What to adjust when bs soars between 2-3 hours after a meal

BrendaK · #1 07-04-2008, 11:27 AM

There may be an obvious answer to this question, but this has been happening a lot with Carson lately. His numbers are pretty good 2 hours after a meal, but then they will go up 80-100 points by the 3 hour mark.

Is this a basal issue, or is it a bolus issue? I can't tell if he needs more basal, or if his food is still digesting and he needs more of a bolus. He's been eating bigger meals, but not super high fat or anything.

Any suggestions? Normally he drops between the 2-3 hour mark so we hardly ever deal with this issue.

BTW, we do prebolus most meals.

twodoor2 · #2 07-04-2008, 11:34 AM

That sounds like a typical textbook basal issue. If it was the bolus, he would be coming down steadily until the next bolus, even if he were not in range. When you have a drop for the first two hours, and then a typical rise thereafter, it's either a fat spike or a basal issue. You've ruled out the fat, so I'm voting basal.

wilf · #3 07-04-2008, 11:49 AM

I second the basal vote. Since you're pumping, no problem to try increasing basal after the meal and see if it helps.

BrendaK · #4 07-04-2008, 11:53 AM

Yes, I was thinking basal, too. I feel like Carson is just one step ahead of me. I keep raising all of his rates, and he still keeps needing more and more insulin. A month ago he was around 15-16 units TDD. Now he is at 20 units and needing a lot more. I just can't keep up!!!!

LJS118 · #5 07-04-2008, 12:40 PM

another vote for basals

Jacob'sDad · #6 07-04-2008, 02:48 PM

I think I have to go against the flow here. If he is fine at two hours and then goes up 90 points in one hour then he would have to be VERY short on basal for that to happen from basal alone.
I started a thread about how similar a basal shortage is to a bolus shortage of the same amount. The popular opinion there seemed to be that it all came down to absorption and if absorption were the same then the affect of the shortage would be about the same.
So basically he would have to be short enough basal in 1 hour to cause a 90 point climb. I don't know what his ISF is but let's say it's 90. He would have to be short a full unit of basal in that hour to cause a 90 point climb. I doubt if he's off that far.
I think it could be a bolus issue or a combination of basal and bolus, but not just basal.

Jacob has very slow digestion at lunch and dinner. Even without high fat his insulin can hit him before the food causing his BG to drop and then rise. If I prebolused by 1/2 hour at lunch or dinner I will guarantee you he would drop low because the insulin would hit him first. I think it's worse in the summer too, with the extra activity causing the insulin to absorb faster.
So here's a possible scenario: Let's say that Carson is experiencing slow digestion and his bolus is too low. Well, he might have enough bolus to keep him from dropping low but then when the food digests there's not enough bolus left to prevent the spike. If you gave him more of a bolus he might go low first before he comes back up.
How far ahead of the meal are you prebolusing? You might want to try giving the bolus right when he starts to eat or even giving an extended bolus. You could also try lowering his carb ratio, but not prebolusing and possibly raising his basal rate too.

Now, this is all just my opinion and I reserve the right to be completely wrong.

Abby-Dabby-Doo · #7 07-04-2008, 03:13 PM

My opinion depends. If it's evey meal, it very well could be basals. If it's a high fatty meal, I would think about a dual wave and have some of the insulin be given over 1 to 2 hours. Example would be a 80/20 dual wave over an hour. That 20% would be given later and still be working just a smidge at the 3 and 4 hour mark.

Adinsmom · #8 07-05-2008, 04:55 PM

What happens if you don't pre bolus?

Twinklet · #9 07-05-2008, 06:29 PM

I'd try to combo bolus his meals for a day and see if digestion is the issue.

Flutterby · #10 07-05-2008, 06:47 PM

is it always the same meal? if its happening at all meals, and you don't do an extended wave bolus, that may be what he needs.. I couldn't see a basal needing to be adjusted 2-3hours after ALL meals.. if its always breakfast, or lunch, or dinner, then I'd be inclined to go for a basal problem.. my instinct would be to look at the bolus, and if you use extended boluses..

If you use extended boluses already, then I'd have to rethink it