Don't Jack with My Basals

I’m high, which means I’m also very cranky at the moment.

My well-intentioned CDE suggested a LOT of changes to my basal profile today and asked me to be both brave and patient, reworking my 23 units of basal into 21 units and redistributing those units across the board into a profile she thought better matched my overnight and post-meal needs. She changed my sensitivity from 1:32 to 1:20 and changed my insulin:carb ratios from 1:8 to 1:6. She felt that my post-prandials at lunch and dinner were showing that my basals were compensating for low boluses on the meal and correction side. Okay, I get that. I’ve always had that problem to a degree - keeping high basals to compensate for bad carb counting or inaccurate fat/protein consideration.

So I leave the office with all my new settings loaded.

BG = 79. Bolus. Wait 20min. Lunch = 53g of carb (a large but otherwise modest wheat turkey wrap).
1 hour PP = 116. Uh-oh, maybe I’m going to go too low. Let’s watch. 2 hours PP = 177. WTF?
I do a correction with the new sensitivity factor, thinking "this is why my basal was higher here."
1 hour later = 163. Okay, give it time, Melissa. Takes a while to correct a high. 2 hours = 54. WTF (again?)
The correction factor seems too intense now.
I pop 4 glucose tabs and am starving, so I then bolus for a 26g snack on top of that. (I’m pregnant. I eat a lot…and often.)
2 hours later = 200. ARGH!!!

Seriously, why mess up basals that were producing nearly flat lines and give me this? My standard deviation yesterday was 18. EIGHTEEN. My avg BG was 117. If you could hear me now, you’d hear growling. You’d probably even hear my baby growling. She doesn’t need her blood sugar to be 200.

I will give it two more days…unless overnight goes much worse. At least my CGMS warm-up period is over and I will have my beautiful wavy lines in front of me.

In the words of a great piece of literature: “It has been a terrible, horrible, no good, very bad day. I think I’ll move to Australia.”

(In all fairness, if I’d had these numbers 5 years ago, I wouldn’t have seen anything wrong with it.)

It’s frustrating, isn’t it? I have a hard time letting go and giving control up to someone else to make decisions… funny thing is that my CDE suggested nearly the same changes to me to day… she wanted me to cut back on my basal a bit and increase my I:C’s across the board… I was like, uh NO! My basal/bolus is already like 40/60!

My basal/bolus was 45/55 and she wants it closer to 40/60 - so yeah, I hear you. How much tighter does she want yours?? I remember when docs were bugging me to shoot for 50/50.

I feel like a sloppy juggler. I hate for anybody to grab a ball out of the air when I’ve got a rhythm going - even if it looks like I’m going to drop one.

Congratulations on your baby!

Geesh, why do they want to mess with success? Did CDEs all get a memo stating that 40/60 is the ideal regardless of how well we’re doing?

I have difficulty with the acceptence of the numbers of basal /bolus ratio…if I sit in the car being driven to my app’t I need to put a temp basal of 165 percent in place…when I walk a lot ( as presently ; training for a half M ) I put my temp basal sometimes : 45 percent …I know a chap , who cycles for miles and miles and his ratio is NOT 50/50 …why not keep basals /bolus ratio if ultamitely the result is GOOD for YOU …or Excellent for that matter???.
Time to ask the writer, John Walsh of Pumping Insulin once again ?

I forgot to congratulate you MelissaBL on " being with child " …please accept …N.

Grrrr… we are here and growling with you.

How absolutely frustrating.

Also 1:32 to 1:20 is a pretty big change (by almost 40%). Was there lots of evidence of highs not coming down?

In my (oh so humble) opinion, you are a pro. You know what you need to do. So do it.
(Your CDE would love me!!)

Geez. Why change so many things at one time? Now neither you nor your CDE will know which one set off the roller coaster. Personally, I’d go back to my original regimen for a couple days, then change one item and see what happens. I’m surprised you were so complacent with your CDE. You must really like her. :slight_smile:

Hey, great news about the pregnancy. I hadn’t heard. Congratulations!!

Terry

Melissa, mine actually suggested I go with less basal (less than the 40% I use now) and lower all my I:C ratios. Her reasoning was I tend to be a little high after meals, but I usually go back to normal… however I am reluctant to follow her advice because if I lowered by basals I’d surely go high without eating… I don’t want that. The whole point of being on a pump IMO is to stay flat without eating.

I am going to either try bolusing earlier before meals more consistently, or using more super boluses.

lol, reading that reminded me of an old adage

Those who can, do. Those who can’t, teach

present company excluded, of course… /wink

I use my doctors as prescription writers…stopped trusting them to tell me how to adjust my doses long ago. And with the pump and CGM, I feel I’m the best judge of how to adjust my basals and stuff.

Too bad that you CDE made you change so many parameters all at once. I would reset everything back to how it was and tweak my settings one at a time to see if it helps.

