Anyone have high days that won't come down?

I do a variant on this, something like a carb equivalent of 1 gramme for every 4 of protein. My wife got the number from Bernstein’s book but the way we use it is guesswork; who knows what’s in a beef burger? With the Omnipod the extended bolus is a bit clunky and there is only one, so handling carbs which go in almost instantly, protein over a few hours and fat over maybe 8 hours is pretty difficult.

At present I deal with this by ignoring the issue during the day; I don’t get much fat at home and US restaurant meals are primarily carbs with a little protein. At night I run a temporary basal as required for 12 hours, at double or triple my daily basal depending primarily on how much fat I ate. When I get that right I can maintain a bg around 150-200 but I will have to wake up at one or more points to tweak the basal rate (I need to start looping!)

It is possible that two separate metabolic processes are acting here; gluconeogenesis as I mentioned before along with ketogenesis. The latter kicks in when the energy source is almost all fat, the well known “cheese” diet advocated by Wallace.

I don’t know a way to detect gluconeogenesis however ketogenesis is detectable using ketone test strips so long as our blood sugar is below 250mg/dl. I will try to remember next time I’m stuck at 200 to do a ketone test.

Extended bolus works. I just don’t want to calculate that closely!

I had a 200+ in the morning a couple weeks ago. 3 units fast-acting and a 1 mile walk dropped me FAST. A little insulin and even something as easy as a leisurely walk is the knock-out punch I use to get myself in a better range.

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