# Active Insulin Time? Post prandial spikes?



## lauraw1983 (Jan 20, 2016)

Hi all....it's a long long time since I have been here! 

I have had my pump for coming up 2 years in April but recently have really had to rejig a lot of settings due to some weight loss. Felt a bit lost with it all again but I am getting there now thanks to the lovely diabetes dietician at my clinic too, she's very clued up.
Basals seem fairly sorted, just very fine tuning to go, but I am really suffering with post prandial spikes. There's still a question mark whether I need to change my insulin:carb ratio too. I'll give you a little example of last night and today so far...I tested through the night and fasted until 12 noon today to double check basal, testing hourly! I realise these are on the high side, have adjusted basal rate from 6am onwards for tomorrow and will do the same again, may need a little more tweaking.

03:00 - 6.7
06:00 - 6.2
07:00 - 8.2
08:00 - 8.3
09:00 - 9.1
10:00 - 9.6
11:00 - 9.9
12:00 - 8.8
Then ate 50g carb, 5.0 units given and a 0.6u correction.
Two hour post meal reading....
14:00 -16.5 
15:00 - 14.2 (still no correction recommended as correct insulin still on board according to current settings)

This is a similar pattern I have been seeing for a while. Huge spikes. I don't bolus a long time before I eat and realise that is one thing I can and will try, but it's hard with a busy life at times (two kids, working, partner does shift work etc) not to get caught up and sidetracked or to know exactly what I am eating an hour before I do!

Would this jump out to many of you as being a carb ratio issue, or a timing of dose issue?

My friend (whose little boy is on a pump) was today telling me she has her little boy's active insulin time set to 2 hours, so that if at 2 hours he is still high then the pump will start correcting. Mine has always been set at 5 hours. I use novorapid. I worry if I set it to 2 hours, that the pump would overcorrect me and I would crash to a hypo? Any experiences out there that can help? I realise everyone is different but just looking for opinions. Thanks in advance!


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## Pumper_Sue (Jan 20, 2016)

Your friend is playing a dangerous game with her little boy and obviously does not understand the duration of insulin. Yours is set at the right amount.

Looking at your results I would suspect (only because it happens to me) that it's your basal 2 hours previous to the lunch bolus that is incorrect thus causing the highs. Do you also bolus 15 - 20 mins before you eat?


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## lauraw1983 (Jan 20, 2016)

But if I don't eat and do fasting tests, my basal is fine over that period? Lower and I would hypo. I don't eat at the same times every day.....

No I don't always bolus 15-20 mins before, although I am going to be actively making sure I do, to trial it. All in the organisation I suppose but sometimes I have to grab food and eat when I can and can't always pre-bolus.


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## Pumper_Sue (Jan 20, 2016)

lauraw1983 said:


> But if I don't eat and do fasting tests, my basal is fine over that period? Lower and I would hypo. I don't eat at the same times every day.....
> 
> No I don't always bolus 15-20 mins before, although I am going to be actively making sure I do, to trial it. All in the organisation I suppose but sometimes I have to grab food and eat when I can and can't always pre-bolus.


Well if you are starting at 8.8 and@12pm your basal is way to high hence the very high numbers 2 hours later esp if you eaten food and the insulin hasn't had a chance to start working before you do so.
Ideally you should be below 8 before you eat. So this points to basal between the hours 10 and 12.


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## lauraw1983 (Jan 20, 2016)

Ah but I was only 8.8 because I was doing a fasting test - you're right, it is too high and is what I said up there. I have increased for tomorrow, from 6am through to 10am. Because it's from there I saw a rise, which then stayed fairly level. If I had been between 5-7 then, hopefully it would have stayed level at 5-7 through the morning too. Of course it may not, and may need a basal increase from 10-12noon too of my basal, only testing will tell....am I making sense? 

Still a massive spike from the 8.8 to 16.5 though


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## pottersusan (Jan 20, 2016)

I have to give myself my insulin at least 30 mins (and that's being optimistic) before eating to cut down those spikes. At breakfast time I need it an hour or more before I eat .

Its really hard to do when you're busy or eating out, but by doing it most of the time things are much better for me. I have a separate CGM which I monitor closely and try not eat until my BG is 6 or less - this leads to lots of overcooked food! A kitchen timer is my constant companion.

I use Novorapid - which in my opinion is not 'rapid'!


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## Pumper_Sue (Jan 20, 2016)

lauraw1983 said:


> Ah but I was only 8.8 because I was doing a fasting test - you're right, it is too high and is what I said up there. I have increased for tomorrow, from 6am through to 10am. Because it's from there I saw a rise, which then stayed fairly level. If I had been between 5-7 then, hopefully it would have stayed level at 5-7 through the morning too. Of course it may not, and may need a basal increase from 10-12noon too of my basal, only testing will tell....am I making sense?
> 
> Still a massive spike from the 8.8 to 16.5 though


The idea of basal testing is you stay level at reasonable level. Bolus is only for food and correction bolus.
You need to look at raising your basal from 5 am.
Perhaps look at the time blocks you have set for your basal as well.


