Bolus advice please!

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southcoastlass

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Type 1
Hi all

I am fairly new to pumping and a little confused... Two hrs after a meal bolus is given my blood tst reading is good. However I still have insulin on board, sometimes quite a bit and from that time onwards I am hypoing. I have been drastically lowering my basal thinking this was the answer but now having thought logically about it again I wonder if I should still have IOB at all if my meal bolus was correct? HELP!
 
southcoastlass said:
Hi all

I am fairly new to pumping and a little confused... Two hrs after a meal bolus is given my blood tst reading is good. However I still have insulin on board, sometimes quite a bit and from that time onwards I am hypoing. I have been drastically lowering my basal thinking this was the answer but now having thought logically about it again I wonder if I should still have IOB at all if my meal bolus was correct? HELP!
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Yes you would have IOB as the duration of insulin is anything from 3hrs (apidra) to perhaps 6 hours for the human or animal insulin's.


As you are new to pumping Rule no one never guess :D
Simple solution is to basal test and see what's going on. If all ok then check your carb ratio and carb counting skills.

Some foods need different types of bolus so the bolus matches the digestion of the food you have eaten.
 
Hi, if your BGs are in range two hours after a meal that's great. Try reducing your basal rate for the period from one hour after the meal to three hours after the meal - this should prevent you dropping to hypo. This should result in a nice flat profile, whereas if you reduced your bolus you would spike up and then drop back down. 🙂
 
I would expect *some* sort of rise after a meal (even non-D's get that!). I know what I consider to be a reasonable rise, and what I consider to be too much.

Given what you have said either a) your insulin:carb ratio is out or b) the dose is correct, but it is acting too quickly or c) the dose is correct and acting perfectly, but your basal is too high and in combination with the bolus is dropping you low.

Because you are dropping hypo and needing to correct by adding fast-acting carbs it becomes difficult to see exactly what is going on, so basal-testing as Sue suggests would be a good problem-solving strategy.

Alternatively yuou could try a 'square wave' bolus to ease the insulin into action over a longer period and give the food a bit of a head start too see what happens then. Or just try a minor ratio tweak to slightly reduce your meal bolus and see how much of a 'spike' you get for the same meal(s) at 1 and 2 hours after eating when your bolus is typically working hardest.

One of the challenges of tweaking pump therapy is that you can fine-tune doses in so many different ways that it can be difficult to know which to try first! Just write everything down and keep test test testing!
 
I have that problem too!
I've been pumping Apidra which is....rocket fuel....and like yourself I can often have a perfect blood sugar of 5.0 after a meal and with 1.5 to 3.0 units of active insulin on board, there's no wonder I feel like I've been to outer-space and back, by the time I test for my next meal I've crash landed to a hypo...with a bump.

It's basel testing time for me too!

🙂
 
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