Is it basal or bolus dosage that is wrong?

Diabetes Technology Insulin Pumps
1

I’ve been struggling to get my post meal BG down to my bench mark. I’ve been bolusing extra like crazy as my BG rises and still can’t get it down to my benchmark.

I set my benchmark at 100mg but it only comes down a little to 144mg and stays
there and I find myself in the next few hours bolusing 1 unit , another 1 unit , another 1 unit until it comes down! Its about an extra 3-6 units post every meal I need to bolus- thats a lot of insulin!

So the curve looks like this, starts at 81mg, peaks to 180-200mg and then comes down to 144mg and stays there (but i want it to land around 100mg) and sometimes it trends up again. Is it my bolus that is too weak or my basal not enough. I think it’s my bolus but I’m not sure anymore since these additional bolus injections seem to be ineffective. I know sensitivity weakens as BG is higher.

Yes it was a carb based meal but had protein and vegetables as well.

2

I would talk to the doctor and let them know what is going on. I had a similar experience and we moved a few basal rates around until I was on track.

3

@tedos I would do basal testing to make sure my basal keeps me flat. Once you know the basal is good, then you can begin to look at your carb to insulin rations. My I:C ratios change depending upon the time of day and the food/beverage I’m about to consume. My pre-bolus time changes too, depending upon what I’m having.

Edited to add the link.

3 Likes
4

@tedos I agree with @Tapestry. Figure out first if your basal is right. I have different basal rates in my pump with my lowest setting during the night until DP is due to hit. The wrong basal rate can mess with all your other rates.

Then you can work on adjusting the rest. I also have a different !/C ratio for different times of the day.

5

I have already basal tested but im frustrated with the results because I can’t seem to get consistently the same results every time. When I think I’ve nailed down the basal with a straight line over multiple days, I suddenly get variations where the line creeps up and sometimes it goes down. Ive repeated this several times and I’m quite burnt out by it :disappointed:. I can’t seem to get it consistent.

I don’t know how I can get all different outcomes with the same basal setting. I can only boil it down to influences like food earlier in the day or hormonal changes. I should also add, the food I eat 4 hours before this is low in fat and and minimal protein to avoid a delayed rise.

6

Try not to get frustrated or discouraged. :smiley:

Once you have this in line, the rest will follow … but, always be prepared for those variances! They happen. I call them gremlins. There are so many variables to consider. That is one place you might be able to work with. When you are basal testing, keep your days, afternoons, or evenings level - don’t do extra work, walking, gardening, stress, get the same sleep, … and so on. Then, after you get one time-segment down, take a break for a few days and then go to the next time-segment, and so on. You can do this!

If your bg creeps up or down by more than 30 points, then the test needs to be repeated, until you no longer have a variance of more than 30. Now, if it is 35 or even 40, I might not worry too much, but they set the number at 30 for a reason.

Keep trying :smiley:

2 Likes
7

Thanks i am full of them! :sob:

Is it normal to be struggling so much with basal testing! I must have done it about 10 times and haven’t achieved the consistency I want.

The other night I got a flat line for the entire night while i was sleeping for a full 6 hours. The next night it was trending up on a slope. Other nights, basal IQ kicks in frequently even with the slightest drop while maintaining a steady line. So what do i do, increase or decrease ? I can’t win!

Overnight basal testing should be the easiest and less variance… but i can’t even get consistency with that.

8

For some people, yes. Be patient with yourself and with the test. Remember you don’t want any added stress to mess with the testing, so if you need a breather/break, take a few days off between each segment. Three days, without going over or under 30 points from your starting point, that’s all you need for each segment, then put that segment aside and go to the next. It will take time to fine tune them all individually and then once you’ve done that, look at the entire picture.

I think it would help to see your bg numbers and times at this point.

Consistency isn’t what you’re going for.

You need to be three days with no more than 30 points difference, up or down.

So, if you start the basal testing for your first-segment and your bg is 130 when you begin, you shouldn’t go over 160 or below 100 each day of the three days you’re doing that segment. Edited to add: Each day you test before you begin, so the next day you may begin at 160, so you don’t want to go over 190 or below 130. The next day if you begin at 110 you don’t want to go over 140 or below 80.

Then, if you need it, give yourself a break for a few days before you move to segment-two, following the same 30 points up or down.

Integrated Diabetes calls the segments I’m referring to as phases. There are four - morning, afternoon, evening, overnight. They suggest beginning with the overnight.

This all takes time. Three days for each segment/phase, followed by a few days break (if you need it), times four segments/phases is at least 12 days. If you go high or low during any of the segments/phases and have to start over, or if you take a few breaks between segments/phases, that will add more time to the basal testing.

1 Like
9

Thanks @Tapestry .

Yes thats what I mean re consistency. It’s not the same BG every night but the BG doesn’t float up or down over 30 points - I get all three variations hence not consistent :sweat_smile:. It’s like I can get no floating +/- 30 points for 3 days and the next week, i start getting them so my basal which I thought was right, is wrong the next week. When do I lock it down if it keeps changing?

I show you what i mean, here are 4 consecutive days of data (with the same basal setup) between 12am to 9am (my overnight basal). I’m rocking it on tuesday with a flat line. But monday it says I’m not enough around the 2am mark, wednesday says the same but more subtly. Thursday tells a different story and my basal is not enough even before midnight. Which day do I use to make my basal adjustment, they tell different stories? :pleading_face:

Note that when then start floating away, I do bolus to curb it in (I know I shouldn’t bolus during a basal test but as the BG drifts away, in my mind the basal test is over already).

