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.
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.
Absolutely!!! I do every now and then. There are days when I do everything I can to get it go down some, but it won’t. I’ll check it with blood just to make sure it’s really that high then take another bolus. I don’t know what to do???
I recently filled a prescription for inhaled Afrezza that seems to be pretty effective for knocking down stubborn highs pretty quickly. The unit conversions are confusing, though; I haven’t quite figured them out and need to spend a little time on that, plus figuring out whether there is a “rebound” off of the Afrezza. It’s interesting, though, and seems to be nice for a ragey bolus. (I also agree with a high speed walk or bike)
It’s easier to think of them as small, medium, large instead of as units.
Try a 4. If it was not enough, next time try an 8.
I am not sure if they are still doing the 4, 8, and 12 unit cartridges, but that struck me as being dumb. The only doses you can get are all multiples of 4. Like 4, 8, 12, 16, 20…
If they instead had 4 and 6 unit cartridges, you could 4, 6, 8, 10, 12, 14, 16, 18, etc…
I used to do that then I read somewhere that you shouldn’t exercise while suffering from hyperglycaemia, so I stopped and went down the super-bolus route. In the limit, when my pump has been defective for a while and I don’t notice, I’ve done @Eric’s intra-musculature approach. I don’t know it helps but it was satisfying. That was for extremes, not sticky highs.
I consider a sticky high something different. I just don’t get them since I’ve started using a hybrid-closed-loop system. I certainly go high; using a different system doesn’t stop me from doing stuff I shouldn’t What is different is that that system has a sort-of accurate model of the insulin and food in my system and works out an appropriate dose. It takes a while; hours for sure, but it does work in the end (unless I pig out again meanwhile.)
I do also extra-bolus; I do a unit in the morning (not every day) because my hormonal variation over night seems to benefit from it (I’m male) I sometimes do an extra unit at other times. I do this through the system, not by side-injecting insulin, so the system knows what I’ve done but I’ve preempted it so it has to recover; look, whose body is this?
The last sticky high I had was a doozy, and probably the worst I’ve had for years.
My pod had become dislodged or loosened in late afternoon exercise, my BG was rising but not too bad after dinner and actually started trending downward in late evening as my head hit the pillow. Leading me to believe that the pod was OK…and I dealt with BG over 300 from about 11PM until the wee hours, using syringe injections to correct.
BG over 300 for about 6 hours overnight while the Omnipod 5 spilled insulin all over my outside but not inside me. It prompted me to obtain a prescription for Afrezza which I now use for correction bolus. So far, when using for an evening correction bolus with IOB from a meal, I will use a 4 or 8 unit correction depending on trend and wait about an hour to see if another 4 units is needed.
What is different is that that system has a sort-of accurate model of the insulin and food in my system and works out an appropriate dose. It takes a while; hours for sure, but it does work in the end (unless I pig out again meanwhile.)