For the last four evenings, I have had some real odd BG fluctuations: --eat at 6:00PM and take appropriate amount of insulin for carbs; good BG
--Eat meal, BG goes down, and down. Treat low judiciously with juice.
--First time I am above my low threshold (80) all evening is about 12:15AM
--By 1:30AM, BG rising quickly, peaking at 233 at 5:15AM
Every recent night the same pattern emerges. Fine at dinner, bolus for carbs, BG plummets, then around 1-2 AM it rises very fast. I have tried a dual and square wave, with the same lows. And the lows are much below my 80 threshold--55, 61, etc.
For the high BG I did consider a liver dump, but I rarely experience that, usually only after a devastating low. I discounted that idea, as a result. I have counted carbs very carefully when eating dinner.
Here are my thoughts: lower the basal at 5:00 from .5 to .4 and change the dinner I:C ratio from 1 to 15 to 1 to 17. Raise the 10PM basal from .25 to .35 and the midnight basal from .4 to .5. That would provide an extra .9 units during the time my BG rises so quickly.
All input from you experts is always appreciated. Thanks.
Your solution is along the exact lines I was thinking as I read your post, Spock. My goal is always to not spend too much time worrying about why something is happening and just do something to change it. (Keeping careful records so I can always go back if it was some weird fluke)! Let us know how it goes.
I agree with Zoe. It is the nature of D to change all the time, just as our bodies change as we age. You seem to be on the right track with the changes. Nothing too dramatic, and only doing changes once you see a regular pattern. Please keep us posted on how things go.
While I'm the one who brought up the need to not spend time on the why, I think it's a question of degree. Sometimes the why gives useful information on how to fix it either in the short fun - like "change infusion set", or the long run "lessons learned department" - "swear off pasta". I'd say maybe allocate it 3 minutes...then move on to action. I just have to watch my own tendency to dwell on it for hours...or in the case of some bigger questions...years!
Are they meals you've eaten regularly before? Or could the protein or fat or fiber be throwing things off? The other night I had a low-fat, lowish-carb meal that was loaded with fiber and protein. And, like you, went low, treated and ended up high from both the food and the smarties many many hours later. Tried again the next day by saving a portion of the bolus for 2.5 hours later (kinda like pizza bolusing) and it worked out well. This may not apply, and you're probably more on the right track with looking into basals. Just figured it was worth tossing out there.
PS - My autocorrect keeps trying to change bolus into blouse and basal into nasal. Sigh :)
Well I am no expert but I notice no one has suggested that you may be experiencing a Somogyi effect. It is reactive hyperglycemia following hypoglycemia. One thing I learned is that treating hypos with juice creates the opposite problem much later and it lasts for hours. I think you are on the right track in changing your doses.
I actually flatlined last evening from 6PM until 8AM--93 to 110. I did have one hour (11:30 to 12:00) where the CGM read below my low threshold of 80, but only a point or three. So, at this time, it was successful.
I also need to comment on Zoe's last reply. You are right. Sometimes when something is not going well, more is needed than a simple correction--infusion set change, correction with a syringe, etc. But that also can still fit into the 10 second rule--after you have been on a pump as long as many of us have, it is pretty easy to spot a problem with the machinery.