Problem with pump

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.

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?

Have a read of the following article by Gary Scheiner, it discusses bolus timing to reduce postprandial spikes:

http://www.diabetesselfmanagement.c...blood-glucose-management/strike-the-spike-ii/

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.

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.

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...

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.


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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.