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High despite insulin onboard
- Thread starter jessd1
- Start date
SB2015
Well-Known Member
- Relationship to Diabetes
- Type 1
Sorry to have missed this @jessd1
From reading through the info in simplistic terms you need more insulin to avoid the highs. As you are looping with the 780, setting up different profiles won’t make any difference (although these are useful for the times when you have to switch back to manual and I have been caught out for not altering these to reflect the changing insulin needs that I now have - Thanks for the prompt to check mine)
Before any other suggestions have you switched to another vial of insulin? I got caught out and it took me two days of horrible highs before I cottoned on to the fact that having changed sensor, set ,sites and nothing working it was my insulin. Switched to a new vial and hey presto back in range.
Basal
As there are times when you are going high whilst just looking at your cuppa and having not eaten I would want to be looking at making my basal more active. If you shorten the ‘action time’ of your insulin (this is not the same as the duration of the insulin in any other context) the algorithm will give more corrections as it will think that the insulin has runout sooner.
I do find that once I am high the corrections are less effective (as is the case in manual). I will now switch to manual if I am very high and get the levels down before going back into Smartguard. So for me to avoid this it is working out what is making me go high in the first place in order to avoid this.
Corrections to boluses and autocorrections
Any corrections will be based on your sensitivity factors. Have you reviewed these recently? If you are having too many highs these may need to be made stronger
Bolus
You have already mentioned that you pre-bolus so that is not the issue. You are confident with your carb counting. Perhaps it is the insulin/carb ratios that need to be reviewed.
Sensor updating
When you get sensor updating message the pump switches to a set basal dose to keep you ticking over during the issue and then sorts things out once it get back into Smartguard with more corrections (or irritatingly tells you to change you sensor….)
Sorry if you know all this already @jessd1 and have already gone through all of these. I know that I have found it useful to have a list of these. When things start to go awry I can then focus on the list and work through things step by step. My list came from gathering info on here.
Let us know how you get on. (now watching this thread so will pick up more quickly)
From reading through the info in simplistic terms you need more insulin to avoid the highs. As you are looping with the 780, setting up different profiles won’t make any difference (although these are useful for the times when you have to switch back to manual and I have been caught out for not altering these to reflect the changing insulin needs that I now have - Thanks for the prompt to check mine)
Before any other suggestions have you switched to another vial of insulin? I got caught out and it took me two days of horrible highs before I cottoned on to the fact that having changed sensor, set ,sites and nothing working it was my insulin. Switched to a new vial and hey presto back in range.
Basal
As there are times when you are going high whilst just looking at your cuppa and having not eaten I would want to be looking at making my basal more active. If you shorten the ‘action time’ of your insulin (this is not the same as the duration of the insulin in any other context) the algorithm will give more corrections as it will think that the insulin has runout sooner.
I do find that once I am high the corrections are less effective (as is the case in manual). I will now switch to manual if I am very high and get the levels down before going back into Smartguard. So for me to avoid this it is working out what is making me go high in the first place in order to avoid this.
Corrections to boluses and autocorrections
Any corrections will be based on your sensitivity factors. Have you reviewed these recently? If you are having too many highs these may need to be made stronger
Bolus
You have already mentioned that you pre-bolus so that is not the issue. You are confident with your carb counting. Perhaps it is the insulin/carb ratios that need to be reviewed.
Sensor updating
When you get sensor updating message the pump switches to a set basal dose to keep you ticking over during the issue and then sorts things out once it get back into Smartguard with more corrections (or irritatingly tells you to change you sensor….)
Sorry if you know all this already @jessd1 and have already gone through all of these. I know that I have found it useful to have a list of these. When things start to go awry I can then focus on the list and work through things step by step. My list came from gathering info on here.
Let us know how you get on. (now watching this thread so will pick up more quickly)
OMG Why is this proving such a nightmare
Still no reply from my nurse
Today hasn’t been too bad but now this afternoon really caught me out
Had lunch, knew the carbs - bonuses within an hour I’m double figure, saw my number were 9 & rising so took the dogs for a good walk, got back they were 11.4, gave insulin for a cuppa, sat down for 20 mins now I’ve got this honestly this is going my sodding head in
I don’t know what to do
Checked my cancels all fine, no air gaps
Number shad been fine before lunch
I’m meant to be going to the gym in an hour for a leg session then out tonight
So frustrating -
Attachments
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
So the pump is telling me I’m 18.9 offering me no corrections
Just done a bm & 20.2
I am sick of this!!!!
Attachments
Why is it offering me no corrections???
Hi
Please can you explain a bit more -
do find that once I am high the corrections are less effective (as is the case in manual). I will now switch to manual if I am very high and get the levels down before going back into Smartguard. So for me to avoid this it is working out what is making me go high in the first place in order to avoid this.
How do I shorten the action time?
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
I offer no advice, only what I’d do for myself, but in that situation I’d be calculating a correction and giving it by pen.I’d also switch the loop off for a few hours if I was worried it would also try to correct the high itself.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Is it here @jessd1 ?
Adjusting Active Insulin Time - MiniMed™ 780G System Support | Medtronic
Learn how to adjust active insulin time on the MiniMed 780G insulin pump.
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Cannula currently in my leg
Thank you, I will take a look, the pump is saying this- offering no correctionIs it here @jessd1 ?
Adjusting Active Insulin Time - MiniMed™ 780G System Support | Medtronic
Learn how to adjust active insulin time on the MiniMed 780G insulin pump.www.medtronicdiabetes.com
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I’m going to change insulin & site
I wish my nurse would get back to me
She has always advised me coming out of smartguard?? I don’t know what to do for the best to be perfectly honest
Haven’t gone to the gym- drinking lots
Attachments
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Changing insulin and site is sensible. Personally I’d focus on ensuring the insulin and cannula was ok and my basal insulin was getting in. I might also put an increased temp basal for an hour or two, but I’d be cautious as it’s the evening. I’d then correct by pen until my blood sugar came down.
