Ratios

Topher · Jun 22, 2015

This is never ending, thanks so far for all the help, I'm on the vibe and Dexcom for the past 5 weeks and still trying to get things right, which I thought I had but seems to change constantly

What I have noticed is, I spike when I bolus up to 13-14, 2 hours after and I would be 6 when I bolus, and I wait 30 mins before I eat

After 3.5 hours I start to coming down and between 4-5 hours I gradually hit my target of about 6, and still continue to gradually go down

My question is, I think my bolus ratio is too low, and my basal maybe too high, this bringing me down to my target. So if a increased my bolus a small bit and decreased my basal do you think this would help- it's starting to melt my head now
Any help would be great

donnellysdogs · Jun 22, 2015

You're going on the right lines........
As bolus only peaks at 2-3 hours there is still excess to follow later...
So raising your bolus ratio may mean lowering your basal rate that affects your 4-5 hour rates after the bolus........

I always had to work that way on my pump and recommended others did that too.

CarbsRok · Jun 22, 2015

What duration of insulin have you set the pump at?

ewelina · Jun 22, 2015

Topher said:
This is never ending, thanks so far for all the help, I'm on the vibe and Dexcom for the past 5 weeks and still trying to get things right, which I thought I had but seems to change constantly

What I have noticed is, I spike when I bolus up to 13-14, 2 hours after and I would be 6 when I bolus, and I wait 30 mins before I eat

After 3.5 hours I start to coming down and between 4-5 hours I gradually hit my target of about 6, and still continue to gradually go down

My question is, I think my bolus ratio is too low, and my basal maybe too high, this bringing me down to my target. So if a increased my bolus a small bit and decreased my basal do you think this would help- it's starting to melt my head now
Any help would be great

Probably you are right. I would do basal testing though and then work on ratios

ewelina · Jun 22, 2015

CarbsRok said:
What duration of insulin have you set the pump at?

Can we set any duration I don't know about?? Do you mean extended bolus?

CarbsRok · Jun 22, 2015

ewelina said:
Can we set any duration I don't know about?? Do you mean extended bolus?

If you look in your setting you will find something like duration of insulin, (Dif pumps dif wording) you set this to the length of time your insulin works for and not when it peaks. If this is correct then your bolus and correction should work better and also look at what level you are aiming for ie. 5.5 as a target.

CarbsRok · Jun 22, 2015

Topher said:
What I have noticed is, I spike when I bolus up to 13-14, 2 hours after and I would be 6 when I bolus, and I wait 30 mins before I eat

I did suggest you check your blood sugar 30 mins after your bolus and before you ate, what was the result of this?
We really can't help you very much unless you give us the feed back we need.

ewelina · Jun 22, 2015

CarbsRok said:
If you look in your setting you will find something like duration of insulin, (Dif pumps dif wording) you set this to the length of time your insulin works for and not when it peaks. If this is correct then your bolus and correction should work better and also look at what level you are aiming for ie. 5.5 as a target.

ive just checked. On my pump its called acting time and its set for 4 h. There is also offset time which is 1 h. I have no idea what it means

CarbsRok · Jun 22, 2015

ewelina said:
ive just checked. On my pump its called acting time and its set for 4 h. There is also offset time which is 1 h. I have no idea what it means

@donnellysdogs
Non technical for offset time is the pump is disregarding an hour because it takes an hour for the insulin to work. Which I doubt very much it takes that amount of time. (hopefully someone can clarify this)
As I understand it acting time is between 4 1/2 and 5 hours for the rapid insulin's, but you need to check this for yourself.

donnellysdogs · Jun 22, 2015

Off set time
Offset time takes into account the expected delay for the blood glucose level to actually start falling during the acting time of insulin in the body. It describes the first time period within the acting time.

Acting time is the period of time from the start of the meal rise or the delivery of the bolus until your blood glucose level is expected to return to the target level.

Topher · Jun 22, 2015

CarbsRok said:
I did suggest you check your blood sugar 30 mins after your bolus and before you ate, what was the result of this?
We really can't help you very much unless you give us the feed back we need.

