Medtronic 780g "Highs" after lunch

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niksm

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Type 1
Hi All,

I am really struggling at the moment with "highs" after my lunch. Pre-lunch I'm at around 6.1, 1 hour after eating I begin to rise and by the time it hits 1h 30 after eating I'm around 9.0-10.0. Although this is still technically in range because I'm in smart guard and above target range it gives me auto corrections to bring me down. By around 4pm-5pm I'm dropping below 3.8 without fail. I'm only having this issue with this particular meal (Sandwiches, snack bar & crisps), I am a carb heavy eater anyway and other meals I eat with similar or more carbs do not have the same affect as this meal seems to. My target glucose is set to 6.1 (same happened when it was set at 6.7), my AIT is set to 2 hours, lowering this to 2 hours made my corrections less aggressive but I still get some. I inject before my meal (20 mins before) and am on Lyumjev, if I do it anymore before this I'm going to start dropping low before I've even eaten.

I am in contact with my DSN but I still feel at a loss as to what to do to stop this rise and I'm not sure why its happening and I don't think they know either, whether my insulin just isn't kicking in quick enough or what. I've tried doing a "split dose" I first tried doing 70% up front and 30% after an hour but that made the rise worse so I tried 50% up front and 50% after 45 minutes but I still rose to above 10.0. I can't change anything in smart guard other than AIT or Carb Ratio and I don't necessarily think my ratio is wrong as on the weekend it works absolutely fine just not on a weekday with this meal.

I'm wondering if anyone else has had this happen before and what you did to stop it?

Thanks!
 
Have you tried doing a finger prick test 1-1.5 hours after food, if the machine is out of calibration you could be 1-2 mmol lower than the smart guard is indicating - I know as it’s happened to me previously - worth a check
 
I get peaks after carb heavy meals unless I exercise. Have you tried a post meal walk round the block?
 
The problem isn’t the rise because 9 or 10 is fine. The problem is the automatic corrections given which then send you low later. I don’t loop but @SB2015 uses a Medtronic and is very experienced with looping. Can you temporarily change the settings to stop the corrections eg tell it you’re going to exercise or put in the wrong amount of carbs or whatever, or simply put it on manual for a few hours?
 
NeilSmith said:
Have you tried doing a finger prick test 1-1.5 hours after food, if the machine is out of calibration you could be 1-2 mmol lower than the smart guard is indicating - I know as it’s happened to me previously - worth a check
Click to expand...
I have double checked a few times and it's always within .5 mmol when I've done a finger prick test :( ironically my finger prick usually reads a little higher than what the sensor suggests
Radders said:
I get peaks after carb heavy meals unless I exercise. Have you tried a post meal walk round the block?
Click to expand...
I always take a short lunch time walk of around 20-30 minutes but its made no difference to my blood sugar post-meal
Inka said:
The problem isn’t the rise because 9 or 10 is fine. The problem is the automatic corrections given which then send you low later. I don’t loop but @SB2015 uses a Medtronic and is very experienced with looping. Can you temporarily change the settings to stop the corrections eg tell it you’re going to exercise or put in the wrong amount of carbs or whatever, or simply put it on manual for a few hours?
Click to expand...
It's very frustrating because like you say 9 or 10 is fine and I'm happy with that number but the corrections just kill me later on and Im always dropping low around the time I'm leaving work to drive home 🙄 My nurse did say I could set a temporary target which would up my target to 8.3 instead of the usual 6.1. I'm thinking after speaking to her tomorrow (she's on annual leave) I might try that and see how that goes but it seems almost silly to have to do that every single day for 1 meal:rofl:
 
That does sound frustrating. However the blood sugar pattern you are getting, of a spike after lunch followed by a low later on is very familiar to me.
I used to manage it by spreading out my lunchtime carbs so I didn’t get the spike and had something to snack on mid afternoon (without any additional bolus) so that I wasn’t going low just before my journey home, but I appreciate that’s not possible in all jobs.
I’m not looped so I don’t know if that would work but maybe if the spike wasn’t there the corrections wouldn’t come in? For me it was just the lunchtime bolus not coping with the speed of the carb spike.
 
are you entering the correct carbs for the given meal? I know sometimes it’s a bit of trial & error and not an exact - but think of it like this - you don’t give yourself enough to cover the carbs so it ramps up - the pump then works harder to get it back to it’s setpoint (6) but it overdoses, however the smart pump is learning all the time. Possibly another thing is to eat something an hour before you finish work so keep off the low
 
NeilSmith said:
are you entering the correct carbs for the given meal? I know sometimes it’s a bit of trial & error and not an exact - but think of it like this - you don’t give yourself enough to cover the carbs so it ramps up - the pump then works harder to get it back to it’s setpoint (6) but it overdoses, however the smart pump is learning all the time. Possibly another thing is to eat something an hour before you finish work so keep off the low
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Thank you for the reply, funnily enough I fine-tuned this recently so I know for sure it's correct, the sandwiches don't have carb values so I did ask the company for the values and I do sometimes have a sandwich at the weekend and putting in the values the company gave me keeps me in range with no rise then but just not at lunch during the week, the crisps/snack bar have the values on the packet. I do usually bring an extra snack to eat before going home to stop the low I just feel like that isn't an appropriate long term solution as it isn't fixing the actual issue it's just "masking" it instead.