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## lauraw1983 (Jan 20, 2016)

How many time blocks do you have for your basal rates? I did have a 5am one, then took it out to try to simplify things a little while I was trying to sort out all these levels!  I can add one back in.


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## trophywench (Jan 20, 2016)

Yes increase it at 5am, I agree there Sue - but stop the increase at 9.00 am.

This is because - let's say the inc basal gets you to 6.5  at 9am, which is what you want.  Then

10:00 - 9.6 will become 6.5
11:00 - 9.9                     6.8
12:00 - 8.8                     5.7

If you carry the increase beyond 9am, you will be hypo before too long!

Get that right and only THEN move on to 'what do I do about lunch'. 

You are trying to change too much at once and if your BG is OK when you get to pre-lunch, you may not get the same effect at all after you eat it.  I'm bound to say it does look like it needs upping - but I would hesitate to change mine until I'd sorted the morning, frankly.

By the way - I don't find Novo last for 5 hours.  Never have.  4 for me.  Humalog does often tend to have a kick in its tail - but not Novo.  It just dies in its sleep! seemingly.


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## trophywench (Jan 20, 2016)

Time blocks? - shedloads!   You can have 24 if that's what you NEED !  I do have a few 2 hour blocks where the rate is the same, but most are only 1 !


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## lauraw1983 (Jan 20, 2016)

I have wondered about the active time before....I was on Humalog before I pumped but switched to Novorapid for pumping. As far as I can remember I kind of based it on before which was Humalog when it may be less. However it seems a hard thing to test and there's no definitive answer, just opinion out there! Grumble grumble.

As for "doing too much at once" - yes I probably am because I get so frustrated! I do need to nail the mornings first as it's always been my problem time of day!

I'm just sitting writing out my new rates to programme in.....out of interest when you adjust, how do you decide how much to increase by? I was always told by 0.25 or 0.50 only at a time, see what happens then nudge up by more again if needed?


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## lauraw1983 (Jan 20, 2016)

trophywench said:


> Time blocks? - shedloads!   You can have 24 if that's what you NEED !  I do have a few 2 hour blocks where the rate is the same, but most are only 1 !



The last consultant I saw looked at the amount of rates I had and was shocked, said she'd never seen someone with so many!! Think there was 11 or 12....said it made things confusing running tonnes of basal rates and that usually one for 2 hour blocks is fine!


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## everydayupsanddowns (Jan 20, 2016)

It's really tricky to comment on the results you have given ratio-wise while you are adjusting your basals (which is exactly the right way to do it!). I usually alter by maybe 10% or possibly 20%, so depending rate at the time it might be 2-4 'clicks' on your Veo. I've always had at least 9-10 rates - you need what you need!

Interestingly, your 14.2 was approx 3 hours after the 5u, so although you more than likely had some insulin still active at that point, it may not have been quite enough to get you back into the 6s. This might suggest a ratio tweak could be needed, but tricky to tell because once you'd got up to 16.whatever the dose was going to be a bit less effective anyway. 

Hope you get your basals tweaked soon, and that ratios and corrections fall into line


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## lauraw1983 (Jan 21, 2016)

everydayupsanddowns said:


> It's really tricky to comment on the results you have given ratio-wise while you are adjusting your basals (which is exactly the right way to do it!). I usually alter by maybe 10% or possibly 20%, so depending rate at the time it might be 2-4 'clicks' on your Veo. I've always had at least 9-10 rates - you need what you need!
> 
> Interestingly, your 14.2 was approx 3 hours after the 5u, so although you more than likely had some insulin still active at that point, it may not have been quite enough to get you back into the 6s. This might suggest a ratio tweak could be needed, but tricky to tell because once you'd got up to 16.whatever the dose was going to be a bit less effective anyway.
> 
> Hope you get your basals tweaked soon, and that ratios and corrections fall into line



Thank you. It is a bit of a mixed bag of results as issues could be clouding each other. Last night I had a 2.8 hypo though, and although treated as normal and I didn't then get to bed until after 1am....woke to a horrible 17.5. Let's just say I am not in a good mood today.

Waiting for it to drop before I eat anything, it's coming down steadily. No point in basal testing this morning, I will start afresh tomorrow morning with it. I hate diabetes today.

As a side note, I have changed my active time to 4 hours as looking at quite a few of my results, this does seem to be more accurate for me.


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## everydayupsanddowns (Jan 21, 2016)

lauraw1983 said:


> As a side note, I have changed my active time to 4 hours as looking at quite a few of my results, this does seem to be more accurate for me.



I would be a bit surprised if it was much less to be honest (though everyone's different of course!). I set mine down to 3 hours for a while on the Veo to get more aggressive correction advice after meals, but time spent with Libre traces has def shown that activity goes on to 4 hours and slightly further for me.

