On a pump, Sarah, you can get your basals so perfectly fine tuned that if you go to bed at 130 that is pretty much where you will wake up. Since I don't want to wake up at 130 I correct if that's where I'm at at bedtime. I didn't do so when I was on MDI, both because doses were too inexact to chance and because my basal wasn't that reliable. As for correcting lows: Some of us correct under 70, some under 60. But at bedtime I will correct anything under 80. Please remember we are all different and we all speak strictly from our own experience. We are saying, "here is what works for me" and then it is up to the reader to decide if they want to try that suggestion or not.
Yes, more info is needed. For example:
What were you eating in carbs, protein and fat?
What were your 2 - 3 hour post-meal numbers?
Did you perform any 3AM tests? Results?
What do your numbers look like throughout the rest of the day?
Also a message from the food police - Pepsi!?!? Hope it was diet! ;)
I've developed a few habits over the last year or so that may or may not be useful to you. Because I've been diagnosed with two gastro-intestinal complications (GERD and gastroparesis), I try to let at least three hours elapse between my last bite of food and going to bed. Since I'm dealing with these GI issues, this practice makes sense for me but may be useful for you too.
My insulin duration of action (DIA) for me is set at 4.5 hours; your DIA may differ. Allowing at least three hours between eating and bedtime removes most of the dinner BG control issues, both food and insulin, from the equation and makes analyzing control problems easier. If you go to bed with no to little active food and no to little active insulin, then overnight control anomalies like a 475 or even a 225 will most likely be caused by a pump delivery problem or a too-low basal rate. Letting both food and insulin "time-out" before you sleep makes analysis of problems like you report much easier. It also cuts way back on overnight lows due to miscalculated bedtime boluses.
I was an inveterate late evening snacker before I changed my habits, so I know what I suggest may not be easy to execute but if you do it, I know it will make your sleep and life easier.
I follow a carb restricted diet of about 50-75 grams/day. Every meal insulin dose that I give uses an immediate dose for carbs and an extended bolus for protein and fat stretched out over 2-6 hours. My formula for doing this is a bit involved and is customized for me. If you're interested I'd be happy to give details but is similar to what Dave has posted above.
but how do we know what the high AM numbers are from? thus, how to fix them. how does one determine if it's DP or just not enough basal (MDI) or from something we ate. Still can't figure out basal?
Good question, Sarah. If it were me, I would look for answers this way: I wouldn't eat late at night (at least while I was trying to stabilize) because that throws in more variables. I would look at my numbers 2 hours after eating and what I ate. (or better yet, stick with foods I know don't have a delayed action for me). I'd test throughout the night to see when the rise started. If it's high overnight but not in the in between times during the day and at bedtime, I'd assume it's DP. But whether it's DP or "not enough basal" I would still increase basal, only question would be which time zones. It may take longer to figure out with a pump, but you can fine tune it pretty closely. MDI basal is a whole other ballgame because you have timing and split to consider and it still may not be ideal.
Thanks, Zoe. I'm about ready to pull my hair out, again! I can't start the pump until I get some sort of basal set...nothing seems to work. 10 units dropped me 100 points overnight, ugh! I can't figure this out and i'm just about to give up. i just am feeling ill. I'll try this week at 8u am and 6u pm and see what happens. I can't tell if I have DP or just not enough basal or rebound highs.
Sorry, Sarah. Don't tear your hair out! You know my opinion, so I'll be quiet..lol