Trying to figure this out...

[MinimedPumper07]

Alright I am a little confused here. If I eat a big meal, and therefore need a big bolus, isnt it near impossible to keep an 80-120 bg level 2 and 4 hours after eating?

This morning I was at 150. I ate 100 carbs and it was matched perfectly with the bolus, as 2 hours later it was also at 150. However, at that time there was still more than 2 units left on board, so I decided to check 2 hours later and it went down to 73.

Pretty much what I am trying to say is that if you give yourself like a bolus of say 10, even if 2 hours later you are at a good number, it will go down ton because you will have about 5 units left on board. On the other hand if you get it so that 4 hours later you hit your target, instead of 2 hours later, that means you are going to go high at the 2 hour mark, and then drop down to your target.

What I mean is, medium to big boluses seem like a lose lose situation. You either go high first, then hit your target, or you hit your target first, and then go low.

What do you guys think?

[MJM]

Hi pumper,
Firstly your Carb Ration may not be correct. Also what you eat reflects how it will release glucose into the bloodstream. A food with a high GI will release glucose quickly and then chances are you will then go low. If on the other hand you eat a low GI food it will release it's glucose more slowly and hense reduce the fact that you would have a hypo. I would suggest you have a word with your dietition and read up on it on the internet or buy a book on it and study it.There are so many things that can change the way everything reacts that it's difficult to pinpoint any one thing. Your Carbohydrate Ration is the first thing to have a look at. Sometimes that changes frequently and you should be aware of that also. Do you weigh your food or do you guess carb content?
It is difficult to keep blood sugars within range. If for instance you exercise you would need to adjust for it. you can also give a dual wave bolus or square wave bolus. It takes some adjusting and experimenting to get things right. One thing is for sure. Things will never stay at one thing or another and there is constant change, i.e. weather conditions, exercise taken, food taken, worry, aggravation, illness. All these things can affect you blood sugars and many more I haven't mentioned. You won't ever get perfection but you should strive to achieve it. Plenty of fruit and vegetables every day and good exercise and in the long term it should help you avoid problems in the future.
Some people swear by low carb eating. It might work for you and is worth trying also. That or low GI (Glycemic Index) foods would be your best bet. Perhaps someone else might have better ideas. Trial and error can go a long way to solving this. I wish you well in your endeavours.

[MinimedPumper07]

wow, looks like there is a lot i need to know.

i understand the gi rules. however i dont yet know too much about what happens if i mix both, hi and low gi foods.

this is really complicated.

why do u think my carb ratios need changing?

also when do people wanna hit their target, at 2 hours or 4 hours after a meal?

[xMenace]

You can and should be in range 24/7, but variation is inevitable.

My guess is your basal is too high and your bolus ratio too low, but that's a guess. Start doing some basal profiling: remove the bolus variable by skipping your meal and test hourly. It will open your eyes on how this all fits together.

Basal rate adjust - Google Search (http://www.google.com/search?q=Basal+rate+adjust&rls=com.microsoft:en-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1)

[Shotokan]

Also, you might ask your doctor about Symlin, which minimizes BG spiking after meals for many patients.

[MinimedPumper07]

ok i'll try that maybe tommorow, maybe the day after that, and i'll post the numbers here

is symlin a pill or a shot?

[Funnygrl]

is symlin a pill or a shot?
Shot :nurse:

[Shotokan]

Symlin is injected about 15 minutes before a meal. It is a naturally-occurring hormone in people with a normal pancreas, which helps to regulate blood sugars. If you Google "Symlin" you will find lots of info.

[MinimedPumper07]

ok see right now i am confused. i ate dinner, before dinner i was 136, 2 hrs later i am 97, but 1.6 is still left on board.

will i go down to like 50? i will check in 2 hrs and let u guys know tomorrow

[poodlebone]

ok see right now i am confused. i ate dinner, before dinner i was 136, 2 hrs later i am 97, but 1.6 is still left on board.

will i go down to like 50? i will check in 2 hrs and let u guys know tomorrow

Maybe, maybe not. I am often below 140 at 2 hours and don't go low by hours 3 or 4. It depends on the food and how long it takes to digest. If your meal was white bread and pasta then you might drop lower after 2 hours. If you had protein and fat mixed in, your food and insulin might work well together and you'll be fine.

If you're afraid of dropping too low with insulin still on board you can have a small snack. I do check my IOB and if I feel that my food is running out before the insulin I might have something small, just in case. Not straight carbs, though.

[sbigelow]

Looks like you need to pickup the book Pumping Insulin. I did last week after someone recommended it on this forum. It will teach you how to fine tune your settings. I am starting my first real basal test tonight.

[melissata]

If you are 150 and can wait at least 10 or 15 minutes after taking your bolus to eat, then you won't spike as high. A reading like 15 at 2 hours isn't horrible, especially if you ate 100 grams of high glycemic carbs. But just giving the insulin more time to get you back to target first could make a big difference. I seriously doubt whether a doctor would give you Symlin because you are so newly diagnosed and still honeymooning. I know that you don't want to do shots. The best thing is to try to eat both low and higher glycemic foods together to balance each other out. If you eat a lot of low glycemic foods, you will probably need to use an extended bolus or you will go low. The people that I know using Symlin have to use the extended bolus with every meal, and they also have cut all of their rates.
The reason that I never consider insulin on board is that there are just too many variables to think about. If your settings are correct, I don't understand why everyone is so concerned with IOB. The contents of the meal and how quickly it is going to digest is different for everyone. Looking at your example of having 2 units on board and ending up with a just tad low number tells me that the carbs may have been a little off, or you may have been a little more active the day before or any number of things. Fact is, that it turned out fine. If you didn't have that info on the pump, you wouldn't be worried about it at all. For a meal like that, the results were fine. It really is a matter of numbers. The more carbs you eat at one time, the more the results will vary. I would not guess that your settings were wrong from that one example.

[condensr]

What MJM said is so right on. Its one of the more difficult things: eating different foods often and trying to understand how much insulin those foods will need, as well as how fast the foods absorb. There's just so many variables, its crazy. For instance, if you take the exact same meal side by side, but change the amount of fat in one of the plates, even though the fat itself may not directly affect your glucose, it'll change how much of the carbs are available in the food and how long it takes them to turn in to glucose.

So the IOB factor is only one part in determining a correction: you also have to consider food-on-board too. Like MJM said, the GI is important here.

[MinimedPumper07]

so i was at 97 2 hours after the meal, and 123 4 hours after the meal.

I have come to the conclusion that trying to control this will drive me mad, and just doing my best will work out fine.

your right theres just too many factors, and i just dont feel like thinking about them.

so maybe what im thinking is just test 4 hours after meals, instead of 2, to make sure i came down to my range eventually, and to be able to make a correction right then and there

[poodlebone]

so i was at 97 2 hours after the meal, and 123 4 hours after the meal.

I have come to the conclusion that trying to control this will drive me mad, and just doing my best will work out fine.

your right theres just too many factors, and i just dont feel like thinking about them.

so maybe what im thinking is just test 4 hours after meals, instead of 2, to make sure i came down to my range eventually, and to be able to make a correction right then and there

I would still check at 2 hours. If your 2 hour BG is 400, then you're going to need a correction and it might get worse by hour 4. Just don't let it drive you insane when the 2 hour number is out of range, unless it's very high. Checking at 2 hours, plus hour 3 or 4, will show you how different foods work for you. You might find some that just aren't worth eating anymore due to the aggravation of spikes, or a delayed rise in BG hours later. I always check at 2 hours and 3 hours and often at hour 4.

I'd just hate to go really high and not know for 4 hours.