T-Slim X2: What do you do for meals with multiple courses?

[RobertJ]

I think that sort of reading after a Christmas meal isn’t bad at all. It may be worth splitting your insulin by course. Or taking it after the starter. Too much panicking over the odd high reading.

Thanks, but I just think on the closed-loop system I should be avoiding this kind of thing. It's a bit disappointing to have big highs similar to what I would have had before the closed-loop and before I was on a pump at all. I thought it would intervene in a more effective way than it does.

I have had Type 1 for nearly 22 years so I really want to avoid reaching numbers like 13 or more on a regular basis. Sadly, I am all the time at the moment, including this very moment as I type this.

 

[RobertJ]

So this means 1 unit of insulin for every 12.2 grams of carbs.

That's interesting because my current ratios are lower than that: basically between 1:9 and 1:11 in different parts of the day.

 

[DChes]

I have just had my work Christmas lunch and I really tried to get things right. I did not succeed. Now I'm on a reading of 14.0 mmol/l, and I've been out of range for an hour and a half. I assume I'll be high for at least three hours now.

This was a standard Christmas dinner: turkey, one pig in blanket, stuffing, roast potatoes, swede, carrots, Brussels sprouts and gravy. For dessert I had a dark chocolate cake with cherries.

My strategy was to dose for the main meal fifteen minutes in advance (which ended up being twenty because of how long it took to queue up), and then dose for dessert while I was still eating the main course.

Previously, I've tried giving one big dose for two courses and splitting it, but I'm not sure that works.

I am just so sick of the way large meals always end up like this. The pump is supposed to prevent nasty spikes but I've had some awful experiences recently. It seems like once it starts rising fast, it's a guarantee I'll reach at least 14.0mmol/L and be high for at least three hours. It should be possible on such an advanced system to have large, high-carb meals and only experience a brief, moderate spike.

Is it possible that you have become somewhat insulin resistant over time? I have heard that the more insulin one uses, the more chance that might happen, for some people. Another idea - could you go for a 30 minute walk right before or right after you know you will eat a high carb meal - would that get you in range faster?

 

[RobertJ]

Is it possible that you have become somewhat insulin resistant over time? I have heard that the more insulin one uses, the more chance that might happen, for some people. Another idea - could you go for a 30 minute walk right before or right after you know you will eat a high carb meal - would that get you in range faster?

I do wonder if there's a diminishing returns aspect to giving large amounts of insulin. Sometimes I can't believe how much insulin I'm about to give for one meal (it's large and outside of my normal routine) but it's noticeable how often this doesn't work.

But if I have become insulin resistant over time, what do I do about that?

 

[Zulu1]

I have just had my work Christmas lunch and I really tried to get things right. I did not succeed. Now I'm on a reading of 14.0 mmol/l, and I've been out of range for an hour and a half. I assume I'll be high for at least three hours now.

This was a standard Christmas dinner: turkey, one pig in blanket, stuffing, roast potatoes, swede, carrots, Brussels sprouts and gravy. For dessert I had a dark chocolate cake with cherries.

My strategy was to dose for the main meal fifteen minutes in advance (which ended up being twenty because of how long it took to queue up), and then dose for dessert while I was still eating the main course.

Previously, I've tried giving one big dose for two courses and splitting it, but I'm not sure that works.

I am just so sick of the way large meals always end up like this. The pump is supposed to prevent nasty spikes but I've had some awful experiences recently. It seems like once it starts rising fast, it's a guarantee I'll reach at least 14.0mmol/L and be high for at least three hours. It should be possible on such an advanced system to have large, high-carb meals and only experience a brief, moderate spike.

Machines can only give a reading at that time, we are what we eat, it’s a lifelong commitment to maintain a sensible diet because of the condition we have. Stay focused and keep going

 

[RobertJ]

I've had an interesting period since I started this thread. From about mid-December until mid-January, things were really good. Even on Christmas Day I was 84% in range. I recently had a period of eight days of 90% in range or more.

However, since last weekend it has fallen apart. I am now spiking up to 13mmol/L or 14mmol/L several times a day. I am also going low more.

Last night I went for a restaurant meal but I was on 3.0mmol/L at the start. These scenarios are always a nightmare because the pump decides you need a much-reduced dose, which inevitably causes a spike because of how little insulin is on board for the meal you have. This is what happened last night.

Do other people experience this? A period of amazing control that ends with one bad day that turns into a bad week?

 

[Juicyj]

I've had an interesting period since I started this thread. From about mid-December until mid-January, things were really good. Even on Christmas Day I was 84% in range. I recently had a period of eight days of 90% in range or more.

However, since last weekend it has fallen apart. I am now spiking up to 13mmol/L or 14mmol/L several times a day. I am also going low more.

