Can't help myself ! Need your help

I’m a T1 and an insulin pump user. I thought i would be able to adjust basal settings on my own but the erratic readings made me perplexed. In the following paragraph there is the schedule of basal settings and bg readings during the test. I appreciate the valuable HELP of yours.

7-8 AM -0.75
8-9 AM -0.75
9-10 AM -0.72. 9AM Bg - 134
10-11 AM -0.72. 10AM Bg - 165
11AM-12PM -0.67 11AM Bg - 178
12 - 1PM -0.67 12PM BG - 180
1-2PM - 0.67. 1PM Bg - 196
2-3PM - 0.67. 2PM Bg - 144
3-4PM - 0.67. 3PM Bg - 151

Thanks

What did you do to basal test? Usually it is only done for a section of a day, like 6AM to noon, noon to 6PM, 6PM to midnight and midnight to 6AM. Take the noon to 6PM test. I would eat a very light , low carb "snack" around 10AM and bolus normally. Then eat nothing until 6PM. Test hourly, like you did. Repeat for another section of time the next day, etc.

If you did not eat anything overnight until 3PM, your body will go into starvation mode and produce glucose to keep you going. I would suspect that may be part of the problem from 10AM to 3PM.

If you did follow the rules, you need higher basals. Raise them slowly and carefully. it seems logical that if you raise basals, you will see immediate changes, but it often takes several days to see how the changes work. And remember that changes should begin 2 hours before high BGs kicked in on the testing. For example, to lower the 10AM reading, you would need to raise the 8AM basal. Honestly a lot of it is trail and error. And once you get it right where you wanted it and everything is great, it will change again--that is just diabetes.

Keep us informed. Be safe. And preserver!

Yes, you need to raise the basals two hours before. So if that 134 at 9:00 is when it's starting to rise, you need to raise your basal for 7AM. As it continues to rise till 1PM, you need to raise the basals more for those time zones up until 11AM. Don't be afraid to have your numbers different for different time zones; that's what the pump is good for. Gradually increase it and sit with each step a couple days until you start to see the results you want.

But you need to take into account your meal periods. I believe you are a late schedule person, so those larger jumps could be from food if they are two hours after a meal.

I've used Gary Scheiner's basal testing protocol with good results. I agree with all the points made by Spock and Zoe.

Don't expect to complete each segment of the day on the first try. You'll need to be patient and persevere.

When I consulted with Gary Scheiner, he recommended using basal rates in "whole tenths increments." That is 0.1, 0.2, 0.3, 0.4, etc. Although modern pumps can adjust basal rates to very fine increments like 0.025, I think using them when beginning to set basal rates just clouds up analysis. At least in the beginning you should be able to adjust in 0.1 amounts and observe whether that course adjustment is working or not.

When you have the course adjustments in the "right neighborhood" you can then make some fine adjustments, if needed. For example let's say that 0.7 units/hour is driving your BGs too low but 0.6 units/hour allows the BG to rise too much, then trying 0.65 units/hour would make sense.

But why confuse the situation in the beginning with adjusting three digits to the right of the decimal point? By the way, all of my nine basal rates are set in even multiples of 0.1 units/hour. In other words I have not needed to fine tune any of my basal rates with the small 0.025 steps.

Like Spock, I'm confused by your post. Did you do a 24 hour fast? Or is this list of basal rates for just one part of the day?

Good luck. You are definitely on the right path. Setting basal rates that work for you is the first step to making the pump "your pump." Then setting the insulin to carb ratios and the insulin sensitivity factor will be easier.

Thank you Spock for your post. That is right I didn't eat anything overnight, I slept at 5am which is my usual routine nothing new. I woke up at 9 in the morning and that's when I began doing the basal test and left for my class. This isn't the first time I performed a basal test. Since I've always suspected that during the classes my bg rises lil bit so today I had a good chance to do it.

One question. If I eat low carb snack at 10AM how can I start the test before 2PM? won't it affect the next readings irrespective of how small it is?

Hello Zoe.
I was confused whether to compare the readings against each other and make changes accordingly or to compare the each reading from the first one i.e. 134 in the above case and change according to that.

Based on the reading, it is sure that sugar continued to rise from 9Am to 1
PM and then a BIG drop at 2. Since the readings after My idea is to make the biggest change, by 0.05 u/hr at 7AM to stop it from increasing and then either do the basal test again since the highs after 10AM weren't so big though they continued to rise OR I make the very small increments like 0.025 or 0.30 from 8-11AM.

