I’ve been pumping for about 4 years and two years ago added a CGM - I love it and the ability to see and fine tune my therapy has made an a1c under 6 a reality.
The strange thing is the wide difference in my basal rates. My current daytime basal rate (consistent from 6am to 9pm) is .6, I drop to .35 at 9pm and .25 at midnight and still wake frequently with overnight lows, I tend to go to bed around 110-120 and wake up around 70.
Does anyone else have such a wide difference in their daytime and overnight basals? I’m very active during the day and eat very low carb (less than 50 grams per day). I know that I’m physically inactive overnight so that could be what’s driving the difference, but am wondering if I’m under-bolusing and over-basaling during the day? I did fast to figure out my basal rates and could go through the fasting schedule again to make sure.
I have a bit of the same issue. Prior to starting back on the pump this past year, I had horrible issues with dawn phenomenon. I was bottoming out in the middle of the night and waking up near 300 almost every day. It was horrible and made me feel like crap most of the time.
Anyway, right now, my basal rates are about the same as yours, and I’m considered to be fairly insulin sensitive. I will generally not go to sleep until my BG is around 130…and I still have some wicked middle-of-the-night lows. Waking up, I can be anywhere from 60 to 130.
I consider myself an active person - I sometimes work out twice a day and engage in some pretty serious physical activity when I do. I have found that these intense workouts definitely contribute to my lows. If I have a day when I work out fairly heavily, I am almost certain to go low at night.
Have you considered programming your pump to stop delivering insulin for a short period of time overnight (i.e., a 0% basal rate)? Maybe 2-3 hours? I would say that the issue isn’t with your bolusing but likely your basal rates.
YES! YES! YES! I have 6 different rates 12A- .35, 2 A -.525, 6A -.65, 3 P- .525, 6 P- .45 and 10P- .35 It just takes this many, and I still get low overnight, but it varies. I don’t have dawn phenom, obviously. But I can go to bed with a great BG, and have my CGM buzzing low all night.
The variety of rates have really helped. One of the things I noticed is that the rate BEFORE I go to sleep is very important to avoid overnight lows. I used to pump .6 from 6P to 12A, and have made some radical changes which have really helped.
My endo told me once the using the same number all the time was best, but I think that is ridiculous. Different times of day mean different activity levels, stress levels, food, etc. It makes sense to have a variety. I say whatever it takes is what I do.
Yes, I have a similar disparity, but my overnight rates are .5 and my daytime rate is .25. But, then again, I eat more carbs in one meal than you do in an entire day.
You have a CGM… when does your BG drop from 120 to 70? Is it sudden at 1am, or even and gradual throughout the night? I’d tend to think that you might be taking too much insulin during the day (basal or bolus, don’t know) and it catches up to you at night. Also, since you are low-carb, do you do a lot of square/extended bolus? The effect of that might be working on you after you go to bed.
I lowered my evening basals, because I was having lows at 10-11 pm. That has generally helped. The overnight lows usually begin around 12 am. It is a gradual downward slope and alarms begin around 1 am. Sometimes even after I treat it will continue to buzz. I have had nights where I have had 16 oz of apple juice (over 1.5 hours) (64 carbs) and still buzzed. That is more carbs than I eat in a day almost and normally more carbs than I eat at a meal. I only square wave when I eat a high fat food–normally pizza or Chinese.
I bolus at 1 unit per 10 carbs. I do think that is a little higher than it shold be, but I do like tight control. (See my post about freaking out)
Any ideas are appreciated, (if this was directed at me!
