I have a few questions for anyone who has any insight, it would be greatly appreciated!
I had a question about I:C ratios and whether or not I should adjust. So recently my Dr. changed my target to 120. I am on the omnipod 5 pump and I use the G6. A week went by and my fasting BG went from 140 to 80-90 (I dont have a spike in the morning so I stay steady before I eat and the most I usually rise before eating is about 140-150. I noticed I wasn’t hitting my new target (120) I would always go below my target (on auto mode before and after meals). I got a little frustrated because being less than 100 for me just makes me feel lightheaded all day, especially in the morning.
So my dr. mentioned that I keep going below my target in the morning and after meals because my body & the pump has to adjust from always being higher. She says it will level out to 120 but I have yet to see this happen and I keep dropping below the target.
Has anyone ever experienced this? Should I increase my target to 130 I just feel like this is going to lead to me being on a rollercoaster and it’s so draining to constantly have to drink OJ to get back to 130 or even 150.
I don’t understand why I’m still dropping 1 hr later. My I:C ratio is already 1:15 for lunch and 1:18 for dinner. (which I think is a loose ratio but I have increased it to 18 because of how soon I am coming back down) I started my BG for dinner at 170 (I know that’s a little high) 1 hour later I was 198 and I still had 1.8 units of insulin on board. I had an arrow trending down (not straight down) and it was dropping by 20-30 points) so I took some OJ. I was afraid I was going to drop and of course, I overcorrected and then I went high… Should I have waited it out? I am just so afraid of lows but I really dont want to get on a rollercoaster chasing my numbers.
Thanks, everyone in advance
I had a similar issue a while back. I was running higher than I wanted and my trainer* recommended I lower the low end of my target. But lowering your target to say 120 does not guarantee that’s where you will always land, so I had to raise it to hit my goal.
Hope that wasn’t too confusing - sorry - but I think the take-away is, once you adjust your goal number, you may still need to tweak it to hit the target you’re aiming for… “They” say to allow 3 days minimum for your body to adjust to changes. Since you’ve already allowed plenty of time you may want to consider raising the lower number a bit. Some people are comfortable making adjustments on their own but if you’re not, by all means discuss with your doctor. Something midway between 120 and your previous target might be a good place to start.
- I was my endo’s first patient on the Omnipod 5 and she had not yet gotten training, so I was working with my trainer regarding adjustments.
Kayla @KayD, you have many questions and I won’t attempt to directly respond with my suggestions but, rather in a round-about manner.
Your first question, ‘should I adjust I:C ratio’ very definitely yes you should BUT ONLY IF YOU KNOW WHAT YOU ARE DOING, and only if other settings - such as basal rates, insulin duration setting, and insulin sensitivity - are properly set first. (BTW, to me, it sounds as if your doctor knows diabetes well.) Most probably you will need to disable auto-mode to properly adjust basal rates; and ISF too strong is a major cause of “lows” in auto-mode. avoid overbasalization - a word that first appeared a few editions ago in the ADA Professional Guide as a major cause of Emergency hypoglycemia.
Target? Target for what? Meal target of 120, or daily target of 120 which would reward you with a 90-day 6.0% laboratory HbA1c? If you mean meal target, a "heavy ISF which is used to calculate the correction part [three parts to the basic formula] of your meal bolus would be excessive and lead to being lower than expected too soon after eating. If you are using Rapid-Acting [mot Fast-Acting or Ultra-Rapid-Acting] insulin such as Humalog or Novolog in your pump, you should expect that your BGL returns to your pre-meal target 4-5 hours after the bolus - this is the ultimate, yet elusive, goal.
yea i pretty much tweak as my body changes so i know how to safely adjust. & yea my doc i would say is educated when it comes to knowing about diabetes and pumps etc. but sometimes she pushes for perfect numbers and that’s what causes me to spiral. Right now my ISF is 1u will drop my BG 100 pts. but you said it! i think its most times overbasalization b/c even when i see my numbers trending down i still get insulin every 5 minutes (which my nurse doesnt agree with she thinks I should go on the tandem) With Omnipod 5 there is no way to stop the micro boluses unless you are in manual and they didn’t set my basal rates up b/c they want me in auto mode 98% of the time. (which i dont follow 100% because thats not realistic or safe)
target they want me 120 so ANY time my bg reads more than that the pump will correct me with a micro bolus OR when i go to give myself a meal. I dont see how this makes sense this seems a bit aggressive. 1 hr post meal i tend to see a drop not significant im talking 4-6 pts every 5 minutes with little under 2 units on board. but then i eventually need 15g of carbs to prevent a low. Im waiting for my dr to call me back to tell her i will be adjusting my settings. My IOB is currently set to 3 hrs but i mentioned in aother discussion I am considering going up to 4 or 4.5 hrs. How do i get the pump to ease up (back off!) I want to be able to trust it b/c ive seen what it can do it is a great pump…but not at this rate lol
yea im going to try 130 i was at 140 when i first started and that kept me too high so im hoping this works thanks!!
