Tandem T:Slim X2 – basically every meal out is a disaster

[RobertJ]

In recent weeks, my control has been very good. My 30-day average was 90% until a few days ago.

Over this past weekend, I had some meals out and they all resulted in three to four hours of high blood sugar. For this reason, I dread every single meal out.

I cannot decide whether it's worth attempting to eat what I actually want or just having a salad every time I go to a restaurant. I notice, for example, that I can have a few beers and maintain good control. However, beers with any meal seems to result in long highs.

I have tried so many different combinations with splitting doses. Initially, I tried the whole two hours if I was a having a high carb, high protein and high-fat meal. However, that didn't work because it just meant there wasn't enough insulin up front. Recently I've tried slipping 70/30 for one hour or even 70/30 for 45 minutes but none of those has been a success.

Does anyone try doing the stuff that non-diabetics do, such as a two pints of beer, a burger and fries or something along those lines? Or even steak with vegetables and fries, i.e. slightly less carbohydrate? I know this stuff may not be healthy but I would like to enjoy it occasionally if it was possible. Based on recent experience, it seems like the T:Slim does not prevent big, long spikes in these situations.

 

[EllieM]

For me the tslim algorithm breaks if I go above 10 for any length of time, because it doesn't allow for the fact that I am much more insulin resistant when over 10. So if I spike and it looks like I'm not going to go straight back down, I manually bolus a bit extra.

Still very much a work in progress, but I managed an Indian on Saturday (onion bhajis, a small amount of my partner's naan and a couple of spoonfuls of rice with some fish curry and my bgs were perfect. Probably more by luck than judgement though.... I'm moderately low carb though, so I probably wouldn't have more than 40g, even on a meal out.

 

[EllieM]

I think with high protein meals you have to recognise that the protein will need insulin, but it gets absorbed later.

My advice would be to keep experimenting.

(edited for typo)

 

[searley]

In recent weeks, my control has been very good. My 30-day average was 90% until a few days ago.

Over this past weekend, I had some meals out and they all resulted in three to four hours of high blood sugar. For this reason, I dread every single meal out.

I cannot decide whether it's worth attempting to eat what I actually want or just having a salad every time I go to a restaurant. I notice, for example, that I can have a few beers and maintain good control. However, beers with any meal seems to result in long highs.

I have tried so many different combinations with splitting doses. Initially, I tried the whole two hours if I was a having a high carb, high protein and high-fat meal. However, that didn't work because it just meant there wasn't enough insulin up front. Recently I've tried slipping 70/30 for one hour or even 70/30 for 45 minutes but none of those has been a success.

Does anyone try doing the stuff that non-diabetics do, such as a two pints of beer, a burger and fries or something along those lines? Or even steak with vegetables and fries, i.e. slightly less carbohydrate? I know this stuff may not be healthy but I would like to enjoy it occasionally if it was possible. Based on recent experience, it seems like the T:Slim does not prevent big, long spikes in these situations.

Personally, I eat what I want no point going out other wise

The odd session going high is not going to hurt too much in the long run

You may just need to manually dose and not trust the pump in these cases, the tslim does not give full corrections and only a limited number of corrections

So you can over ride it's selected insulin qty or you could even take a pen with you

 

[RobertJ]

For me the tslim algorithm breaks if I go above 10 for any length of time, because it doesn't allow for the fact that I am much more insulin resistant when over 10. So if I spike and it looks like I'm not going to go straight back down, I manually bolus a bit extra.

Still very much a work in progress, but I managed an Indian on Saturday (onion bhajis, a small amount of my partner's naan and a couple of spoonfuls of rice with some fish curry and my bgs were perfect. Probably more by luck than judgement though.... I'm moderately low carb though, so I probably wouldn't have more than 40g, even on a meal out.

Thanks, @EllieM. For large meals, I experience the same problem you describe. If the arrow is going up (even diagonally) and I go above 10, it basically means it won't stop rising until at least 13.

I very rarely manually bolus because I have been told it will compromise the pump's ability to help in the long run. In other words, I should let the pump do the work, even if I'm going high. However, maybe I'll do this in the future if I have a large meal and it seems like a long high is happening.

I am glad you successfully managed an Indian meal out. I haven't had one of these for years. I used to attempt to have curry, naan, rice, two pints of Kingfisher, but that fills me with dread now.

 

[RobertJ]

Personally, I eat what I want no point going out other wise

The odd session going high is not going to hurt too much in the long run

You may just need to manually dose and not trust the pump in these cases, the tslim does not give full corrections and only a limited number of corrections

So you can over ride it's selected insulin qty or you could even take a pen with you

Thank you, @searley . I agree with this principle but based on recent experience I don't know what to do with meals out. I cannot really enjoy a meal out if it results in four hours of misery afterwards.

When you manually dose, at what stage do you do so?

Also, what is your experience with dose-splitting?