# odd after meal issues :( HELP



## SilentAssassin1642 (Sep 14, 2010)

I'm getting a little annoyed with things at the moment. As you know, I basal tested the other day and got brilliant results. I changed a tad over lunch time, but EVERY lunch time after eating I shoot up to 17 plus. So, I played with my ratios so I get a little more insulin

Today after a normal lunch, and a little more insulin (10u total, done over 1 hour), I was up at 20.9 two hours later. And I felt awful.

This is happening every lunch time at work and it's starting to upset me. What else can I do? Basals seem ok, but something is going wrong. I'm wondering if I've suddenly developed an aversion to white bread? Because that's all I had today, a freaking HAM SANDWICH and I went up to 20!

I ended up having a massive rant at work about it and there were tears. I was out of action for ages as I had mild ketones and had to keep running to the loo. Honestly, I don't know what else to do. I can't get hold of my team at bournemouth - i tried emailing the nurse last night but apparently her email is now defunct. And it's one i've been emailing her on for yonks.

I just don't know what to do! Is this a sign I need to do more basal testing? I'm doing an overnight this weekend anyway as I keep waking up with levels of 9 or more. Not only that but after EVERY breakfast I shoot up to 18! It's getting boring now and starting to really upset me as you can imagine. I'm wondering if it is ratio issues? Or whether or not I should just say sod it and not bother with breakfast and lunch any more 

I knew this was going to be hard but I would have thought by now I'd have a little more of a grip on things. Basal tests seem really good, I was so pleased with them the other day and I'm using my own judgement to make changes but jeez I am so lost with this one. Why am I going so high after both of these meals? Do I change ratios and have even more insulin? I just don't know anymore. 

I just need some help and really don't feel like I'm getting very much from my team. Is it so much to ask? I feel lost. I feel upset.

Oh, and if anyone thinks they can email me saying I don't deserve my pump because of this then they will feel the sharp edge of my tongue. I'm just not in the mood for it anymore.


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## Robster65 (Sep 14, 2010)

Hi SA.

Could it be stress causing your BG to rise ?

I get the feeling that you're finding it all a bit of a strain and maybe the anticipation of high BG is actually causing it. A self-fulfilling prophecy so to speak.

Also, white bread is high GI, so maybe that's giving you spikes that you hadn't accounted for.

Hope you can get it sorted soon.

Rob


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## bev (Sep 14, 2010)

Hi Sam,
You have done all the hard work already!

Your basals are almost perfect - so you now *know* without a doubt that its your ratio's that are out.Thats good news!

If this were Alex I would start with the breakfast - forget lunch etc. Keep tweaking your breakfast every morning until you get it as you want it. Then move onto lunch etc. If your having cereals then you may want to do a dual wave over a few hours to help lessen the breakfast spike. Or you could try a 'superbolus' to help with the spike.
I would cut out white bread for now until you are confident that your ratio's are right.

Stop being so hard on yourself - pumping is hard work to begin with and I think your doing brilliantly - you are getting some great results and its still early days - so dont feel that your not getting anywhere with it. Alex has been on his pump for 1 year now and we are still learning!

I dont know who is sending you messages saying you dont deserve your pump - but treat it with the contempt it deserves - IGNORE IT!Bev


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## shiv (Sep 14, 2010)

I can't help with the ratios etc, but I now dodge white bread like a bullet. It didn't used to shoot me up but the past few weeks every time I've eaten it it has shot me way up into the high teens and left me feeling awful. Just out of interest, I found some oat based bread (I think most of the big brands do an oat bread) which kept me pretty stable and tasted good.


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## Twitchy (Sep 15, 2010)

Hi!

Sounds like a nightmare!   But what Bev said makes sense - especially the last bit - I'm amazed anyone could be so nasty?!!  Don't take it on board!! 