Monday

image
image896×878 38.5 KB

Tuesday

image
image848×884 35.4 KB

Wednesday

image
image856×878 36.7 KB

Thursday

image
image836×888 35.9 KB

10

All three of those variations are fine, as long as they do not go over or under 30 points from when you began. And, your beginning bg is not above 250 or below 70. Read the link above to basal testing from Integrated Diabetes.

If I can try to help more, I will, but I would need to see the actual numbers, not the line graph, because I can’t tell what the actual bg is. It appears you don’t follow US measurements, so one of us would need to convert to US.

If anyone else can help shed some light, that would be wonderful!

1 Like
11

Thanks. I’ve read the website, I think its the same author as the person (Gary S) who wrote “Think like a pancreas” and it reflects whats in the book so I think I’m doing it correctly. Just not the black and white outcome I was hoping for :smiley:

12

I understand. It doesn’t happen overnight or in a period of four days or ten.

When you go low, below 70, you need to end the test, lower your basal (the link explains this) and then restart the test. The same is true when you go high.

Be patient with yourself and with your body’s way of telling you it needs more or less insulin - and do that, slowly. It took me over six months before I had my basal where I wanted it. I have five different basal segments, you might need more or less because we are all different. And then there are the … gremlins! :laughing:

Keep trying, you’ll get there!

13

thank you!!!

14

This is another site talking about basal testing and it spells out the do’s and don’ts a little more.

2 Likes
15

It’s never the same. You might have a sperate basal rate for morning afternoon and evening, M-F and the weekend. Or when you go out and party. Going for a hike or being a lounge lizard
If you feel unwell or monthly cycles.

Start a diary and look for patterns
You may need to square wave for up to 50% of protein if you low carb

1 Like
16

Does anyone have any ideas how to basal test with the feet on the floor FOTF happening in the morning? When I basal tested my morning phase a few weeks ago, I didn’t seem to have FOTF kicking in but recently it’s definitely happening.

I tried to ride it out but my BG just keeps rising with the arrow diagonally up. If I don’t bolus to curb it, I’ll be spending the rest of the day battling high sugars. It’s risen from 4.1 mmol (74mg) to 7.8 mmol (140 mg) this morning and arrow is still trending diagonally upwards. Once I bolus, my basal test ends.

17

The Dawn phenomenon is handled by the pump, better than MDI. You can set the hourly dose. Do you have a diabetic medical advisor?
The dawn phenomenon: What can you do? - Mayo Clinic

https://journals.aace.com/doi/pdf/10.4158/EP14198.OR

Hopefully one of the experienced people will be along. I would guess that becomes a part of your basal testing. You would correct that and move on. If you can eat a decent meal mid afternoon and do the miss the evening meal basal test again. If the rise is similar every time, add to your pump hourly basal rate for that dawn phenomenon time period. A CGM or even Libra would be a big help while you do this. To see the time it starts to rise and to set from. Saves setting the alarm clock to test. The goal would be to pretreat it, so you don’t wake up high, if it’s a similar rise every morning. If not, you might choose the lower rises to put in your hourly settings. Then bolus when you wake up, for the times you are higher than normal.

18

Well this site is slowing down, I thought someone would have come in by now. I would try a more active site. DiabetesUK .co and .org are two other sites I would visit.

19

:slight_smile: thats okay, perhaps its not a common thing that other people have experienced. This is kind of a weird one. Essentially if I correct it with any insulin, i essentially “contaminate” my basal testing with insulin in my system. If i don’t, I can’t basal test because my sugars will just continue to rise. I think yesterday it rose 72 points before I decided I’m not letting it rise any more and abandon my testing.

I’m appreciative of the support I’ve been getting on my posts from the folks here.

1 Like
20

@tedos What you need to do is written about in the basal testing link I posed earlier from Integrated Diabetes. When you go low or high during your basal testing, you cancel the test, decrease or increase accordingly, and then start the test again.

I know you said you’ve already read the link on basal testing and Gary Scheiner’s book, Think Like a Pancreas, but it would be worth a second look :).

If your blood sugar drops by more than 30 mg/dl during the test period, the basal rate is probably too high. If it rises by more than 30 mg/dl, the rate may be too low. The basal rate should be changed in increments of .05 to .2 units/hr depending on your usual settings and the magnitude of the rise or drop that took place. The next day, re-test to see whether the adjustment produces a steadier blood glucose level. Continue to adjust and re-test until steady blood glucose levels are obtained.

…

Note that basal rates are usually changed one or two hours prior to an observed rise or fall in the blood sugar, since the rapid-acting insulin infused by the pump takes about an hour to peak. For example, if your blood sugar rises between 3 am and 7 am, you would increase the basal rate between 2 am and 6 am. Also, keep in mind that it is rare to have multiple “peaks” and “valleys” to a basal insulin program. The vast majority of people require one peak and one valley.

Fine-tuning basal insulin can be complex. Don’t hesitate to reach out to a member of Integrated Diabetes Services’ clinical team for a helping hand. Our phone number is: 877-735-3648

1 Like