I was up at 11pm, 1am, 3am and 5am to check my Basal through the night. I’m happy to say that it didn’t fluctuate by more than 0.8mmol throughout the night so it looks like my night time Basal settings are ok. The problem came again this morning, at 7am I was 6.3, I took a Bolus and waited 20 mins then ate 2 slice of Burgen toast and by 9am my BG was 9.7. This was with a correction bolus of to bring me down to my target of 5.0mmol and with a I:C ratio change from 1:1 to 1.1:1. I took a Bolus total of 3.2 (2.65 for the toast and 0.55 for the BG).
Bit miffed really because on MDI with the same waking BG, same two pieces of toast and an I:C ratio of 1:1 I would have only gone up by 1.5 to 2 mmol by 9am and I wouldn’t have had to wait after taking my Bolus before I ate.
All the other parts of the day my control is fine and the fasting tests that I have done seem to be fine as well. I’m running out of ideas for things to try now. I’ll see what my BG is like at 11am, 4 hours after my Bolus, and see if I am down to 5mmol or if I remain a bit high. I might try upping my Basal in the morning between 06:30 and 09:30 to see if it’s the lack of Basal that is making me peak and not a shortfall of Bolus. Anyone else got any suggestions of what to change and how to check the changes are correct?
Hi Si,
from what you posted it looks like you need to lower your I:C ratio in small steps and inject more insulin for your meal until your numbers after eating are okay. Insulin requirements can vary greatly throughout the day and are usually highest in the morning. Mine is almost twice as high compared to the rest of the day. And they change with time too, so I sometimes have to readjust all my ratios for no apparent reason. Maybe that is happening to you and has nothing to do with your pump.
Kat
I don’t think this is a basal issue.
My insulin resistance (and for many diabetics) is highest in the morning. My I:C ratio is much different in the a.m. - 1:5 in morning vs. 1:10-1:15 the rest of the day - however, it’s just so hard to predict the resistance on any given morning. I eat very low carb throughout the day (10-15 per meal), but I have taken to eating mostly protein in the morning because it just makes it easier to maintain control. But even with that, there can be differences depending on the protein…easier to deal with on a pump (my next move). I recently added Symlin and that has definitely helped.
Hmm, On MDI I was on a ratio of 1:1 all day and my control was really good, A1C of 5.7%. I also didn’t get an DP problems or Insulin resistance that I know of.
I’m wondering now whether it’s because for the first time in years I’ve started to use the outside of my thigh. I used to use my thighs all the time on two injections a day and then on MDI but started to get lumps so I stopped using them apart from my Levemir injections on MDI and then I used the inside not the outside of my thigh, probably been over a year now since I used the outside of my thigh.
I just wonder whether it is something to do with the absorption rate not being as good for my Bolus’s on the outside of my thighs. I’ve heard that people using a site with lipodystrophy have to take more Insulin. I can’t see any visible fatty lumps but I guess that doesn’t mean there isn’t some scar tissue there. Doesn’t seem to effect my Basal though as last night results show and I haven’t changed my Basal from when I was using my Abdomen!
Try using a different correction factor in the morning.
Some people are more insulin resistant in the a.m. I have a lower correction factor in the morning (8:1) than I do the rest of the day (13:1) and it’s helped me avoid post breakfast spikes.
In addition, breakfast is my lowest of low carb meals. It’s mostly protein.
Like other posters here, I have a different correction ratio in the mornings and a different I/C ratio:
Corrections: 1 unit rapid for every 30 mg/dl over target; 4 grams pure glucose to raise low bs by 20 points
I/C ratio: 1 unit rapid-acting insulin for each 8 grams carb.
It looks like you took your post-meal glucose reading only 1.5 hours after eating. What was it at 2 hours? I bet it came down a bit more!
Sometimes it’s easy to get too anxious about peaks. Although peaks out of range aren’t good, they’re gonna happen. The duration of the peak is of more concern to me (as long as peaks are under 180 mg/dl). Wait and see what your pre- and post-meal readings are for a few more days (especially days when your fasting is in range). I never make bolus or basal changes based on one day of data. Too many variables. Best wishes!
My former CDE told me that it’s normal to peak up to 50 BG points two hours after eating. By ‘normal’ she meant this applied to everyone, including non-diabetics. So if my two hour post-prandial reading is within 50 points of my pre-meal, I’m not overly concerned.
