Learning from life on a Libre

[SB2015]

When I was using a Libre alongside my pump (an old workhorse of a Combo) I worked out that if I ate a meal bigger than 60g of carbs (rare but when eating out temptation sometimes gets the better of me) I needed extra insulin above the normal from my carb ratio. I added in a percentage to the bolus. I did the same if my levels got above 14. I added in to boluses and corrections.

Now that I am looping and with the HCL we are told not to lie about carbs I have found that I still need extra for bigger meals especially if I am not able to pre-bolus. This holiday, where I had a bigger meal (>60g CHO) I have tried adding in 10% extra to the carbs (My OH pointed out this solution to me when we were tackling a big spike) As @everydayupsanddowns has pointed out we are not supposed to add fake carbs but we learn what we need to tell the pump to get it to do what we need it to do. This is working for me so far and again makes my HCL a real help whilst I am away on holiday.

 

[everydayupsanddowns]

I asked about dual wave boluses on the MM780G (not available in hybrid closed loop Auto Mode). It was suggested I should just “take everything up front, and let the pump deal with it”.

Unsurprisingly this was not ideal advice. And the initial crash followed by long-slow-increase and high levels overnight followed that experiment - which I chose not to repeat.

Instead I have reverted to manually splitting the dose into two, and setting a phone alarm to remind me to deliver the second part. I’ve not quite got it sorted yet, partly because of the ‘safe bolus’ overrides the MM780 often does, especially if you bolus again with a reasonable amount of IOB. It’s a handy protection against stacking insulin in many circumstances, but when you know you are going to need the extra units, and a few get lopped off, it’s a bit frustrating when you end up that many units short and with small and late micro boluses struggling to catch up 🙄😛

 

[PhoebeC]

See on the Pump Dafne course I did last winter, I am sure the advice is to learn about certain foods and adjust as needed.
I know me and the other patient both said we need extra insulin or certain foods, mine is tuna and the DSN said if it's something we have learnt to add it as the carb amount. If I have insulin for the carb amount say the bread, but not to cover the tuna I will go high and it will give me extra insulin.

I will check the course material over the weekend and share.

 

[SB2015]

See on the Pump Dafne course I did last winter, I am sure the advice is to learn about certain foods and adjust as needed.
I know me and the other patient both said we need extra insulin or certain foods, mine is tuna and the DSN said if it's something we have learnt to add it as the carb amount. If I have insulin for the carb amount say the bread, but not to cover the tuna I will go high and it will give me extra insulin.

I will check the course material over the weekend and share.

Thanks @PhoebeC

I find it useful to remember that the HCL is designed for ‘an average person with T1’ and then helps out with corrections as necessary, but I have definitely picked up some meals where I still need a split. Depending on what it is I can sometimes manage it doing a prebolus and delivering the rest after the meal (chips -especially as my will power is lacking and it seems such a waste to leave those last few !!) with a bit extra for the bigger meal. For some meals I am still working on it.

HCL works well for me in ‘normal circumstances’ and needs a bit of help at the extremes.