It sounds like your basal program includes periods of zero basal. I understand - Caleb had that at certain times of day when he was wee and very insulin sensitive.
In general, I think basal and bolus insulin dosing are viewed and therefore managed separately. It can be difficult to identify which may need to be adjusted when bgs are showing a pattern of being out of range. If you have the sense that your basal program is leading to low bgs, then you should certainly consider that in your treatment decisions and whether to adjust your basal program, particularly since (as you point out) that itās not considered in a pumpās IOB calculation.
Itās similar to when we have to consider the intensity level of activity for Caleb - thatās not considered in the IOB calculation either, but we know itās there, so we do our best to manually compensate for it. Itās all so tricky with so many variables to consider!
I need to do that suggestion of skipping a meal and make sure my basals are correct. My endo set my basal rate down to .425 until midnight to build up my during nighttime and then kicked it up to .450 from midnight on. I was having some lows during the night. I havenāt one of those in ages, but donāt like the numbers I see at 1:00 or so when I get up to use the restroom. I suspect my IC may need to be adjusted as I always need to eat between meals, hence the original question about IOB.
Basal testing is a must. Once that is done, then you can fine tune your IC. I donāt ask my endo to manage my settings, I donāt even have an endo. I do this on my own since I am the one who has to live with my insulin requirements. In fact, when a pattern arises, I do basal testing then and adjust if needed.
I have many times when I canāt just stop and eat lunch, and I sure canāt eat between meals. Dinner time is not always at 5 pm, and my IC at night is much lower than my IC at lunch. A test will tell me if I might be low so I keep a close eye on my bgās all day when I am active. I carry glucose tabs, Dum Dums, or Smarties in my purse or pocket. If your heading low during sleep, that is the first basal test you can do. My own night basal is the lowest of all of my basal settings.
I try to leave a few hours between meals usually so I donāt have iob. If I do I take into consideration what Iām eating, how much iob is left from when etc. and what my bg is. My pump is set to carbs and I have to enter a bg anyway to be able to bolus.
That sounds like my numbers too @yeagen. Right now Iām doing the diet/exercise thing and itās not workingānumbers are sliding upwards especially post-prandial and big jumps after exercising (used to go hypo).
Getting a second opinion from another endo on May 26th since my current one has decided to do nothing but wait for my pancreas to die. I think he got mad cause I couldnāt tolerate Metformin or Metformin ER.
Interesting topic you mentioned. Iām always learning so much on Tudiabetes since all my relatives were MDI.
Thanks for this link. The one presentation you listed, points out all the problems I suspected I had. These things are not always able to be covered in a medical appointment, and they are so relevant! I found so much info I can use, and hopefully share with my CDE. Well beyond basic pump settings for me, after 15 years on the pump, but things that are not usually addressed.
After this, I wonder if I should invest in the latest version of Pumping Insulin as well???
Thanks again!
I have come to believe that it is up to us as patients to manage our condition and the best way to do that is to become smart about it. So given that a book like Pumping Insulin costs less than a single co-pay, that seems like a good deal.
I have an appointment Monday with my endo and I will be asking her some more questions. I also plan to make a call to Medtronics today and ask some questions about my pump. I am kinda a control freak and D baffles me.
We always discuss things from the perspective that the patient often knows more how things go than the doctor. And I am huge on researching my own stuff. But for some reason if I print it and carry it with me, tt has more impact!
Iāve been D since before 1978 and have had tons of control issues. However, about 3 weeks ago I switched to a low carb diet and now see my bgās in range most of the time. Iāve gone from 45-65+ U a day to 24 to 34 units a day. Fewer carbs really does mean better control, plain and simple. Only took me 37 years to be convinced. We have found some very good things to eat in lieu of all the usual suspects like pizza, chile rellenos, lasagna, bread, rice, potatoes, pasta. Now itās meat, fish, veggies, FRUIT (lots of fruitāthe right kinds donāt raise bgās very much). Good recipes help make my new diet a pleasure rather than making me feel like Iām missing out by not eating junk. Just avoiding bread, pasta, and potatoes would be a huge step forward for anyone trying to control bgās.
Usually, if I have IOB, I have FOB, or food-on-board too and I try t take that into consideration. If itās Thanksgiving and the appetizer battle is done and weāre moving onto the dinner āwarā, I am going to unlimber the artillery and FFE! kaboom!
We have found some very good things to eat in lieu of all the usual suspects like pizza, chile rellenos, lasagna, bread, rice, potatoes, pasta. Now itās meat, fish, veggies, FRUIT (lots of fruitāthe right kinds donāt raise bgās very much). Good recipes help make my new diet a pleasure rather than making me feel like Iām missing out by not eating junk. Just avoiding bread, pasta, and potatoes would be a huge step forward for anyone trying to control bgās.