My duration is set to 4 hours, I would be around 6mmol before my food and bolus if I wait 30 minutes I would go down to 4.8-4.5, I eat then spike to 13-14 mmol 2 hours later, then start to come down after about 3.5 hours

ewelina · Jun 22, 2015

CarbsRok said:
If you look in your setting you will find something like duration of insulin, (Dif pumps dif wording) you set this to the length of time your insulin works for and not when it peaks. If this is correct then your bolus and correction should work better and also look at what level you are aiming for ie. 5.5 as a target.

CarbsRok said:
@donnellysdogs
Non technical for offset time is the pump is disregarding an hour because it takes an hour for the insulin to work. Which I doubt very much it takes that amount of time. (hopefully someone can clarify this)
As I understand it acting time is between 4 1/2 and 5 hours for the rapid insulin's, but you need to check this for yourself.

Thank you for your reply. It must be a bit tricky to test it but I will try. Yes I agree 1h for offset time seems too long

donnellysdogs · Jun 22, 2015

Ie my insulin took an hour an half from injecting a correction (not worked out on food bolusing-as this would depend upon fat, and GI Etc).
Ie if I took a correction at a level of 9.0-without eating (as I only eat once a day) I could fully analyse be testing every 15 mins how quick it took for my levels to start a significant drop)... So this was my offset time.

If I got a level over 12.0 I did the same test again.. (No eating involved at all) and this told me that my body significantly needed more insulin for a correction over 12.0)

CarbsRok · Jun 22, 2015

Topher said:
My duration is set to 4 hours, I would be around 6mmol before my food and bolus if I wait 30 minutes I would go down to 4.8-4.5, I eat then spike to 13-14 mmol 2 hours later, then start to come down after about 3.5 hours

So what type of bolus are you using and what are you eating?

donnellysdogs · Jun 22, 2015

Because I was so anal and ate only one meal a day I could really find out my acting times and offset times....

If there was any food at all within a 5 hour period before or after a high level then you cannot be so exact as I used to be.

ewelina · Jun 22, 2015

donnellysdogs said:
Because I was so anal and ate only one meal a day I could really find out my acting times and offset times....

If there was any food at all within a 5 hour period before or after a high level then you cannot be so exact as I used to be.

Yes true. Sometimes I think I should go to two meals a day. Life would become easier I suppose.

donnellysdogs · Jun 22, 2015

Depends on how exact you are.. But also on eating habits.. I've always preferred one meal a day so it never bothered me.
I was the opposite to everybody else-i used eating as bolus testing-lol..
Not starving as basal testing!!

donnellysdogs · Jun 22, 2015

Topher said:
My duration is set to 4 hours, I would be around 6mmol before my food and bolus if I wait 30 minutes I would go down to 4.8-4.5, I eat then spike to 13-14 mmol 2 hours later, then start to come down after about 3.5 hours

That is way out!!!

On pump I certainly didn't ever bolus 30 mins before my food.. If you hsve your offset and acting time set right and your basals your really shouldnt have to bolus ahead..

Infact the Insight pump has a lag time so that if you were say 4.5 before a meal you could actually delay the time that the insulin for the bolus is pumped in to you...

Have you fully basal tested now and established your offset / acting times?

Topher · Jun 22, 2015

donnellysdogs said:
That is way out!!!

On pump I certainly didn't ever bolus 30 mins before my food.. If you hsve your offset and acting time set right and your basals your really shouldnt have to bolus ahead..

Infact the Insight pump has a lag time so that if you were say 4.5 before a meal you could actually delay the time that the insulin for the bolus is pumped in to you...

Have you fully basal tested now and established your offset / acting times?

I'm using humalog insulin, Yep my tested all my basals and they keep me quite right maybe a little too tight for me. My off set time is about 20-25 mins and my bs start to come down once I bolus

But as soon as I eat my bs start rising with in 30 mins and I spike, that's why I think my ratios maybe incorrect, I didn't have these problems on mdi, and I'm quite insulin sensitivity, my Tdd is only about 17 units

I only have 30g carbs at breakfast and 35g at lunch

noblehead · Jun 22, 2015

Topher said:
My question is, I think my bolus ratio is too low, and my basal maybe too high, this bringing me down to my target. So if a increased my bolus a small bit and decreased my basal do you think this would help- it's starting to melt my head now
Any help would be great

The only way you'll truly know is by basal testing, I'm sure you know how to do this already but if your in doubt have a look at the following:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

To alter the duration of the insulin on a Omnipod Pump it comes under Insulin Action.

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