Dosing advice

So I have an appointment with my doctor in 2 weeks, but I have been noticing a trend that I’d like to correct so I was just looking for some advice. I usually take my first bolus around 915am. Around 1pm my blood sugar starts to crash, right before I’m about to eat lunch. Do you think that my insulin carb factor might need to be raised for my morning bolus or do you think I need to lower my basal rate between 9am and 1pm? Thanks-

I'm assuming by "your first bolus" you mean for breakfast. Normally I would say if you are crashing before lunch that your basal is too high. But I notice there is only 3 3/4 hours in between your breakfast and lunch bolus. That's close enough together that you could have some insulin on board from your breakfast bolus. My suggestion was to move your meals a bit further apart. (I try and eat 5 hours apart to avoid overlap). I'm assuming you take into account the IOB when you bolus for lunch. You might see how much you have left when you are crashing and compute a small reduction of your breakfast I:C (or just reduce it by one and see how that does for a couple days).

But eating so close together does make it hard to sort through the variables. Rather than making too many changes and having to backtrack, my suggestion would be to move your meals further apart. Then if you are still crashing before lunch you will want to try tweaking your basal by a small amount for that period. (If lunch is at 2, and that's when you go low tweak it at noon). I also wonder what you mean by "crashing" Sometimes people are say 70 or 80 and feel "off" because they're used to being high, when really that is a good number for before meals.

So your first bolus is around 9:15am? Also, do you usually do a correction bolus along with that meal? also, what time do you eat lunch? do u do a correction bolus along with that meal too? these answers determine my answer to your post.

Yes my bolus at 915 is my first meal and then I typically eat lunch between 1 and 130. I have my insulin on board set for 4 hours so if I eat lunch within 4 hours it does take that into account. I’d say between 1230 and 1pm my sugar starts to drop and within a matter of a half hour it goes from 80 down into the 50’s. I am not doing any correction bolus between waking up and lunch, in fact it’s rare that I ever do one unless I eat really bad and misjudge the carbs, but that’s not a common occurrence for me. I don’t think adjusting meal times is an option for me because I have a long commute so I leave the house too early to eat before work and I don’t get to work till 9. I should mention I do snack around 1130 also, but its always a small snack with basically no carbs, like almonds.

Thanks for the further details, Melissa. Does your blood sugar go up a little from your pre-breakfast number to your two hour post prandial? If, let's say you're 100 before breakfast, then go up to 115 at 11:15, then at 12:30-1:00 you start that slide down to 80 and into the 50s I would definitely reduce your basal rate for the period around 10:30; it sounds like the basal is pulling you down.

But if on the other hand you just keep dropping - like starting at 100, then 85 at two hours then keep going down from there till the 4 hour point then I would alter the morning I:C a point. It might in that case be both I:C and basal. I understand your schedule makes it hard to space your meals, but it does make the cause and effect a tad murky and might take some playing around to figure it out. Depending on your answer to the scenarios I describe above, I would experiment, but only do one at a time - basal or I:C. If you do both together you won't know which was responsible for the change.

Thanks Zoe for all ur responses! I would say that my 2 hour post meal sugar is not low. My sugar rises post meal but then drops. So it sounds like my first step should be lowering my basal. By how much would you lower it?

Hi Melissa, why don’t you do a basal test covering that time period i .e. miss out breakfast completely (though starting with a blood sugar within normal range) and test every hour, say, to see what effect your basals are having? If your BG is still ok after 3 1/2 > 4 hours, you’ll know it’s your insulin carb ratio or something else you need to look at.

Definitely sounds like basal. I usually only make changes in the smallest increments - .025. Then I see how that does for awhile before deciding to drop another step. Since you drop from about 12:30 to 1:30, I would make the change from 10:00 to 11:30 or 12:00 (creating a new "time zone").

Thanks I’m going to try this tomorrow and see how it goes. Do u have a different program set up for the weekends? Sorry about all the questions, I’ve only been pumping for about a month!

I don't work fulltime and work in part from home so weekends aren't different for me. But I've heard other people do. I didn't realize you have only been pumping for a month. It definitely takes awhile to get your numbers in line when you start pumping. I think you're doing great, asking all the right questions and tweaking things as needed!

I agree with Ingrid. Melissa you got at exactly what I was asking for. I was wondering if your insulin on board was working. to do your basal checks, avoid any carbs from breakfast time until about 2 hrs after your suppose to eat lunch. During this time check your blood sugar every two hours or as needed to avoid lows. If your blood sugar changes anywhere from 30 points up/down during fasting, then your basal needs to be adjusted. If not, we know its your insulin to carb ratio.