I’m sure your doctor means we’ll but perfect numbers are not realistic. And if your quest for perfection causes you to go low then she needs to understand that’s a problem.
I was diagnosed in 1963. Asi recall tight control “became a thing” sometime after I got out of college (@Dennis ?). and there were incidences of people being hospitalized with hypos who had been able to manage lows at home on their own before. If your doctor’s target is uncomfortable or dangerous for you, it’s your right to tell your doctor you want to set it higher. I don’t think you mentioned anything about highs in general or how far your rise after meals, but in my purely personal, non-medicalb opinion the numbers you did share look like they allow for some leeway.
Kayla @KayD, you said the most important word, SAFE - yes your safety comes first and overrules all else.
You hit on something I only mentioned in passing - setting for insulin duration; the duration setting in my thinking is very important in the almost continuous micro-bolus devices. When insulin duration is set for three hours, the pump when determining if a micro is necessary will believe that there isn’t any insulin available when there actually could be a significant amount available and working; s good starting point for insulin duration could be 5 hours - and then work back as need is proven. Keep in mind too, that each squirt of a basal may remain effective for 5 hours.
I’m now in my 6th year with Tandem t-Slim and find it works very well for me having used the CIQ since it was released.
@Dennis @wadawabbit I am going to just take it slow and adjust as needed. I feel like my body has changed ever since I had a baby I’m sensitive to insulin most days and there are times when I dont even bolus and my blood sugar stays steady highest it would go is 190 after meals without any bolus then it will come back down. Like today I had eggs and french fries (17g for the fries) now I’m already 1:18 at night so I entered in the carbs and I saw 0.8u & i made the decision not to bolus. My starting bg was 183 i still had about 0.9 IOB and pump was still correcting me b/c it showed i was in the 200s on dexcom. So i didnt bolus. 1 hr later i am 173. dexcom shows im 210 and its still correcting me trying to bring me to my target. I hope this makes sense. I am most sensitive to insulin like many others at night and most resistant in the morning. i made the decision to bring my I:C ratio from 15 to 18 maybe 2-3 weeks ago because i was still dropping after meals. Dexcom always reads about 20 pts higher most times but i was struggling with highs a few months ago. Since i’ve been off birth control i don’t need nearly as much insulin as I used to. My a1c is much higher because of this so i am curious to see what my a1c will be in three months time. Im sure i am going to see a drop with the lows ive been having. (i wont say my a1c ) but its up there right now im a work in progress.
Another option would be to turn off auto mode, which would stop the micro-corrections. Of course you may need to adjust your basal rates. From time to time I’ve been kicked out of auto mode and switched to manual, forgotten to turn it off - and done quite well!
Have you considered the ilet pump? It’s very new At least in the US market. One Forum member is on it and loves it.
@wadawabbit i was speaking to a rep about it, its tubed so im thinking about it! & by kicked out you mean insulin delivery reached its max?
Yes. Or doesn’t happen but occasionally I get a high and the maximum delivery isn’t enough to bring it down so I get an alert and have to switch to manual.
I am not a fan of ANY doctor making a decision for me. They help me get what I want within the guidelines. Does you doctor know that you feel lightheaded and why would they make that decision if he or she knew. If they did and knew what it did to you, find a new one. They work for you! Your numbers are good so don’t worry about that and likely the more your target is at 100, the less you will feel lightheaded. Your body is reacting because it’s not used to what your doctor decided. This is me and some get upset with my views but I don’t ever ask a doctor what to do. Mine rarely makes any suggestions because she knows I run the show and know how to make my own adjustments. She asks ME if I think X move would work better. I have been using a Medtronic pump and sensor for 35 years. I am 67 with zero diabetes complications so I know what I am doing. Again that is me. I wish you continued good luck. Many diabetics would love your predicament! You are succeeding!