Loving new pump - a few questions

[Winni]

Haven't read everyone's replies, Fi, sorry if I'm repeating. But when I eat pizza or takeaway, I've found take split dose as normal. Then, at 2 hrs I test-normally normal range, but I then add a temp basal of 120% for next 4 hours (I've tried less than 4 and I end up high). Next morning I'm back to normal.
Even if I'm low at 2 hours and I don't correct and then set TBR I end up sky high after 8+ hours.
X

[sedge]

Well what I do is this - not sure what it's called on a medtronic pump so I'll describe it.

A split bolus i just that - some now and the rest later.  On mine it's called an Extended bolus.

I don't, I have some now and release the rest of the bolus drip by drip (a bit like a TBR only with bolus instead of basal) over 'X' number of hours.  On my Roche pump, this is called a Multi-wave bolus.  For whatever reason, this so far has prevented me getting the 'spike' in the middle of the night after I've gone to bed.  I'm not quite sure why, maybe because the BG is only being reduced by little bits at a time instead of whamming a huge amount in all at once?  And maybe that's a more natural way of dealing with it? 

Maybe the pancreas does that, Ooer, high BG alert! - I'll try 0.5u and see what that does? - a bit later, Well, that didn't do it, I'd better lob in another soupcon ... and so forth.  And it's just enough to keep your BG OK-ish instead of the body going into full panic mode and having complete hysterics and unable to anything sensible, when its owner tries to hit the glucose with a lump hammer?

[skybluedeb]

Sedge I have the same problem with high carb meals and corrections just not appearing to do anything! I spend the night testing and correcting and just waiting for a hypo that never comes. I tried the multi wave once (on your advice I think) but went really high an hour after eating which bro g pregnant freaked me out so I didn't do any more experimenting. How did you work out the number of hours to drip feed the insulin across and how do you know what amount to give yourself up front?

[sedge]

Well I just let it do what it suggests upfront, because if you are high or low, the Roche automatically adds or minuses the correction to or from the upfront bit.

I still limit my rice or pasta to about 50g carb though, and do the rest over 3 hours and find that does it for me.  Except I'm not limiting it - I used to have to have far less than that - so to me that's making quite a pig.  I tried 4 hours and had a high like you, so next time I had exactly the same amount of rice and changed it to 3 hours.  It worked so I've stuck with that.  I don't always test at 2 hours though - if it works OK a few times then I just assume it's still OK and only test it occasionally when I just think I will.  I don't see it as crucial in the overall scheme of things for ME.

And of course I'm not preg either.  And it is crucial for you at the mo.  Plenty of time to experiment after! - if you ever have time for anything ever again LOL

[everydayupsanddowns]

Stabmedaily - I'll quite happily go to bed at 5-6 with 2+ units active these days as experience shows that these are needed. (a few overnight tests early on as you say, 'waiting for a hypo that never came'. Not enough active at bedtime usually results in a rise overnight. Last night (whole wheat spaghetti) my dual wave was not long enough and I was correcting at bedtime and at 3am.

[Winni]

Sedge, it's the same on Medtronic pumps. It drips it in over x hours. But, what I'm saying is, if I have say an 80g carb meal and use the dual wave bolus, I'm fine after 2 hours or so when the split bolus has finished. But then I need more (even though no more carbs). I could just add more carbs onto the original bolus and split it longer-same thing I suppose. I just like to keep track of how many carbs per day on the pump totals. So if I'm not actually eating 100g of carbs, I'd rather not 'lie' and use the extra as TBR.

Deb, pretty sure my ratio needs went up quite dramatically at your stage. Just up them lots. I ended up takin over 30u of insulin with 1 meal as I got to the 30 week mark. If you need it, take it. And I found the evening ratio rose the most x

[everydayupsanddowns]

Winni - in your situation, and if I worked out that for 100g meal the ratio was off and I needed, say, 120g's worth of bolus here's what I do:

Measure BG and enter 120g into the bolus calculator
Press Act
Notice/remember the calculated bolus suggestion on the Estimate Details screen
Press Esc to back out of the calculation.
You will return to the BG value on the bolus wizard.
Enter 100g into the bolus calculator
Press Act
Adjust the insulin on the Set Bolus screen to match the initial 120g calculation
Press Act
Then set the square/multi wave options and away you go...

That way your records will accurately show both dose for the meal and estimated carbs eaten

[Winni]

Ahhhh, thanks, Mike. Yes, that makes sense. I'll give it a go. X

[sedge]

That's excellent Mike! - he's good at finding ways round stuff isn't he Winni?

[Fiona80]

Ah lots of good tips. I will try a few of these and see what works best. Really interesting that folk put on TBR after going to bed - hand't thought of that. Was at clinic yesterday and the pump nurse was saying some people need insulin over 8 hours for a pizza!

