I now use very large temp basals for my peaks, along with moderate boluses, rather than just boluses. It works much better for me.
For the past year and a half I have had many hormone peaks. In the past, as I followed my endo’s instructions, I used only bolus insulin to deal with them. My CF (insulin correction factor) did not apply to my peaks: I had to use gobs of insulin. I would stack every hour or hour and a quarter, sometimes 4 times on a row, to come down. I could use 3/4 of my TDD to come down from one peak. After my peak, I would often get into deep lows, for 2 hours or more, that would require huge amounts of carbs, sometimes up to 80 carbs. Life was frustrating, and sometimes frightening.
In my family, we are a lot into experimenting, though. Since I get so many peaks, they affect my life a lot. So I have focused on finding a better way to deal with peaks. I am now able to deal with most of my peaks more comfortably, and with much less of a risk for lows.
Because my hormone peaks don’t respond to a single bolus, I figured that hormones were remaining elevated for several hours: they must not be a one-shot deal. So I decided to start using temp boluses. First I tested several levels up to 50%. I found that it was harder to recover from basals above +35%. So I decided to use +35% temp boluses. So, in a first step, I started using a +35% temp bolus, 12 hours long (to cancel once I was coming down), added to boluses.
Then I realized that, often, a certain amount of bolus insulin will take me back down, but just in more time: if my CF is 1:30, for instance, if I use 1:25 for my peak bolus CF in addition to a high temp basal, I will still come down without stacking, but it will take me a lot longer: most of my bolus insulin seems to take more than 2 hours to really activate when I am in a big hormone peak. So then I have to make a decision if I am willing to come down faster but deal with a low by stacking. Normally, even with stacking, if I stack fast, I don’t come back much faster but I have much deeper lows.
But, after more time (about 3 hours) I do need to stack—but I must remember that I still have a good amount of IOB from my previous bolus. This is where it’s really important to know what your DIA is (duration of insulin action). My DIA is 5.5 hours (or more for big boluses), even though I don’t see much effect after a normal meal bolus after 2.5 hours.
I know this sounds complicated. But the conclusion is not so hard. I use a slighly higher CF for my hormone peaks, but I combine that with high basal. Then, I stack past 2.5 or 3 hours, but I keep in mind my IOB from my first injections. It works well: I come back from my lows, although a bit slowly, and I don’t have deep, long lows.
Then I decided to try to accelerate how long it took me to come down. Now, I increase my temp basal when I go higher. When I pass 120 on a peak, I switch to +35% temp basal. When I hit 200, I go to +50%. If I hit 275, I go to +80%. On the way down it’s the same. When I come down to 250 I take my temp basal down to +50%. When I reach 200-175 (depending on slope) I cancel all temp basal. I also use suspends but I will discuss that in another thread.
Finally, I also use a trick. I move meal times a bit to help with taking a peak down. If I am reaching 200 and I am, say, 2 hours from a meal, I will also add a 60 carb meal injection, and that will really help me come down fast.
So, here is an example. Say I start peaking. As I go through 120 (or lower if I notice it), I switch to +35% and inject a 2 unit bolus by pen (always better than by pump). 15 minutes later, I am at 150: I inject 1 more. 10 minutes later, I am at 180 and going up fast: I inject 1.5 more, and turn my temp basal to +50. Next time I look at my phone, I am at 250, and I notice I am slowing down. I inject 3 more, and now I wait. I peak around 270, then start coming back down a bit, then it looks like it is inflecting up. I switch to +80%, and decide to inject early for dinner. I also look at my old injections: they were more than 2.5 hours ago, so I add 1/2 of what I need to come down as if I had no IOB, that’s 1/2 of about 8, say 4 (the rest I assume is IOB), plus 5 units of dinner is 9, that I inject in 2 pen injections to make them more efficient.
45 minutes later, I have peaked above 300, but now I am coming down. As I pass 250 on the way down, I go to +50% basal. Not 15 minutes later, I am at 180: I am coming down fast, so I cancel all temp basal and suspend. When I get to 150, I eat dinner a bit early. I hit a slight low, take a large clem (that’s 14 carbs), then a glass of milk for another 9 carbs. I can see myself coming back up, I cancel my suspend, and I am good. Except that I wasted 5 hours on a high and couldn’t work on my paper Still, it’s much better than it used to be!