You should do what’s best for you and what you decide to do. The above is just what I’d do and not advice.
You should do what’s best for you and what you decide to do. The above is just what I’d do and not advice.
Thank you
As mentioned my nurse always advised to stay in smartguard mode
She tells me you’ve got to trust the pump & let it do the work don’t interfere
Obviously something is NOT right currently
I’m tired of these HIGHS & how they make me feel
Today all I have had is breakfast - overnight oats/pumpkin seeds with berries
Lunch chicken & avocado roll
Lots of water & 3 cups of tea
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Your nurse isn’t you. Unless it’s dangerous to come out of Smartguard, I’d consider it if it were me. I know I could do a better job. Anyway, there must be a point (even for the nurse) that a person should revert to manual, eg if they were close to DKA.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
As I said, this is what I’d do - ignore the pump and use my own judgement. I trust my own brain more than the pump.
SB2015
Well-Known Member
- Relationship to Diabetes
- Type 1
Hi Jess
The bottom line is that as your levels are high you are not getting enough insulin. From what you have written so far I suspect that this is the carb ratios and sensitivity factors that are the issues, as well as you action time. It doses not sound as if you are confident to check and change things yourself and I would suggest that you phone your DSn and ask for an urgent appointment.
It is important to let the loop do its job but this will not be working well when your levels are so high. I was given a flow chart to follow with high BG. See photo. If you develop ketones then there is a different chart. When you are in manual you will be responsible for doing the corrections yourself. Were you given a flow chart to follow to do this. The pump won’t make suggestions as it is in manual. It will keep account of what insulin you put in and carbs you eat so will know what insulin you have still working.
Carbs and meals
You mention that you have oats for breakfast. I was surprised at the impact of those on my BG and they made me spike after each time I ate them. Have you tried a different breakfast?
How many carbs are you eating at each of your meals.
When I was using a pump in manual I found that if I ate larger meals (for me >30g of carbs ) my insulin didn’t work as well and I needed more insulin. That is still the same for me even though I am looping, so I tend to stick to around 30g of carbs. It is a case of finding what will work for you.
At this stage it feels like you need some support from your team to help you make alterations to your settings and understand what these are doing. It is a case of trial and improvement and working on things step by step. I found the switch to looping very difficult at the start, but now would not go back.
Attachments
SB2015
Well-Known Member
- Relationship to Diabetes
- Type 1
Also Jess, if you are in manual mode the pump won’t make suggestions about corrections. That will be up to you to decide what corrections you need. In manual mode the pump will give alarms when high or low and keep track of insulin that you have given. This also tracks how much you have given and is still active. @everydayupsanddowns has used the Medtronic in manual for a while before he looped so he will be able to tell you more. I switched to this when I started looping so only use it in manual briefly when Smartguard has a strop.
I was given a chart for high BG advising on how to calculate these corrections . I have attached the one for looping above which is similar.
What advice have you been given?
What did you do on pens when you needed to correct?
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
Sorry you are having such a rough time @jessd1
Those kind of high levels (above 12ish) are usually a signal of insulin not being delivered/absorbed for me. I had 2 sites fail over the BH weekend just gone, and they were pretty easy to spot.
So change site, and if that doesn’t work try a fresh vial of insulin?
The correction not being offered is probably down to the insulin on board - with the pump calculating how much potential BG reduction you could get with the insulin you’ve already delivered.
For my failed sites, I corrected with a syringe because the insulin my pump *thought* had been delivered wasn’t getting absorbed, so its calculations were all out of whack.
A few things you can check:
What is your insulin sensitivity set at?
Settings > Delivery Settings > Bolus Wizard Setup
And for manual mode, what is your BG Target set at? (On the same screen)
Plus check your Active Insulin Time. Insulins like NovoRapid are generally active for 4-5 hours, but setting this artificially short, like 3 hours or less, can “allow” the bolus calculator / smartguard to act sooner.
Are these very high levels out of the ordinary for you? Or are they happening a lot of the time? It may be that all your settings (eg Smartguard target, carb ratios, and manual mode basal) may all need adjusting?
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Are you using Fiasp in your pump?
I find with Fiasp that if my levels go high (above 10) I need double in the correction factor I would normally use and if I ever got as high as 20, I dread to think how much Fiasp I would need to get me back down.
Other people find that their normal correction factor works with Fiasp but takes a lot longer to work when they are very high. I wonder if the pump algorithm can't cope with your reaction to Fiasp at high levels, if that is what you are using.
I am however not on a pump myself and only know about them from comments I have read on this forum. I do use Fiasp though and once my levels get above 10 I usually have to stack corrections to get it down which I know is very much frowned upon and I am not sure a pump would allow you to do that, so it may be you need to think about trying a different insulin in your pump if you currently use Fiasp.
I find with Fiasp that if my levels go high (above 10) I need double in the correction factor I would normally use and if I ever got as high as 20, I dread to think how much Fiasp I would need to get me back down.
Other people find that their normal correction factor works with Fiasp but takes a lot longer to work when they are very high. I wonder if the pump algorithm can't cope with your reaction to Fiasp at high levels, if that is what you are using.
I am however not on a pump myself and only know about them from comments I have read on this forum. I do use Fiasp though and once my levels get above 10 I usually have to stack corrections to get it down which I know is very much frowned upon and I am not sure a pump would allow you to do that, so it may be you need to think about trying a different insulin in your pump if you currently use Fiasp.