Need quick tips (high after meals, on target before next meal)

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Permalink Reply by Brenda on October 9, 2009 at 8:07pm

A tip of the hat to you Kelly!! I'm really struggling and frustrated right now and I needed your encouragement. No throw in the towel for me.

I'm doing fine, but really think for as much effort that I put into the D that the numbers should be better. The good news is that I'm already doing all those behaviors you would want a d to do. Checking BG, pump, excercise (45-60 min. DAILY!!), etc. When I am home I weigh my food. I used to measure but I think weighing is more accurate.

My old endo wouldn't get in the trenches with me and help me figure this out. She was OK when the A1C would come in slightly above 7. I got the call yesterday that I have been accepted as a new patient for an endo that I have heard many positive comments about. I'm soooooo excited I can hardly stand it.

I feel great right now, but I can't wait to feel even better! I know it will take time, but don't think it will need to be a major overhaul......maybe some tweaking here and there.

Thanks for your kind words. Tudiabetes is such a place of inspiration, encouragement and motivation. Gotta love it!

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Permalink Reply by Kelly Rawlings on October 10, 2009 at 7:00am

Looking forward to hearing how the tweaking works for you. Congratulations on your efforts thus far--and thanks for sharing!

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Permalink Reply by Jim on October 10, 2009 at 2:26pm

Color me jealous. My last A1c was 5.9 and I've never even come close to consistently below 140 at one hour - hell, half the time, my insulin doesn't even seem to hit me for an hour or two after the bolus, and sometimes much longer, leading to frequent post-mealtime highs. Of course, it's not consistently enough like this that I could just bolus two hours in advance, as every third or fourth time, if I bolus early, I'm low in an hour, either due to the insulin hitting me more quickly, or delayed digestion (always nice to have a huge spike 3 or 4 hours after a meal!). And now, after having had some severe hypo events, I'm having to recalibrate myself to higher levels in general to get back and maintain my hypo awareness. #@%^#@^@#% I hate this disease.

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Permalink Reply by Kelly Rawlings on October 12, 2009 at 10:35am

Have you tried the dual-wave bolus feature (or whatever it's called with your brand of pump)?

It takes some fine-tuning (OK, a LOT of fine-tuning), but better mimics how insulin is secreted in response to eating. Provides some insulin up front to cover carbs that turn to glucose most quickly, a trickle of insulin over a set span of time (30 minutes most meals for me, up to 2-3 hours for high fat splurges like pizza) to deal with slower-to-turn-to-glucose complex carbs, protein, etc.

I don't think I'll ever hit 5.9 unless I get a CGM. But that's also because I'm trying very, very hard to maintain what hypo awareness I have left and refuse to trade a stellar A1C for too many ups and downs. To me, that's key to my quality of life. I make sure to have the tests that tell me whether I'm at risk of kidney or vessel complications (microalbumin, regular eye exams, sensation in feet, all types of cholesterol and blood pressure in range)—so far, so good.

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Permalink Reply by FatCatAnna on October 16, 2009 at 11:49am

Kelly - I don't use a CGMS - but I've managed over the last few A1C's since going on the insulin pump to get below 6%. It's just the tweaking that I do now with combo boluses for my main meals that I find on an even keel. Infrequent lows (I'm still - touch wood - hypo aware afer 40+ years) unless I goof up with too much insulin when I bolus for an "unknown" and less spikes with my BG's. Granted, sometimes I get lazy - who doesn't - and I do spike up - but it's so rare - and don't feel bad that enjoyed that sinful piece of dessert or something like that. I don't think it's fair for us to guilt trip ourselves when things don't go "according" to plan all the time - but that's just me!

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Permalink Reply by Danny on October 7, 2009 at 5:32pm

Glad to hear your peaks are not as high Kelly. Thank you for linking my discussion.

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Permalink Reply by Kelly Rawlings on October 9, 2009 at 1:05pm

And thank you for providing that discussion and tips!

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Permalink Reply by Terry Keelan on October 7, 2009 at 2:51pm

If you're consistenly on a downward trend between two particular meals no matter when you bolus or what ratio you use, I'd suspect your basal is too high for that time of day.

Don't change it until you're done experimenting with your bolus, though. One thing at a time.

Terry

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Permalink Reply by Michael on October 7, 2009 at 4:42pm

A common sense approach:

If you are producing no insulin...

A basal should keep your blood sugar level in your target range throughout the day.

A bolus should correct for anything you eat and bring you back into your target range.

Keeping these assumptions in mind, to me it looks like your insulin carb ratio is to low ie. you are not taking enough insulin at meals.

But, you basal is to high as it is bringing you back in line by the next meal. (Remember a basal is supposed to keep your blood sugar in your target range throughout the day)

I agree with other posters, timing is a big deal, as well as considering what you ate.

I especially agree with only adjusting one variable at a time. Most literature I have read instructs you to adjust your basal first.

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Permalink Reply by Brenda on October 7, 2009 at 6:52pm

Thanks to all for the great suggestions and encouragement. I'll start with the timing and see what impact that has. I also know with the change in seasons I need to test my basals.....I just hate the process. I was cycling a great deal in the summer and have cut back a bit and replaced it with walking which is just not the same. Regardless of the impact of the timing changes.......I still need to test the darn basals.

As always, you guys are the best!!!

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Permalink Reply by Scott on October 8, 2009 at 1:22pm

If it was me, I would increase the meal bolus (ie increase your carb ratio) and decrease the basal rate. Get your 2hour numbers where you want them and adjust the basal to keep them there

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Permalink Reply by Brenda on October 8, 2009 at 4:03pm

Thanks Scott. I am going to increase my carb ratio a little all the way around. I'm just not as active this time of year. But I still need to test basals......which I avoid. I did get a call today that I was accepted as a new patient with an endo that I've heard good things about. My appt. is in November. I do fair.....I just think the control should be better for the amount of effort I put into it.

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