… or at least that’s what my CDE said today (I’ve only seen her for a while and I’m not going to see her anymore - I don’t feel she’s helping).
So, I’ve been on the pump now for about a month and my basal rate looks like this:
I have to admit, I agree, it does look strange - two bumps in the course of a day seem to be quite normal, but my second bump is from 10am to 2pm, where other patients have a drop in their insulin needs. So I’m wondering what could be the reason for my profile to look so different from ‘usual’? I’d say, well, if it works, who cares, but it is a little early to tell that. The CDE suggested that I use the basal rate around this time to cover part of my lunch, but my basal rate test showed this: 8am: 101 mg/dl; 9am: 117; 10am: 135; 11am: 155; 12am: 151; 13:30am: 131; 14am: 139 If I used my basal rate to cover for my lunch, I should be dropping at noon, but actually it seems more that I’m climbing slightly from 8 to 11.
Do you have any suggestions what might be happening here? Do you have strange basal ratings of your own? Am I missing something? (I know I should relax and observe and give it a little more time. But you know how it is, when you’re impatient and compulsive and feel all your efforts should finally pay off…) I’d appreciate any input!
In my opinion the scale of the chart makes it look very dramatic. Your normal rate is 0.7 and your adjustment for dawn and lunch time is just +0.3 - far from being “unphysiological” I would say. Some people in my Glucosurfer project are using +1 or more for dawn. I would just recommend a basal rate test from time to time to verify the profile in different hormonal stages. Just to make sure you are not adjusting to a temporary effect caused by hormones.
If you don’t go low around 13 - 16 with these basal rates (even when you skip lunch) I guess the 11-14 rates are OK… but I would not consider a change of ±0.2 being “unphysiological”.
an occasional basal rate test is perfect for determining if your basal rates are good or if there is an error that should be taken care of…
and any new basal rates need couple days to settle in so don’t worry if the possible changes you make don’t have an immediate effect…
ps: I would not use a basal rate to cover for lunch because if you skipped lunch you’d go low.
if you need to lower your post-lunch BGs when eating a higher GI meals try using a superbolus
(http://www.diabetesnet.com/diabetes_technology/super_bolus.php#axzz0wILoKFtC)
In keeping with the new language policies of the board, I’ll state my view of this issue “sh*t happens.”
Remember, your basal rate “covers” the insulin requirements that your body has when you don’t eat. If you regularly have things which increase your requirements from 10am - 1pm, then you have increased requirement. Do you regularly do things over the lunch time which are stressful? Do you drive to get lunch? Do you worry about stuff? Are you more or less active? These all affect basal requirements.
In my view, your basal test showed a steady climb from 8a-noon, which suggests you still don’t yet have an optimal basal. I might even suggest trying a flat basal of 0.8 U/hr from 8am -1pm instead of the funny 10-1 spike and see if you obtain a better basal test result.
If you set your basal while fasting the whole time, you will probably have multiple occurences of dawn-phenomena type stuff through the day (at least until your liver decides to stop using its glycogen).
I myself am more insulin sensitive in the late morning, but only IF I ATE BREAKFAST. So when I do fasting testing I end up with results for basal rates that don’t actually reflect my normal data. Suspect the same thing happens with you.
I think the “fasting basal rate testing” concept is a good start but is only precise if we are fasting. You have to feel that you can tweak beyond the results, that the results are not the final word but just a starting point.
Hearing that I’m ‘normal’ is just what I needed. I’m more wondering about the time than the amount of the insulin, though, 'cause 10am - 2pm is neither dusk nor dawn, really.
You’re probably right about the “couple days to settle in” - I hadn’t thought about that.
I’m really trying to use basal and bolus insulin each for its assigned function and not to mix it up, because I can’t believe a lot of good comes from that.
Thanks, your suggestion is very appreciated. I’ll see how it goes in the next days, but if I find my results weird, I’ll give it a try. You also might be right about the stress, as it is usually the time I’m heading to university.
I always only skip one meal to make basal rate testing hoping that it doesn’t have to much influence on my metabolism. How do you know you’re more sensitive when you eating? How can you tell your basal needs and bolus needs apart?
For me with breakfast, it’s perfectly obvious: If I skip breakfast I need more units of insulin to keep my bg in range, than if I actually ate breakfast!
Typically for me in the morning 4 units of H covers a rather carby breakfast when I wake up. But if I don’t eat breakfast at all, I end up taking 5, 6, 7 units doing little corrections throughout the whole morning and having high bg’s most of that time.
Thanks for this infoJohn. I have a similar second hormonal response as soon as I get up. I will try eating as soon as I get up., even before I get dressed…Tell me more your I:c ratio? I have used 1:12 all day long, but I changed insulin sensitivities 22:1 to for a 4 hour period in the morning because my a.m. corrections did not seem to work., I will have to re-consult Pumping Insulin to see what’s up.
And Vera… do not feel that you have to get it" right" all at one time. You are your own science experiement, and it seems that you are quite the capable researcher!!!
I am so appreciative that you posted this response. I recently started eating much lower carb in the mornings (4g or less). Since starting that, everytime I get up, my blood sugar spikes. This never happened before I started eating low carb in the morning, and I suspect it’s because I used to bolus for a carb-filled breakfast each morning when I got up. I hadn’t been able to figure out these weird climbs until now and felt like I was the only one having these odd spikes. It was really stressing me out. It’s so reassuring to hear that other people have “secondary” spikes when they get up, just from the act of getting up! Going forward, if I keep eating low carb, I may take a small bolus to prevent the spike. Thanks again for your post!
I know your problem. I also need additional insulin at lunch if I skip breakfast. The explanation for me is different: What if the insulin is having a long tail? This tail might still be active at lunch. So by skipping the breakfast I will miss a tiny part of active insulin at lunch - just as if some basal is missing.
So that would mean that if you started increasing your basalrates pre-lunch you would drop on breakfast days before lunch. And you could not mistake that for a too high I:C ratio because than you would drop earlier, like 2 hours after breakfast. (Just trying to figure out if it could be the same in my case, but I had to lower my I:C recently because I always dropped postprandial.)
I’m more wondering about the time than the amount of the insulin, though, 'cause 10am - 2pm is neither dusk nor dawn, really.