# Blood sugar query...



## Catherine-louise (Oct 19, 2010)

Hi, 

I'm on the medtronic minimed pump and have a question about after meal blood sugars. I'm eating and then giving my dose of insulin, but recently my blood sugars are shooting up to 16s, 17+, I consult my bolus wizard which tells me not to bolus anymore since I already have an adequate amount of insulin floating around my body. Admittedly, within an hour or so, my blood sugars start returning to normal. 

I spoke to my dietitian who told me it was normal to have your blood sugars 'go up' immediately after eating. And I suppose they do ask you to test your blood sugars 2 hours after eating - so perhaps this is meant to happen? Still, I'm concerned as to whether this is doing much damage in the long run? Complication- wise (please, no mega scary answers, because I already get myself worked up about complications  )

Anyway, your thoughts would be helpful.
Cate


----------



## Northerner (Oct 19, 2010)

Hi Cate, I'm not a pumper, but I would think that, depending on what you are eating, it would be better to bolus before eating, What is probably happening is that your food has begun converting to glucose before your insulin has had a chance to 'get going'. It's one of those tricky things where you have to consider when to bolus according to what you want to eat in order to avoid these 'spikes'.


----------



## Catherine-louise (Oct 19, 2010)

Yes, I think you're probably right. I'm going on a sensor on Thursday to see what's happening with my blood sugars. So I'll see what the results say...

Thanks


----------



## Adrienne (Oct 19, 2010)

Hi

Sorry just a quickie but you should definitely be trying to bolus before you eat at least some of it if you are not sure if you are going to eat it all.  That way the insulin will start working before or at the same time as the food does.

What it sounds like could be happening is that as you bolus after (I'm presuming this is what you meant) the food is starting to work way before the insulin has a chance and the food will take your levels sky high.

I would actually suggest your DSN is wrong and on a pump you can have great levels and there is no need to go up this high.  She should be trying to help you sort out the highs and not tell you they are normal, on a pump they do not have to be normal.   There are all sorts of tricks to get the high smoothed down even if you go up to about 10 each time that is acceptable, not 16 odd.  

Hope that helps a bit.


----------



## Alzibiff (Oct 19, 2010)

Cate,
I have every sympathy with you - I have had the same problem .... and still get it at times!

My advice is as follows but feel free to ignore and/or question..

First off, are your basals what they should be? If not, you have no chance of setting your Bolus Wizard to anything like it should be for you. It can be a long and tedious process but it is worth getting your basal rates as good as they can be before mucking about with bolus settings.
Secondly, is your active insulin time set properly - I had mine on 4 hours for ages until I really spent some time working out what it really was - for me it is now 5 hours (Novorapid).

Remember too that the whole insulin thing involves getting your BG back to what is was prior to your meal, whether that is via a pump or MDI 5hrs (or whatever your active insulin time is) after your meal. (Assuming you take a one shot bolus and not dual or square wave). If you have that right, it would suggest that you need to bolus earlier as has been suggested.

Watch what you are eating too - high sugar content foods - high Glycaemic Index foods - like breakfast cereal are going to push your BG way up in a short time so bolus early for these but don't be surprised if you get a big spike. 

Breakfast for me was always a pain when I had Cornflakes or Rice Krispies - I tried a lower GI cereal called "Lizis Granola" - on the shelves in Tesco - and things are a lot better for me now. I'm not putting it down solely to my change of cereal as I believe that my basals were not right, but every little helps (oops - not advertising Tesco again honest!).

Hope this helps and isn't too far off topic,

Alan


----------



## tracey w (Oct 19, 2010)

cant add to this good advice, but just wondering if you were told to bolus after food for some reason?


----------



## Cate (Oct 19, 2010)

Hi Cate - good name btw 

I assume you're on Novorapid?  Even though it starts acting really quickly, bolusing before your meal will definitely help.  How quickly after eating are you doing your bolus?  Immediately while you're still sitting at the table, or after clearing the table, washing up, whatever?  Can you get it any closer to when you're eating, if you can't do it before the food?  Are you testing before the meal, and your BS is OK then?

Sorry, that's mostly lots of questions, but hopefully give you something to think about


----------



## shiv (Oct 20, 2010)

Hi Cate, when I was on MDI I used to have the same problem (although admittedly would go quite as high - I'd usually hit 12 or 13) but now I am pumping I rarely go above 10 post meal. I would definitely agree with the others and give the insulin a 'head start' by injecting before you eat.


----------



## Catherine-louise (Jan 7, 2011)

It's just so frustrating. My basal rates are nowhere near what they should be and my blood sugars are all over the place but I don't feel like I'm getting nearly enough support  I could cry sometimes, I'm so frustrated. I daren't start messing with my basal rates myself in case I get it all wrong. I'm going on a DAFNE course soon - has anyone been on this and has it helped? Also, can anyone tell me how to check my insulin sensitivity? I'm using a medtronic minimed pump.
Cate.


----------



## Pumper_Sue (Jan 7, 2011)

Catherine-louise said:


> It's just so frustrating. My basal rates are nowhere near what they should be and my blood sugars are all over the place but I don't feel like I'm getting nearly enough support  I could cry sometimes, I'm so frustrated. I daren't start messing with my basal rates myself in case I get it all wrong. I'm going on a DAFNE course soon - has anyone been on this and has it helped? Also, can anyone tell me how to check my insulin sensitivity? I'm using a medtronic minimed pump.
> Cate.



Cate this is a link to basal testing http://www.diatribe.us/issues/13/learning-curve.php
Come on you can do the testing and change your basals.
Remember to make one small change at a time it could take a few weeks to sort it out but don't give up.
To test your insulin duration you need to have a correction dose and see how far it lowers your numbers and over what period.
But before you do this you do need to sort your basal otherwise everything else is pointless.
Not sure what insulin you are using but if it's apidra most people set the duration for 3 hours. The analogues from 4 to 4.5 hours.
This info can be found in your set up menu I suspect.
Hope that helps


----------

