Any Ideas?? Problems hitting my target

[kid_fears99]

Okay so here's the problem I have - I can hit my BG target (130 right now since I just started on the pump), but it doesn't happen for about 6 hours after I bolus. For instance, take today - I started at 1:00 p.m. with a BG of 237. I was eating 62 grams of carbs for lunch, had .05 IOB, and my correction factor is 1:75. So my pump calculates that I need 4.5 u to reach my target. Here's how my BGLs developed over the next few hours:

3:00 = 381
4:00 = 354
5:00 = 241
6:00 = 182
7:00 = 129

So eventually I reached my target of 130, but I spent hours extremely high. I almost corrected, but if I had I would have dropped low. This is not a problem that has come with starting the pump - I always seem to spike for hours after I eat, but if I correct at all (even .5 units), I will drop low before my next meal. Has anyone experienced this? It's really frustrating because by the time I hit my target, it's time to eat again. My doctor seems a bit baffled by it, as does my CDE. I have to call in my levels to the doc every day, so I'm sure she will make some sort of change, but I kinda wanted some insight from you guys first. Any ideas?

[poodlebone]

Okay so here's the problem I have - I can hit my BG target (130 right now since I just started on the pump), but it doesn't happen for about 6 hours after I bolus. For instance, take today - I started at 1:00 p.m. with a BG of 237. I was eating 62 grams of carbs for lunch, had .05 IOB, and my correction factor is 1:75. So my pump calculates that I need 4.5 u to reach my target. Here's how my BGLs developed over the next few hours:

3:00 = 381
4:00 = 354
5:00 = 241
6:00 = 182
7:00 = 129

So eventually I reached my target of 130, but I spent hours extremely high. I almost corrected, but if I had I would have dropped low. This is not a problem that has come with starting the pump - I always seem to spike for hours after I eat, but if I correct at all (even .5 units), I will drop low before my next meal. Has anyone experienced this? It's really frustrating because by the time I hit my target, it's time to eat again. My doctor seems a bit baffled by it, as does my CDE. I have to call in my levels to the doc every day, so I'm sure she will make some sort of change, but I kinda wanted some insight from you guys first. Any ideas?


What insulin are you using? Even though the fast acting insulins are all supposed to be the same (more or less) some people do find there's a big difference between them. I use Humalog and my CDE had suggested I try Novolog, which she said starts to work faster and is out of the system faster. Since I'm used to Humalog I didn't want to switch.

You might also try to correct for the high BG first and delay eating. I've found that if I eat while my BG is high, it can stay high after the meal and need an additional correction, even if I figured an initial correction in with the first bolus. Correct the high, test again in an hour and if it's down you can enter your carbs and bolus for the food.

Also, if you're staying that high for hours your basals might need to be raised.

[JediSkipdogg]

I have a similar problem as you. I spike extremely high after eating and a correction bolus (without food) can take about 4-5 hours to get me within 30 mg/dl of where I want to be. Eventually I'll hit my target range again.

I agree with poodle on the maybe delay eating. However, sometimes that's not possible, so try to eat low carb at that time, to prevent the spike as much.

I wish I had a better answer for you, but unfortunately I don't. For me, I've just learned to live with it. I know for the food spike they do have Symlin out there which is suppose to greatly lessen the spike, however, that requires a shot before each meal. But if you don't mind that, I hear it is excellent.

[DeusXM]

I'm not a pumping expert, but if you're finding a comp bolus will make you go low, I'd have thought you need to decrease your basal insulin by a bit and your bolus insulin by a lot. Your basal insulin shouldn't be lowering your BG, it should be keeping it where it is.

[Cyborg]

It does sound like your basals and/or ISF is not set correctly. Once the pump is set correctly, 1) you shouldn't need to do correction boluses much, 2) your bg should return to near normal approx 4 hours after a meal or correction bolus, and 3) you should be able to skip meals without going low.

Not sure what testing you have done, but you should start out with your basal testing and then move on to the carb ratios. There is a good book called Pumping Insulin that describes how to do the testing. There is also good information here (http://www.insulin-pumpers.org/howto.shtml).

Good luck...

[Simon]

Could it be your liver was dumping before lunch? This causes insulin inhibition which will prevent the insulin from doing its job until the inhibition wears off. If you skip breakfast this may well happen.

[JediSkipdogg]

I don't see where you guys/gals keep thinking it's the basal? If it was the basal rates, then the correction factors would have to be off or she wouldn't have been able to hit her target 6 hours later.

[Cyborg]

try to eat low carb at that time, to prevent the spike as much.

I wouldn't eat low carb all the time on a pump. One of the best parts of pumping is having the freedom to eat what you want, when you want.

To fine tune your pump settings, it is better to eat a fair amount of carbs so you can see the results more clearly. I would eat pre-packaged meals that have accurate carb counts for doing the pump fine tuning.

[JediSkipdogg]

I wouldn't eat low carb all the time on a pump. One of the best parts of pumping is having the freedom to eat what you want, when you want.

To fine tune your pump settings, it is better to eat a fair amount of carbs so you can see the results more clearly. I would eat pre-packaged meals that have accurate carb counts for doing the pump fine tuning.

Well, if you have a post meal spike of 130 mg/dl, then low carb is a way to help lessen that if you don't want to use Symlin. Like for breakfast, I try to stay under 20 carbs total, I once ate 84 carbs for breakfast, and at my breakfast ratio that was 14 units of insulin. I spiked from around 150 to over 400 in the 3 hour period after that and yet returned back to normal at the 5 hour mark. So for some, without Symlin, low carb is the way to go, notice, I said low, not none.

[Cyborg]

I'm pleased when I have a post meal spike of only 130. I get more concerned with spikes of about 180 and above. Symlin does help with the spikes from large amounts of carbs or for high glycemic index foods.

Many diabetics have higher insulin resistance and/or the Dawn Phenomena working against them in the morning. In this case, you'd probably have better results eating low carb for breakfast and I do this often myself.

[amccrazgrl]

I just want to say pumping takes time for some people.
As my friend sugar free on here is having probs getting his bs down w/ his pump too.
He is Cozmo pumper too.