point in this is - they still went HIGH ‍ what the heck??? I am attaching my screen shot

Please anyone how can I sort this out

my other point is look how much insulin I have apparently on board
What’s it doing?? Because in my mind IT IS NOT WORKING - just tired of this

 

[Dexta]

Hi Sasha. Just a thought. Does your control improve at all soon after you change your cannula/infusion set and then deteriorate?

I know your night and morning control seems good, but I’m just wondering if it could be your cannula site that’s partially restricting insulin absorption.

 

[Juicyj]

Hello @Sasha1!

This is what i'd do if faced with this situation - either start with basal fasting tests and check how my basal insulin profile is stacking up during this period, or just go straight ahead and change my bolus ratio covering the time frame over this period. https://www.mysugr.com/en/blog/basal-rate-testing

Repeated events suggest either your basal or bolus ratio needs adjusting, so rather than fighting it with corrections either do a couple of basal fasting tests or look at your insulin settings and see where the bolus adjustment need to be made, no one here can advise on what to adjust by so if you're not sure yourself contact your DSN and get some guidance on this.

 

[Sasha1!]

Hello @Sasha1!

This is what i'd do if faced with this situation - either start with basal fasting tests and check how my basal insulin profile is stacking up during this period, or just go straight ahead and change my bolus ratio covering the time frame over this period. https://www.mysugr.com/en/blog/basal-rate-testing

Repeated events suggest either your basal or bolus ratio needs adjusting, so rather than fighting it with corrections either do a couple of basal fasting tests or look at your insulin settings and see where the bolus adjustment need to be made, no one here can advise on what to adjust by so if you're not sure yourself contact your DSN and get some guidance on this.

Thank you
Same old battle with my Nurse ‍ she tells me the pump will eventually bring me down?!! My thoughts on this are are t ok actually serious - you think I feel well like this not to mention the damage it is doing to me!! I find it pretty **** poor service ……. Hence am sorry but I ask for help on heat - the afternoons lately are a sodding nightmare
Surely this isn’t right - let alone just accept it-which is what my nurse is basically saying!

 

[Juicyj]

Thank you
Same old battle with my Nurse ‍ she tells me the pump will eventually bring me down?!! My thoughts on this are are t ok actually serious - you think I feel well like this not to mention the damage it is doing to me!! I find it pretty **** poor service ……. Hence am sorry but I ask for help on heat - the afternoons lately are a sodding nightmare
Surely this isn’t right - let alone just accept it-which is what my nurse is basically saying!

That's a poor response from your nurse, can you ask to speak to another nurse ? Yes eventually the pump will correct it - but that does not address the issue which is preventing it from going high to start with and that's your argument. Thy should review your pump settings to manage it.

Can you review your bolus ratios in your pump yourself and would you feel ok doing so ? We cannot here advise on adjusting this, it's against forum rules.

 

[WILCOMAN]

I have exactly the same setup as you and what I do is bolus thirty minutes before I eat and that works well for me

 

[Sasha1!]

That's a poor response from your nurse, can you ask to speak to another nurse ? Yes eventually the pump will correct it - but that does not address the issue which is preventing it from going high to start with and that's your argument. Thy should review your pump settings to manage it.

Can you review your bolus ratios in your pump yourself and would you feel ok doing so ? We cannot here advise on adjusting this, it's against forum rules.

I feel a bit unsure about making the changes but feel if I do it gradually should be ok
Exactly my point - I’d like to prevent it happening in the first place
Today been another rollercoaster
Will make some changes tomorrow

 

[Sasha1!]

So this is now ‍ I just don’t know what is going on- have plenty of insulin on board

 

[Sasha1!]

Now this at 10.25pm
‍‍‍‍ tired of diabetes this week

 

[Juicyj]

The issue I have when dealing with this is the waiting game, you're clock watching waiting for it to come down, then if it's late at night the fear of hypos during the night.

If you're not used to doing ratio changes then create a new profile to do it, screenshot the change so it's date recorded and as you say gradual changes are perfect, a minor tweak and sit and wait a few days and then again, record everything though to track and record or simply write it down in a diary, it's empowering to self manage your t1d without relying on the response from someone who isn't interested in helping as that's like fighting a brick wall.

100% know how you feel..

 

[Sasha1!]

The issue I have when dealing with this is the waiting game, you're clock watching waiting for it to come down, then if it's late at night the fear of hypos during the night.