It's a big change going on to pumping, but it sounds like you've cracked the basals, which has to be a massive bonus! Fingers crossed, with a bit of tinkering the bolus ratios will be cracked soon too - don't despair!  Sending you a hug! (((())))

Twitchy x


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## rossoneri (Sep 15, 2010)

I would agree with the previous posts, it appears that you have got the basal rates as good as they need to be for you to progress.  
Do you have instructions for doing a bolus test to improve your ratios?  If not then I could look what I was given and write them up here if you like.  I recall you saying that when you moved to the pump you were advised to start on the pump with a standard ratio for the whole day rather than utilising the ratios you were already using on MDI.  That still seems rather odd advice to me.


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## bigpurpleduck (Sep 15, 2010)

Hi Sam,

I can't offer any additional specific advice. I agree it sounds like your ratios. If you haven't changed these since you started pumping this would definitely be a good idea. My ratios were all out when I first started.

I had this problem of major spikes after meals when I first started pumping, but this was one of the major issues I'd had on MDI too. Just wanted to let you know that you will get there. After some tweaking and trial of error, I quickly brought the spikes down. Now that I'm concentrating harder than ever before, my post-meal spikes are rarely going above 10 (this could only have happened in my wildest dreams on MDI - then it was more like 20).

Keep the faith and don't despair! It's just trial and error. You know your own diabetes and BG better than anyone else and you will get there. Maybe just go for a small ratio change to begin with and see how you get on.


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## SilentAssassin1642 (Sep 15, 2010)

Lo all - I am a very sad little assassin today

I played with ratios and went to a 1:8 I believe (I will have to check) and I even cut out the sandwich (I have a feeling it may be the bread) - still ended up at 17.0 two hours later and that was doing a multiwave over 1 hour. If I do it over 2 I'll end up at 20 or more.

I'm despairing. I really am. I'm half tempted to just not have lunch, that'll stop the highs  

To those asking about the email. I've had some nasty emails from someone who thought it would be ok to tell me i don't deserve the pump, have never basal tested and would end up in hospital or worse. very upsetting.

I'm wondering if these highs could be related to some problems i'm having with my teeth atm? Swollen at the back, very sore and I'm wondering if its a mild infection mixed in with a wisom tooth coming through?


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## katie (Sep 15, 2010)

You say you go up to 18 after breakfast. What are your levels like before lunch? Also, what do you have for breakfast?

Like Shiv said, I would totally avoid white bread and have multigrain or something instead.


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## rossoneri (Sep 15, 2010)

One further suggestion, how about just sticking with a standard bolus delivery for the time being and not using the multiwave or extended delivery?  It might just be worthwhile keeping matters as straightforward as possible until the results become more stable.

Have the spikes only begun with the problems with the teeth?  It might be a factor as having toothache is quite stressful too and presumably you notice it more when you eat.  

Anyway keep your spirits up and ignore the silly emails, to paraphrase Churchill I am sure that you will eventually have this pump control sorted whilst they will remain stupid and ignorant.


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## Ellie Jones (Sep 16, 2010)

Reading through your thread...  I still ponder if you basal it out of kilter..

To start with the basal can be a real sod to pin down, as you can rely on just one lot of fasting tests, so need several to compare which takes time to collect frustrating I know...  But well worth the hassel..

But assuming these are correct then you have to consider is it a ratio problem or bolous issues that causing the spike?

I see that you are using the multi/duel wave bolus, are you actually deliverying enough on the first delivery to avoid the spike, then using the second phase to maitain levels?

Or you may need to bring the bolus back a bit, with giving your bolus then waiting to eat, so it gives the insulin enough time to start working to avoid the spike!

It might well be that you'll not deliverying enough insulin on the first delivery to avoid the spike, or perhaps the mulit/duel wave isn't the right bolus to use?


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## SilentAssassin1642 (Sep 16, 2010)

Ellie Jones said:


> Reading through your thread...  I still ponder if you basal it out of kilter..
> 
> To start with the basal can be a real sod to pin down, as you can rely on just one lot of fasting tests, so need several to compare which takes time to collect frustrating I know...  But well worth the hassel..
> 
> ...



i have to say - today has been much better. Don't know why. Odd. Levels haven't gone any higher than 10, a couple of hypos. I did a normal bolus for breakfast which seemed to help. Strange.


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