Radders said:
That does sound frustrating. However the blood sugar pattern you are getting, of a spike after lunch followed by a low later on is very familiar to me.
I used to manage it by spreading out my lunchtime carbs so I didn’t get the spike and had something to snack on mid afternoon (without any additional bolus) so that I wasn’t going low just before my journey home, but I appreciate that’s not possible in all jobs.
I’m not looped so I don’t know if that would work but maybe if the spike wasn’t there the corrections wouldn’t come in? For me it was just the lunchtime bolus not coping with the speed of the carb spike.
Click to expand...
I do think the spike is what causes the issues and brings on the corrections. I work in an office so spreading out the food wouldn't be an issue for me really and I can eat whilst working so if all else fails I may just give this a go!
 
My nurse did say I could set a temporary target which would up my target to 8.3 instead of the usual 6.1. I'm thinking after speaking to her tomorrow (she's on annual leave) I might try that and see how that goes but it seems almost silly to have to do that every single day for 1 meal:rofl:

This looks like the answer to me, and was the kind of thing I was thinking about @niksm I’m sure I’ve read about other loopers here who alter settings like that as a temporary work round. I’d try that and see how it works.
 
Todays experiment of setting a temp target before autocorrections kick in is going tremendously think my lunch bolus during the work week with this meal gets lost.
 

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Hi @niksm
Sorry you have been having difficulties with your looping after lunches.
I am wondering about where you have changed you active insulin time. I think that you said that you took this down to two hours. That will mean that after two hours your pump will think any bolus is no longer active and will start doing corrections to bring you down to target. I am wondering whether this is the issue. you will have your bolus active as well as some corrections going on at the same time. I know that Lyumjev is faster to get going but I am not sure about the time it keeps going once started, especially as it is basically Novorapid with a different wrapper to enable it to start sooner. That might be worth looking at.
With all the vagaries of Duabetes it is a case of finding workarounds for any issues that arise, which is why I started this thread in the hopes that we can help each other. Let us know how you get on with any other changes you try. I agree with you that setting a temp target doesn’t seem to be a long term solution but if it works then perhaps that is just what is needed, and may work for others.
 
Thank you for your reply, definitely a frustrating one diabetes is never an easy ride!! Although I didn’t want to I’ve decided to try lower my carb intake at lunch and see if the sandwiches are the issue and causing the awful spike. If I can stop the spike that’d be great and if it means sacrificing sandwiches I will do it just to stop the stress of feeling out of control!! (I’m going from 86g to 48g carbs at lunch, I can possibly lower that but I’m reluctant to change more than 1 thing at my lunch unless I absolutely need to). Not ashamed to say I love my carbs :rofl:
 
Well - I've not tried looping at all - BUT having used unlooped pumps for nearly 20 years the first thing I'd have a go at if a different carb/insulin ratio in the week isn't acceptable, is to change my basal pattern for work days. I'm 1,000% certain that needing to 'eat to the insulin' would not be acceptable to me - never should be these days unless anyone's hypo! Yes we all had to do it 50+ years ago - but NOT now.
 
trophywench said:
Well - I've not tried looping at all - BUT having used unlooped pumps for nearly 20 years the first thing I'd have a go at if a different carb/insulin ratio in the week isn't acceptable, is to change my basal pattern for work days. I'm 1,000% certain that needing to 'eat to the insulin' would not be acceptable to me - never should be these days unless anyone's hypo! Yes we all had to do it 50+ years ago - but NOT now.
Click to expand...

It is an odd thing about ‘looping’ - finding your way in and around the algorithm of whichever sensor augmented pump you are working with. I guess they design them with some sort of theoretical generic person with diabetes in mind, and make the algorithm work for them - but of course we are all slightly different, so both with the MM640G, and now with the tSlim I’ve had to learn what to ‘tell it’ and how to work around any differences so that it works for me (more often than not).

They can be frustrating at times, but I really wouldn’t want to go back to a non-sensor-augmented pump now!
 
As we both know fine damn too well mate - no insulin pump ever designed has ever been Plug and Play! The things all have their own little idiosyncrasies just as people do - hence the trick is still finding the ways of fitting the two traits together as painlessly as humanly possible.

ie the jolly ole learning curve that is still lifelong!
 
Hi
I have had similar experiences.
I am on Medtronic 780g with Gardian4/Smartgard CGM.

I note that for my setup Medtronic firmly recommends 10- 20 minutes interval between telling the pump about carbs and actually eating. With your issue it sounds a bit like the insulin is “chasing “the carbs.
By delaying the eating for 20 minutes you may not need to take as much insulin and the carb ratio can be adjusted accordingly.
If you need to take less insulin then there is less chance you will go so low so quickly after the peak.
I ho it all works out for you.
REE
 
Please note that lowering your AIT will make corrections more aggressive, in my experience.
 
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