My CDE still wants me to shoot for 50/50, eventhough I clearly work better at 40 (bolus)/60 (basal). We are all different. At least my CDE doesn’t do so many drastic changes at once! Good luck and watch those lows.

I agree with Kristin, hon… You know what to do… so do it! Do your own tweaking to your basals. I am VERY fortunate to have a doctor that also has Type 1 Diabetes and is on a pump as well. He has taught me alot over the years, and not long ago… a year maybe, CDE, or CDMI, or what ever they call themselves, jacked up my basals and really had me screwed up. High all day, bottoming out during the night… Long story short, I went back to what I knew worked, about a month later, she moved back to California!! hahaha Good luck!

POOR BABY! She must be wondering what you are doing to her!
I have only been on the pump a few months, so I am no expert…But I imagine that your needs are different throughout the day with the hormone changes and everything, I just adjusted my basal’s (I have 4 different basal’s) to reflect my menstrual cycle, and will prob have to change it back in a few days. If I notice a pattern for a few days I will try something else, I am sure you are used to doing that but are being extra careful about it now. I have different I:C ratios throughout the day too. Personally, I don’t care to much for trying to adjust something that may need a little tweaking with drastic changes. It’s your body and you have to live with feeling like poo, not the doctors or trainers. Like everyone else says, YOU know what is best. My trainer gives me SUGGESTIONS, it’s up to me if I feel good about it.
luck to you and wishing you feel better!

Any time I make changes suggested by my endo, or even fellow diabetics, things don’t work out. I am my own best doctor. I just made a lot of changes to my settings on my pump after years of many lows and things are going fairly well but I also know it won’t last ;-)…

I changed my target setting from 100 to 120 and I changed my correction factor from 1 unit per 70 to 1 unit to 100, and I am experiencing less lows. I also changed my carb ratio at dinner time, but sometimes I have a hard time believing my settings and over zap, grrrr!!!

I also really watch the insulin on board and try to take that into account and trust my settings, that is the hard part as I want immediate back to normal when high, I am not patient. :slight_smile:

Congrats on the baby news I am so excited for you!!! :slight_smile:

Another thought : I changed to using the Sure-T’s ( MM ) 3 months ago and my overall numbers are much better, consequently I will need to adjust : basal , bolus, ratio’s , corrections …and you are right : one thing at the time . Our Team are our CONSULTANTS .

Wow, Oh, my gosh and What the Friggin’ is going on? My DOCTOR would even tell your CDE to have patience!!! He only changed one thing at time—always!! And I’m skeptical about trusting a CDE to make changes like that—isn’t a doctor only supposed to do that? Course, I’ve only been pregnant once, for eight weeks, so I’ve never had to have these things talked about… I’m sure none of the B.G.'s are good for your baby, but I don’t want you to worry about that—just get yourself back onto a more even B.G. trail… for you both!!! Actually makes me pissed off and crying at the same time… Rebecca :frowning:

P.S. Australia is where Simon Baker is from, you know? He’s that gorgeous and talented actor on the only new show that made it in the top ten last year----hey, if he can look and act that good and be from there, why not move there? … or at least vacation there!!! (and come back looking and acting as cool as he is, right? ) LOL!!! {;-0

Don’t tell me your mother forgot to pack dessert!! Sorry you’re going through a rough patch…It is so frustrating. growl away…

Hi Melissa:

Thanks for the welcome. When I was pregnant with my son 14 years ago (unexpectedly, with a GH of 11.7-- I call it Glycosolated Hemoglobin and we use the mml method of counting blood sugars and GHs in Canada), my insulin needs changed completely. I was lower than usual most of the time and could eat more on the same doses-- just went on the pump a month and a half ago, so multi-injections were the name of the game. I went to a high-risk unit for check-ups and adjustments on a regular basis and had what was considered good control during pregnancy. (I think that nowadays, I wouldn’t be considered to have had good control. Times change.)

My son was born healthy, although his BS was a little low and they had to give him glucose from forumula. Still, not bad for an unplanned pregnancy in the “olden” days.

I’ve been diabetic for 36 years. Started with one injection a day, mixing Toronto and Lente insulin. Over the years, progressed to 4 shots a day with Lantus and Humalog. Now on the pump with Humalog and thinking I was better off with Lantus. My blood sugars are more erratic now and I can’t always figure out why. At least on the injections I almost always knew why I was high or low. Often don’t have a clue with the pump. My pump instructor has made changes to ratios and sensitivity factors, but basal hasn’t changed. I’d like to experiment with that myself, but don’t know enough about it to do it. I’m on the Animas 2020. I like it, but the infusion sets can be a problem. The insets 1 and 2 are both annoying-- hit and miss-- but no one has ever shown me how the self-administered ones work.

Anyway, back to you. I think your person changed too many of your settings and . . . well, for no good reason that I can see. Were you having lows all the time from too high boluses? What was the reasoning behind it?