Lingering highs

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Simbul

Simbul

Active Member
Relationship to Diabetes
Type 1
This is one of those ideas I've formed from anecdotal evidence so I'm curious to hear what you think about it.

The theory (or what my consultant said last time) is that correcting a high (with a bolus wizard in my case) should bring BG down to the target value in about 4 hours.
However, I've seen time and again that my high readings tend to linger. For example, I'll eat out and end up with a 15 or 16. Despite correcting, my BG will stay in the 10-12 range for far longer than 4 hours; sometimes even half a day.

Has anyone experienced something similar?
 
Simbul said:
Has anyone experienced something similar?
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What are you eating to get numbers like that? If the food is of high fat or protein content then perhaps consider splitting your bolus or doing an extended bolus.
Do you also remember to add an extra percentage for bloods over 12 as insulin resistance tends to kick in with high blood sugars.
 
I think its mostly high-fat food. Any restaurant tends to be higher in fat than what I eat at home, but let's say Indian as an example. That tends to wreak havoc on my BG pretty regularly :D

Can you elaborate on insulin resistance above 12? Do you mean my insulin sensitivity ratio should be lower the higher my BG is?
Won't that put me at risk of dropping too low once BG gets under 12 and my insulin resistance is back to normal?
 
If over 12 most people find they need higher correction levels to combat the higher numbers, so you need to experiment to see how much extra you need, obviously the higher you are the higher the resistance. No it wont put you at risk of dropping lower.


Simbul said:
Any restaurant tends to be higher in fat than what I eat at home, but let's say Indian as an example. That tends to wreak havoc on my BG pretty regularly
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Hate to tell you this but that's just basic insulin mismanagement if you are going high and staying high after high fat meals. So you need to look into splitting and or extending your bolus for those meals, then you wont have such a problem.
Perhaps look in your pump manual for guidance or invest in the book pumping insulin 🙂
 
Pumper_Sue said:
If over 12 most people find they need higher correction levels to combat the higher numbers, so you need to experiment to see how much extra you need, obviously the higher you are the higher the resistance. No it wont put you at risk of dropping lower
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Problem is, Sue, we are all different. I need to adjust my correction ratio downwards, not upwards, if I'm very high, because I need less insulin to sort it. I think this is because my kidneys swing into action and remove some of the glucose for me, like they do before diagnosis.
 
Simbul said:
higher in fat than what I eat at home, but let's say Indian as an example. That tends to wreak havoc on my BG pretty regularly :D
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Hi Simbul, you are not alone in finding that restaurant meals play havoc with BGs. Indian meal is the worst culprit for me, so I limit myself to grills and sneak a tiny bit of my husband's yummy stuff.

As others have said, if you are eating food that is high in fat, you may find that you need to use the extended bolus for that. When on injections I used to try to split my injection but then regularly forgot the second part, so it was just worse. However now on a pump there is the facility for the multiwave and extended bolus. A Robin said we are all different, so the only way of working out how long you need to extend the delivery is from your own experience.

Simbul said:
Can you elaborate on insulin resistance above 12? Do you mean my insulin sensitivity ratio should be lower the higher my BG is?
Won't that put me at risk of dropping too low once BG gets under 12 and my insulin resistance is back to normal?
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I am not sure which pump you are using, but on my Combo I have a 'health' setting which I can use to increase or decrease a specific bolus. I have one set at each of +20%, +50%, -20% and -50%. If my BG is above 12 I use the +20% setting to increase the bolus. This seems to work and does not result in a hypo later.
I have only come to these figures from trial and improvement.
 
That's very interesting. I'm using a MiniMed 640G and I can configure insulin sensitivity based on time of day but not based on BG levels. I'll play around with that a bit by increasing my correction manually and see what happens. Given my values seem to be staying high it's more likely that I'm under-correcting rather than the opposite, but I'll keep your warning in mind @Robin.

As for extending my bolus, I'm usually doing that, though I may not be doing enough of it. I've managed to get my BG under control about 2-4 hours after a meal, but then I get these spikes hours and hours after I've stopped eating (6 to 8 or even 10 hours, if at night). Has anyone else experienced something of that sort?
 
Simbul said:
As for extending my bolus, I'm usually doing that, though I may not be doing enough of it. I've managed to get my BG under control about 2-4 hours after a meal, but then I get these spikes hours and hours after I've stopped eating (6 to 8 or even 10 hours, if at night). Has anyone else experienced something of that sort?
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If you BG is rising well after the meals it sounds as if it may be your basal rates that need adjusting. Have you done a fasting basal rate test recently. Once you have your basal rates sorted you can start to adjust your ratios. I will try to find TrophyWench's post with a link about basal rate testing made easy and flag it up for you.
 