I think the picture is complicated because the 'curve' they use to calculate IOB isn't actually quite what happens in everyone - so you can get a false picture of how much insulin is (or isn't) still knocking around. Plus, of course on Medtronic pumps, the IOB figure completely ignores the other essential factor COB - carbs on board  - which has a BIG bearing on what BG is going to do. Roche pumps only track 'corrections' for IOB, but I've never been keen on that approach because my wild-guestimates of carbs are sometimes rather less than 100% accurate


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## lauraw1983 (Jan 21, 2016)

I had it set as 5, definitely wasn't quite right.

As an aside, I was just googling about eating porridge and your blog popped up! An older post though....how do you bolus for it? I know a normal bolus causes me a huge spike, but not quite sure where to start with trialling splitting it! At the moment I just avoid porridge......I'm not planning to eat it while still figuring all this out but it's next on my hit list after!


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## everydayupsanddowns (Jan 21, 2016)

LOL! Must be from a while back - haven't eaten much porridge for years. Still rather in the 'rocket fuel' category for me. I would eat it if I fancied it, but would not expect great BGs after as it's not very 'tried and tested'.

My approach to all breakfasts remains the same - and that is to wait *at least* 30 minutes between bolus and eating. More if I start off higher. I also have a higher insulin ratio at breakfast time alongside a hefty basal tweak from 1hr before waking until an hour or two after.

Essentially just crawling out from under the duvet seems to require an added bolus (even if I don't plan to eat for several hours). In desperation I have resorted to 2x breakfasts that I have seen working OK over the years. A slice of Burgen toast for weekdays, and croissant at weekends. If those misbehave I know my settings (most likely basal) is on the move. I DO have other breakfasts once in a while, but I accept that those will probably come with some errant BGs as it's a time of day that I seem to find a bit of a challenge BG-wise.


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## lauraw1983 (Jan 21, 2016)

Aww what! That is not the answer I wanted 

I'm doing slimming world and change up my breakfasts (well all meals really!) a lot....I get so bored otherwise. Oats are a favourite food of mine, but whether cooked or raw they are causing problems!   I can see why people will eat things where they know the BG effect....I'm maybe just a rebel!  

In a couple of weeks once these basals and everything are adjusted and working better for me, I'll be sick of porridge/oats.....my mission is to find out how the heck to split the bolus!


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## everydayupsanddowns (Jan 21, 2016)

Not a rebel at all. Some things are *always* worth fighting for. Pushing through the BG chaos until you have 'fixed' them. And there will def be a way that you can get good BG responses. You just need to find it!

Don't be afraid to try some weirdness. With some of my choices I have taken the step of seeing what correction I usually need 1-2 hours after eating and having it (or part of it) up front. Works a treat! But I don't need to do that for everything. Sometimes the elegant idea of a 'ratio' just doesn't seem to work for me. But as soon as I have seen a pattern, I have something to work on (well... until the goalposts move again!).

If I was facing a meal where I struggled with spikes though I would tend to give all insulin *upfront*. Split doses tend to work best for me where foods/combos are more slowly absorbed and I run the risk of running hypo 1-2hrs after eating only to rise 4 hours after (when the dose has run out). Splitting just delays the insulin even further and makes the spike even worse for me.

But...

Others *do* find benefit with spreading the dose and/or adding a hefty TBR for the hours after their 'tricky' meals. So don't discount those ideas just based on my experience.

Happy experimenting


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## Sally71 (Jan 21, 2016)

I find porridge one of the biggest pains in the posterior to bolus for.  We have to spread the dose out by minimum 90 minutes or daughter WILL go hypo.  How much up front is a bit harder to judge, had an unexpected 3.7 last week even after the 90 min spread, that was with 50% up front, can only conclude that less than 50% is better! At the moment am doing 40% up front over 2 hours and that seems to work ok.  It's all guesswork though!


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## lauraw1983 (Jan 21, 2016)

Hmm the porridge thing is a mystery! Thanks for all the info. 

Interestingly my hypo last night was after a kind of oaty bake thing (SW recipe, higher protein, sweetener not sugar etc) and the results from that would suggest that the insulin worked far too fast, dropped to a hypo then released much more slowly overnight!   Different time of day though, it's morning that are awful for me! Been reading a bit more about it today, I will be trialing split boluses and square wave too possibly.....plus the more obvious 20-30 minute bolus before eating.

For now I am still absolutely tearing my hair out with these basals


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## SB2015 (Feb 14, 2016)

Porridge is definitely worth sorting in my mind.  I have it most active mornings now.

I have porridge, bolus before ( about 20 min or how long it takes to make and get round to eating) to deal with spike from honey and milk in it, but do multi wave 50/50 over two hours.  Seems to keep me level through Pilates etc for which I also do 30% TBR as I leave the house for 20 min walk there,   It took time working this all out, but as others have said before there is no point fiddling with tweaks to ratios and timings until you have basal sorted out.  

Keep at it, and keep asking.  It is well worth it.


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