Last night I went for a restaurant meal but I was on 3.0mmol/L at the start. These scenarios are always a nightmare because the pump decides you need a much-reduced dose, which inevitably causes a spike because of how little insulin is on board for the meal you have. This is what happened last night.

Do other people experience this? A period of amazing control that ends with one bad day that turns into a bad week?

Same here, I was hitting 85% TIR before Xmas and since then I am around 70-75%, highs stay high and need vigorous exercise and corrections, feels like I have hit a wall since..

 

[RobertJ]

Same here, I was hitting 85% TIR before Xmas and since then I am around 70-75%, highs stay high and need vigorous exercise and corrections, feels like I have hit a wall since..

Sorry to hear that, @Juicyj .

I have noticed a common problem I run into, which is when a low turns into a high. I did some activity this morning and had a late breakfast. Before breakfast it was 3.4mmol/L. It then rose to 13.1mmol/L after breakfast and remained high for three hours.

I think if the speed of the rise is rapid, it causes the pump to remain high for a long time.

 

[Hopeful34]

Last night I went for a restaurant meal but I was on 3.0mmol/L at the start. These scenarios are always a nightmare because the pump decides you need a much-reduced dose, which inevitably causes a spike because of how little insulin is on board for the meal you have. This is what happened last night.

The tslim gives you the option to take a reduced dose, or the normal one you'd take for the carbs you're eating. In this situation I do the following:

1. When it asks if I want a reduced dose, say no. Make a mental note of what it would give if I wasn't hypo.
2. Go back to the start screen and press bolus again. Accept the lower dose, and when my levels have gone up a bit (trial and error to get the timing and amount right), I give some of the difference in the 2 doses it offered initially. This prevents the very high rise for me.

 

[sninge]

If I have treated a low ( popped a sugar cube in, or drunk some coke ) and about to eat a meal then I never accept a reduced dose, the problem I find is the sensors will still read low for 15-30 mins after im back in range and keep my basal stopped for that time, sometimes its been stopped for an hour because its spotted the low coming, we are lucky with the tslim because we can just bolus a random unit of insulin, which is what I will do to cover the lost insulin if im about to eat a meal, if I don't I am guaranteed a high. I have a friend on Medtronic and she says she can't do that unless she lies to the pump and tells it she is eating carbs. None of the pumps are perfect yet!
My insulin active time is only 1 hr and my biggest wish is that we could change that on the pump settings as you cant go below 3 hrs!

 

[Hopeful34]

My insulin active time is only 1 hr and my biggest wish is that we could change that on the pump settings as you cant go below 3 hrs!

On control IQ you can't change it from 5 hours @sninge

 

[RobertJ]

I would like to revisit this topic. My control has been pretty good. This month, I have had several days over 90% in range, and some better still.

However, I still dread meals out. I would love to look forward to them, which I absolutely would if I was not diabetic.

On Sunday I had a two-course roast dinner with two pints of ale. Things remained in range throughout both courses and as I was leaving the pub it was 10.5mmol/L. I'll take that, I thought.

Over the next hour, though, it went up to 13.5mmol/L and the pump gave me three separate correction doses. Three and a half hours after the meal, it was still about 11mmol/L and I overrode the pump and gave 2 units.

I am afraid, in retrospect, any enjoyment from that meal was not worth it. I had nearly four hours of misery.

Maybe more insulin was needed after the meal, but that raises an obvious question: If I split the dose over a longer time period and perhaps give less up front, won't I just go high up front? It seems that, with this meal, the answer was to give much, much more insulin so I receive a higher amount before and after.

 

[Hopeful34]

Did you go low with the extra 2 units?
How long before your meal did you bolus for it?

 

[sninge]

Thanks Hopeful 34 for your correction about the 5 hrs active time, its been a while since I looked and I guess I was being hopeful!
I do find when I go out for a meal, more often than not my sugars will rise after I've left the restaurant. One thought I had about that was that I sit still for much longer to eat a meal than I would ever do at home and that must have some effect but also you have the high levels of fat in the food that affects sugars for a while. What I've started doing recently is to give myself a unit of insulin extended over an hour either when I've finished eating or when I leave the restaurant, this does seem to work for me. Because its extended for over an hour, if I didn't need it I could easily treat it with a sugar cube ( or similar ) if I start to drop too low, that I find much easier and certainly quicker than if it goes high.

 

[RobertJ]

Did you go low with the extra 2 units?
How long before your meal did you bolus for it?

No I didn't go low after my intervention of 2 units.

For this meal, I gave a dose for each course. I wasn't timing it but I think there was a 10-12 minute gap before each one.

I think I made the mistake of just underestimating everything. For example, the Yorkshire pudding was one of those really big ones. That alone could be 20-30g of carbohydrate but I did not account for it.