Thanks @SB2015. My BG is usually fine after my usual meals. It's restaurant food that wreaks havoc on it, which makes me think there's something wrong with the bolus rather than the basal.

However, it has been a while since my last fasting test, so taking your advice will to me good. The links you posted are going to be helpful: thanks 🙂


I also found this little tidbit in the first article:

  • You may not take in any calories for at least 4 hours preceding the basal test.
  • The meal/snack preceding the basal test should be low in fat (no restaurant food or take-out; these tend to take much longer to finish digesting).
Back to my original question, I think we can infer from the above that restaurant food is supposed to take longer than 4 hours to digest.
 
Their 4 hour period is to ensure that the last dose of insulin given for carbs is cleared. The low fat meal is to ensure that the carbs from the food you ate four hours earlier has completely cleared the system. So when you start the fasting test you have no active insulin and no carbs mucking up the readings.

I treated myself to if push cakes and chips last time I went out for lunch!!! Not a good idea as I went up to 16.
If I am being sensible I just have a salad which has identifiable bits in for which I can count the carbs, and no greasy fatty sauces. However I am not always sensible.
 
SB2015 said:
The low fat meal is to ensure that the carbs from the food you ate four hours earlier has completely cleared the system. So when you start the fasting test you have no active insulin and no carbs mucking up the readings.
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True. In addition, you can infer from those statements that high-fat food can still raise your BG after more than 4 hours, which I wasn't aware of.

As people were pointing out in another thread, we can't really be sensible all the time. Sure it would be nice to never waver, but we're all human after all and sometimes we have to have our fishcakes and chips and our Indian food 🙂
 
Simbul said:
True. In addition, you can infer from those statements that high-fat food can still raise your BG after more than 4 hours, which I wasn't aware of.
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If on the rare occasion I have gluten free fish and chips at 5.30 pm, my bloods start to rise at about 4 AM the following morning so I learnt a long time ago if I do have f&c then I change my basal to +30% for 4 hours for that night to start at 2 AM. Thus problem solved.
 
The ghee in Indian food usually massively delays the carbs for me - much more than for other high-fat meals. I would generally do a combo/dual wave bolus over several hours to cover the evening and in addition set a square wave bolus for several hours overnight based on my experience of how much my levels usually rise after going to sleep.

I also have to over-estimate the insulin:carbs by quite some way (say dose for 80-100g CHO but only aim to eat around 60-70) which is possibly just my own estimation-errors of food on plate/carb values of the stuff we normally eat. If I think I'm eating 'correctly' for the dose I almost always end up above range.

I just practiced/recorded/kept notes a fair few times until I worked out a system that generally worked for me and Indian takeaways. Some 'scientific research' is easier to struggle through than others 😛
 
Good to know it's a common issue. So far I've used dual wave + an increased basal to cover the night, but I've been very tentative about it and results have not been significant. I'll go at it a bit more forcefully next time I have to wrangle Indian food :D
 
Sometimes you have to be brave! You can always stop boluses/change settings back if you overdo it by mistake. My daughter's BGs shot up to 13 and wouldn't come down again today, no idea why as she had not eaten or done anything unusual. Correction dose with her lunch had no noticeable effect. Perhaps I need to adjust her insulin sensitivity; I shall be watching that over the next few days. In the end I did an extra correction mid afternoon and stuck her on a +20% temp basal for a couple of hours and that did the job!

It might just be that it's school holidays, I find it almost impossible to keep her stable then as no two days are the same :(
 
Pumper_Sue said:
If on the rare occasion I have gluten free fish and chips at 5.30 pm, my bloods start to rise at about 4 AM the following morning so I learnt a long time ago if I do have f&c then I change my basal to +30% for 4 hours for that night to start at 2 AM. Thus problem solved.
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What pump are you on Sue. I am not aware on the Combo of a way of delaying the TBR for a period of time.
 
SB2015 said:
What pump are you on Sue. I am not aware on the Combo of a way of delaying the TBR for a period of time.
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I have the Animas vibe and all you do is change the basal percentage before you go to bed and change it back in the morning. As they say there are ways and means :D
 
Pumper_Sue said:
I have the Animas vibe and all you do is change the basal percentage before you go to bed and change it back in the morning. As they say there are ways and means :D
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I can set the TBR to go through the whole night, but have no way of delaying its start.
 
SB2015 said:
I can set the TBR to go through the whole night, but have no way of delaying its start.
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Yes I've often thought that would be handy too.
 
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