If you're not used to doing ratio changes then create a new profile to do it, screenshot the change so it's date recorded and as you say gradual changes are perfect, a minor tweak and sit and wait a few days and then again, record everything though to track and record or simply write it down in a diary, it's empowering to self manage your t1d without relying on the response from someone who isn't interested in helping as that's like fighting a brick wall.

100% know how you feel..

Thanks- this is good to hear
I was starting to think maybe I had done something to irritate her - then was like well perhaps this is my fault - I just don’t understand - she keeps feeling me I want too tight a control on my diabetes & that it’s just not possible?! Surely though better that I want to look after my health than just abuse it?!!
Am setting up a new profile now
Just been out for a good walk with my dogs & had a BLT out along with a coffee- have for 60grams (which should easily cover it) oh no
Look at my graph
Also can someone please explain…. I have 2.475 of active insulin on board - so why are my numbers so off - does this just mean my ratios are NOT correct
Would just like it clarifying …. Many thanks

 

[Antje77]

Just been out for a good walk with my dogs & had a BLT out along with a coffee- have for 60grams (which should easily cover it) oh no
Look at my graph
Also can someone please explain…. I have 2.475 of active insulin on board - so why are my numbers so off - does this just mean my ratios are NOT correct
Would just like it clarifying …. Many thanks

I'm curious to see if it comes down in the next couple of hours.
If it does, the ratio probably was correct, but the food hit quicker than the insulin. Do you pre-bolus at all?
If it stays high, it likely is that your ratio is off. Or you're like me, it's simply almost impossible for me to dose for 60 grams of carbs in one go.

 

[Juicyj]

I think it's important to state that regardless of how much insulin you have on board that there are other factors at play here, so when did you last change your infusion set ? There's a bedding in period with new set changes and pooling can occur around the site, so can sometimes take longer to adsorb, if you have lumps that can delay absorption rate too, so check sites carefully and rotate well. Antje mentioned about pre-bolusing, assuming your on novorapid it can take 20 mins or so to start working so a pre-bolus can help align that issue. Again if your ratio is off then you will spike higher, so tweaking your bolus to counter is good but only do so based on patterns, I tend to tweak if I see the same pattern occurring 2-3 times before acting otherwise it could just be an anomaly.

Having tight control is good but it's a devil's game to keep it tight too and can affect your mental state, so acknowledging high numbers is vital but letting it control your life is not a good way of handling it, we should see numbers as a guide and not as an entity to control. There is a fine mental balance with controlling t1d and understanding what tools we need to help us cope daily, my tools are my ability to fine tune, exercise and zone out from t1d, on bad days it can literally take over your life but on good days we can quite literally forget it exists by relying on our subconscious to manage and adjust it without paying it much thought, hopefully you can get here by learning more about t1d and empowering yourself.

I mentioned in an earlier post about insulin resistance which changes throughout the day, mornings and carbs are generally a no no for me unless super active, but later in the day around 4-6 I can eat carbs no issue, it's all about learning what works best for you.

Also sometimes we encounter incredible health care providers who are supportive and help us massively, we also encounter some who become obstacles, it's vital to recognise who is helping and who is an obstacle to avoid.

 

[Antje77]

Antje mentioned about pre-bolusing, assuming your on novorapid it can take 20 mins or so to start working

I completely agree with your post, I just like to elaborat that it's very individual how long it takes for insulin to start working. I need much longer than 20 minutes, even on a faster acting insulin than Novorapid.

 

[Juicyj]

Thanks Antje - yes agree it's quite different for us all, I think when I was using Novosluggish it would take around 30 mins to start kicking in.. arrgghhhh..........

 

[Sasha1!]

I'm curious to see if it comes down in the next couple of hours.
If it does, the ratio probably was correct, but the food hit quicker than the insulin. Do you pre-bolus at all?
If it stays high, it likely is that your ratio is off. Or you're like me, it's simply almost impossible for me to dose for 60 grams of carbs in one go.

 

[Antje77]

So it looks like you did take enough insulin.
Keep a close eye on that graph in case you keep dropping. Most of the bolus for your meal should have worn off by now, but sometimes it works a little longer for me, especially with larger boluses.

Do you bolus and eat imediately, or do you give the insulin some time before eating?

Thanks Antje - yes agree it's quite different for us all, I think when I was using Novosluggish it would take around 30 mins to start kicking in.. arrgghhhh..........
View attachment 73591

Lucky you! Even on Fiasp or Lyumjev I need to give it 30 to 60 minutes. Correction doses usually kick in at around 2 hours for me.