Understanding the Omnipod 5, insulin to carb ratio's and high blood sugars

[Fitzzz]

Hi All,

I've been type 1 diabetic for 23 years, but have to admit I have very little knowledge on the beefy stuff. I know what diabetes is, what I should avoid, what's bad for me etc. but I've got no idea when it comes to insulin to carb ratio's, insulin reactivity and sensitivity, what's a normal IOB, slow releasing carbs, etc. etc..

I was previously on Novorapid and Toujeo pens alongside Freestyle Libre 3 sensor, but changed to Omnipod 5 using Novorapid alongside the Freestyle Libre 2 Plus sensor. I had really bad control before which is why I was put on the pump. When I first came on the pump, my control improved significantly and I experienced very little high blood sugars and little to no low blood sugars.

Over the last few months this has changed and I am experiencing a lot of highs. When going to the clinic, they say it's due to me overcorrecting a low - even thought the majority of examples are not off the back of a low!

My main concern is going high after breakfast. This morning I bolused 20 minutes before eating. My blood sugars were 11.0 when I bolused, and 16.4 1 hour after eating. Since then I've been hovering at around 18-19. I have given myself 1 unit of insulin 40 minutes ago, but still no decrease yet.

My insulin to carb ration is 1 - 9 between 00:00 and 11:30, and 1 - 12 between 11:30 - 00:00.

Is anyone able to help me? Like I say, when I go to the clinic they're not helpful at all and I feel really let down by them. I spent years of not looking after myself properly and am really trying to improve this now. Any other tips and tricks, advice, common knowledge I should have would be welcome.

Thank you

 

[Idle Sean]

Hi All,

I've been type 1 diabetic for 23 years, but have to admit I have very little knowledge on the beefy stuff. I know what diabetes is, what I should avoid, what's bad for me etc. but I've got no idea when it comes to insulin to carb ratio's, insulin reactivity and sensitivity, what's a normal IOB, slow releasing carbs, etc. etc..

I was previously on Novorapid and Toujeo pens alongside Freestyle Libre 3 sensor, but changed to Omnipod 5 using Novorapid alongside the Freestyle Libre 2 Plus sensor. I had really bad control before which is why I was put on the pump. When I first came on the pump, my control improved significantly and I experienced very little high blood sugars and little to no low blood sugars.

Over the last few months this has changed and I am experiencing a lot of highs. When going to the clinic, they say it's due to me overcorrecting a low - even thought the majority of examples are not off the back of a low!

My main concern is going high after breakfast. This morning I bolused 20 minutes before eating. My blood sugars were 11.0 when I bolused, and 16.4 1 hour after eating. Since then I've been hovering at around 18-19. I have given myself 1 unit of insulin 40 minutes ago, but still no decrease yet.

My insulin to carb ration is 1 - 9 between 00:00 and 11:30, and 1 - 12 between 11:30 - 00:00.

Is anyone able to help me? Like I say, when I go to the clinic they're not helpful at all and I feel really let down by them. I spent years of not looking after myself properly and am really trying to improve this now. Any other tips and tricks, advice, common knowledge I should have would be welcome.

Thank you

Hi Fitzzz
I can't comment on "what you're doing wrong" but tell you what IAction. I'm on NovoRapid don't eat between 22:00 - 06:00 so my ICRatio is academic [and with the OP5 split 22:00-00 & 00:00-0600] then I have a breakfast ratio 06:00-11:00; Lunck/snack 11:00-17:00; dinner/eve 17:00-22:00. I have a different ICRatio for each. At the end of each time-zone, I record [I have a Google Sheet] the highest and lowest sensor blood glucose (SBG) in the zone. {{{I colour code according to [I'm on Dexcom] 4.4-8.3 (the Dexcom tight range at night) as green; outside that range but inside the daytime/DAFNE 3.9-10 range as grey, above 10 as orange, and below 3.9 as red}}} I've just realized all that is irrelevant! If I am above target (highest) I decrease my ICRatio by 0.2g/u every day until both are green/grey? If I'm below target (lowest) I increase ICRatio by 0.2g/u every day [DAFNE says wait 2 days to establish a pattern but inc/dec by 1-2g/u which would [kill me / go on a Chocolate binge]

There are other settings like Duration Of Insulin Action. I'm on NovoRapid but set it to 2h [the min] to make it more responsive.

I find the Bolus Calculation infuriating. The basic calculation is right, then it takes of if you're below, fair enough; if you're above it adds, fair enough, and then.. [I'm assuming you're in automated] being high, and adding, IT TAKES IT OFF AND MORE BECAUSE OF IOB THAT IT PUT THERE BECAUSE YOU'RE HIGH ... rant over for now.
For that reason I find the correction factor largely superfluous, I can't workout if it uses it when I'm low and it ignores it when I'm high or vice versa.
Apart from the ICRatio, I find the "Target Glucose & Correct Above" has the most effect.
Mine is set to 6.1(both) 24h a day (all time zones) I've tried varying it but it seems to allow the pump to slack off.
My 90d TIR is 87% and I'm trying to get to 100% so my answers may not work for you but I hope they help!