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Problem with pump

Discussion in 'Insulin Pump Forum' started by Shaggy_Dog_1, May 29, 2016.

  1. Shaggy_Dog_1

    Shaggy_Dog_1 Type 1 · Member

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    Ok, I'm relatively new to pump therapy, but I believe I've got my basic basal rate sorted. The problem that I have is this: whenever I eat, I bolus the correct dose of insulin, or at least what I believe to be the correct dose, and within an hour my BG readings are heading towards 20 mmol/l. I've wasted a few cannula believing that there must be a blockage, but no, nothing makes it any better. Any ideas as to why my BG would peak so high and so quickly, assuming that ratios and carbs are more or less correct? The effect is as if I've forgotten to bolus at all . . .

    thanks

    Simon
     
  2. noblehead

    noblehead Type 1 · Guru
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    Hi Simon,

    20mmol/l is quite a spike, do you pre-bolus ahead of your food to give your insulin a chance to work? Many of us find that bolusing 15-30mins ahead reduces postprandial spikes.
     
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  3. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Firstly double check your basal, just in case :
    Secondly what sort of waiting time are you using before meals ie., how long before you eat are you bolusing?
    Thirdly what are you eating. It takes 2 hours for your insulin to peak unless using Apidra so 1 hour after eating seems very odd for such a hike.
    What are your levels when you start to eat?
     
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  4. Shaggy_Dog_1

    Shaggy_Dog_1 Type 1 · Member

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    Hi both, thanks for answering. I tend to bolus between 15 minutes and 2 minutes before eating, much the same as I did when injecting, but then I did not have such a spike. My levels before eating are, of course, variable, but tend to be in the 4 -7 mmol/l range. As an example of what I'm eating, this morning I had my regular bowl of porridge, with yoghurt and stewed rhubarb (unsweetened). With the coffee that follows it works out a 65g of carb. I bolused 10.8 units, and watched as my BG shot upwards! I'm going to try pre-bolusing, at least as much as possible, to see what happens. I love the flexibility of the pump, but still trying to work out how to use it to best effect.
     
  5. noblehead

    noblehead Type 1 · Guru
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  6. iHs

    iHs · Well-Known Member

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    I would think that if a really high spike comes 1hr after eating with a bolus, then its time to adjust the basal 1-2hrsr before the meal bolusunforetunately or try to eat low carb meals for the times in the day when bg rises up a lot more than at other hours. With a pump, bg testing or cgm,fgm is essential to be able to fine tune the settings to cope with any changes that happen. It's not really uncommon for the basal need tto be adjusted when bg levels start to show a pattern. I have to tweak mine at times to cope with weather temperatures changing, weightgain or loss.
     
  7. Diamattic

    Diamattic Type 1 · Well-Known Member

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    I agree with above - there is a good chance that you need to bolus much longer before eating.

    I find that if i bolus and eat right away - my sugars spike as if I had not taken insulin at all (which is right, because it hasn't started working yet) and then when it does start working my sugars are so high that it requires more insulin to bring me back to normal because when your sugars are high enough you will likely develop some resistance to insulin. So i have to bolus again 3 hours after the first one and then watch them constantly to ensure they come back down :/

    Its a pain.

    This could be whats happening to you, especially if you are eating higher carb meals. Try bolusing 20-30 minutes before eating , and then eating slowly - see if that helps any.
     
  8. donnellysdogs

    donnellysdogs Type 1 · Master

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    Could just be that your bolus ratio is incorrect.
    You can work on that by monitoring every hour.. But leaving 5 clear hours between food... That is important. See if you return to your target level without any correction 5 hours later.
    Log yourbreadings in those 5 hours.
    There are good breakfasts to eat without so many carbs...
     
  9. RuthW

    RuthW Type 1 · Well-Known Member

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    It's clear from your answer that the first thing to adjust is timing. The second thing with relatively high carb meals is the 'super bolus'. I use this one for porridge if my pre-prandial blood test is at the higher end of normal (as well as waiting a bit longer before eating). What you do is to subtract 50% from your basal rate for the next 3 hours (set a temporary basal rate on your pump), then add the dose you have subtracted from your basal to the pre-meal bolus. It keeps your blood sugar down and the 'tail' of the higher dose compensates for the reduced basal without sending you into a hypo later. I don't need to use this technique for porridge when my blood sugar is at the lower end of normal. It's a very useful technique for those of us who love our carbs.


    Sent from my iPhone using DCUK Forum mobile app
     
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  10. Chas C

    Chas C Type 1 · Well-Known Member

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    Its very hard to give exact advice as we are all different and foods affect us in different ways.

    For me I always multi bolus for every meal and take insulin about 20-30mins before each meal.

    For breakfast its about 70% up front and rest over 1hr 15mins for low sugar granula and milk.

    For an indian its max 5 units up front (always) with the rest spread over two hours, even though the rest may be 10+ units, as giving more than 5 units in one go impacts the absorption rate.
     
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