Amid the clear pattern of highs the sudden drop of 52points between 1-2 surprised me. May be that's one valley of my basal program that I need to make,.

I think what's important is the pattern of rise and when it starts and ends. As Terry suggests, the fine tuning can come later. Either of your plans sound good and then you can see the results. But remember that one day is not a pattern. I'm assuming that what you shared above is typical and after you make changes wait a couple days to see a pattern of results. Be sure and keep careful records of the changes you make and the results you see. Most people that struggle with settings that seem to be all over the place are people who get impatient and make too many changes too quickly.

Chadha, please explain your basal testing methodology. For me, the BG readings are meaningless without how you tested.

Terry is correct and check his Scheiner link for correct testing protocol. Also, please heed the "whole 10th increments" philosophy for safety.

With no food, you go into starvation mode and produce glucose. Eating 2 hours before prepares your body for much more usual BG results.

Terry is a fantastic and very carefully thought out and researched resource.

I would love to know more about your testing protocol and your schedule. Sleeping only 4 hours at night, no set schedule--it all affects control.

Hello Terry.
Sorry for the delayed response. I'm personally a fan of Garry Scheiner, I believe he is awesome. I got your point about whole tenth increment and keeping the basal in round figures such as in 0.05 or 0.10 increments. I've read Garry's book I know he recommends to not use the increments such as 0.025.

But pal this is what works for me. For most of the day,0.67u/hr, is my basal program. It goes like -
0:00-7:00 - 0.67
7-8 - 0.75 [increased to 0.80] tomorrow
8-9 - 0.75
9-11 - 0.72
13-21 - 0.67
21-23 - 0.72
23-00 - 0.70

Like any Diab my insulin needs are so dynamic, but with me it is even more dynamic reason being my biologicla clock. Within a month or 2 U may become a morning person suddenly and I will remioan one for a month or lil less than that or abruptly I will also become a night owl, the way I've always been. I know it's not good for any diab, not even for a healthy person. The point I'm making is in both the phases my night basal i.e. - 0:00-7:00 AM has always been the same, has always been perfect according to the basal tests done in the past. I became pumper in November and until DEc didn't run any tests.

No, Terry, that wasn't on a 24 hour fast. I did it - "That is right I didn't eat anything overnight, I slept at 5am which is my usual routine nothing new. I woke up at 9 in the morning and that's when I began doing the basal test and left for my class."
Copy n Paste from the above post.

hello again. Zoe, so far I've only increased the basal between 7-8AM, from 0.75-0.80u/hr which is exactly the time where bg goes up. This wasn't new for me to find the 7AM rise by lil, very lil margin. in the past also it rose by only between 30-35, so I overlooked it and chose to confirm it by another testing before making changes. it is clear now. Tomorrow is Sunday i may be testing tomorrow.

I'm sorry, Chadha. I got the impression that you were just starting the process of basal testing and were seeking the community's help with your basal rates. If you've already fine tuned most of your day then my suggestions are not helpful.

I agree with Zoe's suggestions. I would perhaps make incremental changes by 0.1 steps instead of 0.05 steps but you appear to have your own personal preference.

Good luck with solving your current challenge. You will figure it out.

Hey guys. I think I haven’t got my answers yet. Are the readings to be compared against each other or from first reading. Few hours ago I was running another basal test and I again got perplexed in the process.
8pm - 137
9pm - 105
10pm - 100
11PM - 55

Now it is very obvious from the readings that there’s a drop of 32 points between 8-9pm which could be corrected with lil basal adjustment. But what about between 9-10pm? There’s only 5 points drop from 9 to 10pm but if I see it from the beginning(137 at 8pm) there’s a drop of 37 points.
All I wanna know is whether the readings are to be compared and corrected from their last readings or from the beginning like 137 in my case.

Sorry if I’m sounding demanding. I’m stil covering from hypo :slight_smile:
Thank you all very much.

Hi Chadha,
Basal testing point change is done from the time you start the test till the time you end or go low/high. So for the numbers you list the number to compare to is the 137 at 8pm when you started your basal check. So from 8 pm to 11 pm you had a drop of over 80 points total. You definitly need to be decreasing the basal a good two hours before the hard crash and since you had almost a 40 point drop between 8 and 10 personally I would back up and lower it at or even before 8.

On a side note - my son has a very similar central clock irregulrity. He is able to keep on a steady cycle by using a dawn simulator, a light box and a prescription med - Stratera - used for ADD but is not a stimulant.
Have you ever been worked up or treated? For him it made the difference between being sucsessful at school and work or not being able to function.