One thing they didnt quite answer was my active insulin situation. So here's what happens - my BG 1 hour after eating is pretty much where it stays, whether I've calculated my carbs correctly or not. E.G. yesterday 6.4 before breakfast. 1 hour later 5.7, 2 hours later 5.9, 3 hours later 6.1, 4 hours later 5.7...and so on. Same if I get it wrong - miscalculated carbs yesterday dinner time - 5.1 before dinner but 13.4 1 hour after and it stayed around 13 for the remainder of the night. Didnt correct as wanted to see whether it shifted downwards itself as the bolus wizard would suggest (i.e. it wouldnt recommend a correction coz of active insulin) I'm on humalog. The reason I'm so interested in my 1 hour post-meal readings is that when I was pregnant my control was good but I still ended up with a BIG baby. I often wonder if it was the 1 hour spikes that caused some of the problem. So I now seem to have them under control - not always (depends on type of food) but pretty much OK - what does this pattern suggest about my active insulin time do you think?? Gone within an hour?! I've now got it set at 3 hours but it pretty much feels like I should set it to 1 or 2! Or I suppose the bolus and food are still working 2 or 3 hours later but it's jsut that the release rate match is good? But I do feel that if my BG is high at 2 hours after eating, I need a correction and the bolus for food is just not going to touch it. In pregnancy I will go back to getting the 1 hour spikes unless I start taking my humalog about 30 mins before eating. It just takes so much longer to work when pregnant, whereas when not pregnant it seems the humalog time is working really well with the carb release 9take the humalog same time as food)

Any thoughts??

[Dollyrocker]

If you calculated your bolus wrong then the pump won't recommend a correction for a couple of hours as, for all the pump knows, you ate what you told it you were going to eat. It's not going to tell you to correct until it works out that you're highr than you should be which may be a few hours later

If you realise after you bolused that you calculated it wrong then I would use the wizard again and tell it the missing carbs so it can work it out, i.e if you initially said you aid 50g of carbs but realised later that it was actually 100g then put another 50 through the bolus wizard.

[everydayupsanddowns]

...E.G. yesterday 6.4 before breakfast. 1 hour later 5.7, 2 hours later 5.9, 3 hours later 6.1, 4 hours later 5.7...and so on. Same if I get it wrong - miscalculated carbs yesterday dinner time - 5.1 before dinner but 13.4 1 hour after and it stayed around 13 for the remainder of the night. Didnt correct as wanted to see whether it shifted downwards itself as the bolus wizard would suggest (i.e. it wouldnt recommend a correction coz of active insulin) I'm on humalog. The reason I'm so interested in my 1 hour post-meal readings is that when I was pregnant my control was good but I still ended up with a BIG baby. I often wonder if it was the 1 hour spikes that caused some of the problem. So I now seem to have them under control - not always (depends on type of food) but pretty much OK - what does this pattern suggest about my active insulin time do you think?? Gone within an hour?! I've now got it set at 3 hours but it pretty much feels like I should set it to 1 or 2! Or I suppose the bolus and food are still working 2 or 3 hours later but it's jsut that the release rate match is good? But I do feel that if my BG is high at 2 hours after eating, I need a correction and the bolus for food is just not going to touch it...

Sometimes I will overrule Artoo if I can sort of 'sense' that active insulin is not enough to bring the spike down (even though by numbers/ratios/sentitivity it *should* be). The other night when you got to 13 and stayed there for example... If that were me I would suspect other things at play than just my food/insulin balance. I'd reckon my liver was throwing its toys out of the pram for some reason and my meal bolus was unable to cope with liver dumped glucose *and* the food being absorbed.

My meals certainly don't stop providing glucose after 1 hour, even at 2 or 3 hours they can still have some push left in them. Similarly I would not think that the insulin has stopped working just because my levels stayed level. In an ideal world we'd be able to exactly match the activity of the insulin with the activity of the food and BGs would barely wobble all day long (that's what a healthy pancreas does after all). We only 'expect' a rise after eating because matching the push of food with the pull of insulin over the entire course of their activity is so darned tricky.

Have you done a set basal tests recently? Fine tuning bolus and insulin sentitivity settings is all but impossible if your basal is off - cos you'll never know whether a rise or fall is down to meal dose or basal shortfall/overenthusiasm.

[Fiona80]

Hi, yeah I've tested and tested my basals and seem to have them pretty much bang on. I was having trouble in the mornings for a while working out if bolus or basal was to blame but after 3 mornings of a carb free breakfast & bg's staying stable I realised it was the bolus & changed from 1:8 to 1:7. Fine now.

Dollyrocker - yeah I know that the wizard won't recommend a correction at that point - it was really the issue of active insulin I was asking about after realising that my bg stays pretty level from 1 hour after eating. But I know what you mean though about miscalculating carbs - you're never going to shift down until you correct it. I guess what I'm asking is what active insulin time I should programme into my pump. As Mike says, the food wont be out of my system after an hour so I think the timing match between when humalog works & food release must be quite good (although it's not in pregnancy). But if I get a high and my wizard is set to only correct after 3 hours it's not really a realistic picture of what I need. Just wondered if anyone else has their active insulin time as low as 2 /3 hours...

[Pattidevans]

Fiona

No idea what goes on with the pump, but I know when I was injecting Humalog it had a definite 5 hour duration for me.  It seemed to be most active from 4.5 hours to 5 hours when I could easily drop 3mmol.  Doesn't sound as if it's doing that for you though.  I guess MDI is SUCH a blunt instrument!

[Winni]

Mine is Fi. Or was. I had it set to 3 hrs. I was 'asked' to increase it to 4 as they said three was way too low, but I'm not so sure. My control is worse than before. Your post is making me think about swapping it back...