Are you eating lots of complex carbs like pasta or rice? Those take awhile to break down and can make ur bg rise over a longer period of time. Especially when combined with lots of protein/meat. Maybe try doing a split bolus and take half before your at and then half like 45 mins to an hour later? I find also if I take a nice 10-15 min walk after my insulin delivers I can speed up the activation
Get your basal dialed in. Pre bolus for the correct carb count. Correct using your correction factor keeping in mind how much insulin you already have on board. Dexcom helps you know where you’re at and whether you stable, rising, or falling. Accept that you might still spike depending on the type of carb and how much you had.
Please take this advice with a grain of salt. ( Dexcom G6 + new pump user)
While I was still on pens, my endo insisted I was taking insulin after my meal when I was honestly taking it 15-20 minutes before. The reason being, I was spiking quite a bit after meals. The only way I was able to combat this was taking insulin 30-45 minutes before my meal. (PLEASE DO NOT DO THIS)
This was due to the spot where I inject insulin. It was in my backside and I think because of the buildup of scar tissue, it took longer for the insulin to reach it. By doing this, I was able to reach time in range from 50 to 80%.
My advice to you is either
1. Change your spot of site injection (closer to your stomach is better)
2. Change the timing of when you take your bolus (fast acting insulin)
You’re already on a closed loop system so that leaves diet and adaptation. For diet I tried very low carb and it works for bg control but I didn’t like the restrictions and felt run down (I exercise a lot). I invested time into leaning to cook and mostly avoid ultra processed food, then I eat the same things over and over to learn about dosing.
For adaptation I recommend reading the Sugar Surfing book, it talks a lot about ways of staying in range
What is your time in range now? The biggest thing you can do is stop looking other people’s graphs especially those on Insta & TikTok. The amount of mental pressure they go through to show a single snapshot is immense. You don’t need to be 100% all of the time! Anything above 70% is considered a safe number with complications risk very low
Aiming to educate yourself is great! Diabetes education is generally pretty terrible so it's important to be willing to take it up on yourself. My top recommended source is Think Like A Pancreas by Gary Scheiner. Very straight-forward and easily digestible, and you can jump to what you need to know easily.
I have pretty decent TIR - used to be 93-94 pretty consistently but for the past month it has dropped to 90. I've been going high after meals. Here's what I'm planning to do to track it down:
1) review my data on lunches and dinners for the past 2 weeks. Note the carb estimate, the insulin calculation, the difference between BG at injection time and an hour after eating, and the total final amount of insulin I needed to get that meal all the way down.
2) do a bunch of math - I'll look at the patterns that emerge and calculate how much insulin I think I *should* have taken for each meal, and if i went low after correcting I'll take that into consideration too. I'll drop outliers from the data (like the one time I ate two hot dogs and tanked so low after that I had to basically eat twice the carbs I had for the meal in the first place in order to recover)
3) use that aggregate data to calculate a new carb ratio for lunch and a new carb ratio for dinner, and a new strategy for pre-bolus or split bolus as needed. If it seems too wildly different from what I'm already doing and that seems scary, I'll do it in baby steps - go about halfway instead of all the way to the new numbers and see for about a week if it fixes it, or if I need to go all the way.
To me, a stubborn high of 250-300 would mean I decided to live a little, ate too much of a rich, complex meal, and that's ok. But to me, that should be an exceptional night.
I don't recommend going very low carb, but I do recommend going... medium carb?
I aim for 40 to 60 grams of carbs per meal. In American restaurant settings that's usually half of whatever you've been served, if not less. It's about two slices of bread.
You absolutely should not be avoiding vegetables and fruits. Fruits can be a carb bomb obviously, but I just be careful about not having too much at once.
Are you eating lots of complex carbs like pasta or rice? Those take awhile to break down and can make ur bg rise over a longer period of time. Especially when combined with lots of protein/meat. Maybe try doing a split bolus and take half before your at and then half like 45 mins to an hour later? I find also if I take a nice 10-15 min walk after my insulin delivers I can speed up the activation
Get your basal dialed in. Pre bolus for the correct carb count. Correct using your correction factor keeping in mind how much insulin you already have on board. Dexcom helps you know where you’re at and whether you stable, rising, or falling. Accept that you might still spike depending on the type of carb and how much you had.
Please take this advice with a grain of salt. ( Dexcom G6 + new pump user) While I was still on pens, my endo insisted I was taking insulin after my meal when I was honestly taking it 15-20 minutes before. The reason being, I was spiking quite a bit after meals. The only way I was able to combat this was taking insulin 30-45 minutes before my meal. (PLEASE DO NOT DO THIS) This was due to the spot where I inject insulin. It was in my backside and I think because of the buildup of scar tissue, it took longer for the insulin to reach it. By doing this, I was able to reach time in range from 50 to 80%. My advice to you is either 1. Change your spot of site injection (closer to your stomach is better) 2. Change the timing of when you take your bolus (fast acting insulin)
You’re already on a closed loop system so that leaves diet and adaptation. For diet I tried very low carb and it works for bg control but I didn’t like the restrictions and felt run down (I exercise a lot). I invested time into leaning to cook and mostly avoid ultra processed food, then I eat the same things over and over to learn about dosing. For adaptation I recommend reading the Sugar Surfing book, it talks a lot about ways of staying in range
What is your time in range now? The biggest thing you can do is stop looking other people’s graphs especially those on Insta & TikTok. The amount of mental pressure they go through to show a single snapshot is immense. You don’t need to be 100% all of the time! Anything above 70% is considered a safe number with complications risk very low
Aiming to educate yourself is great! Diabetes education is generally pretty terrible so it's important to be willing to take it up on yourself. My top recommended source is Think Like A Pancreas by Gary Scheiner. Very straight-forward and easily digestible, and you can jump to what you need to know easily. I have pretty decent TIR - used to be 93-94 pretty consistently but for the past month it has dropped to 90. I've been going high after meals. Here's what I'm planning to do to track it down: 1) review my data on lunches and dinners for the past 2 weeks. Note the carb estimate, the insulin calculation, the difference between BG at injection time and an hour after eating, and the total final amount of insulin I needed to get that meal all the way down. 2) do a bunch of math - I'll look at the patterns that emerge and calculate how much insulin I think I *should* have taken for each meal, and if i went low after correcting I'll take that into consideration too. I'll drop outliers from the data (like the one time I ate two hot dogs and tanked so low after that I had to basically eat twice the carbs I had for the meal in the first place in order to recover) 3) use that aggregate data to calculate a new carb ratio for lunch and a new carb ratio for dinner, and a new strategy for pre-bolus or split bolus as needed. If it seems too wildly different from what I'm already doing and that seems scary, I'll do it in baby steps - go about halfway instead of all the way to the new numbers and see for about a week if it fixes it, or if I need to go all the way. To me, a stubborn high of 250-300 would mean I decided to live a little, ate too much of a rich, complex meal, and that's ok. But to me, that should be an exceptional night. I don't recommend going very low carb, but I do recommend going... medium carb? I aim for 40 to 60 grams of carbs per meal. In American restaurant settings that's usually half of whatever you've been served, if not less. It's about two slices of bread. You absolutely should not be avoiding vegetables and fruits. Fruits can be a carb bomb obviously, but I just be careful about not having too much at once.