Oh my goodness. This is why I despise most endos. The whole system is broken. They can’t live with us to make the immediate, necessary changes, yet they don’t teach us how to self-manage.
Personally, I think you would benefit greatly by reading something like Pumping Insulin by John Walsh and Ruth Roberts. It’s pretty much the pumpers handbook, and will be the best way to educate yourself since your management team is lacking. You might even be able to find it in your library.
It’s pretty obvious your basal rates are too low. I think it’s normal for them to start low and increase it as necessary, though. Doctors are much more afraid of lows than highs. It isn’t a problem so much in the short term, but if they make you wait much more than a week to adjust your settings, it IS a problem.
We can help you right now with your morning sugars, though.
Did they not teach you about sleep mode? Sleep mode was designed to give the pump tighter control while you’re inactive and fasting, because there are no other external factors to screw with your insulin needs. It will aggressively adjust your basal to keep you between 112-120 all night. You can turn it on by clicking Options > Activity > Sleep: START. The regular Control-IQ algorithm won’t resume until you follow the same pathway in the morning and click “STOP”. While you’re in that activity menu, though, you’ll see an option for “Sleep Schedules”. You have two different setting options, such as one for weekdays and a different one for weekends. Go ahead and set up a schedule now that will turn Sleep mode on and off for you automatically. I would highly suggest you set a time that begins about 2 hours after you usually finish your evening meal and extends to your typical breakfast time (this will also help cover dawn phenomenon and FOTF).
Unfortunately, your pump is going to struggle to achieve that goal just yet because your basal rate is inadequate. I’m not comfortable advising you to change that, but you may call and ask your endo or educator to increase it for you, or you can take it upon yourself to raise it. It’s generally accepted that 5% changes are safe and acceptable. You run no risk of severe hypoglycemia with just a 5% change if you’re already running high.
The one thing I WILL help you with now that will make your nighttimes better is getting your correction factor down. This is the setting that enables control-iq to influence your BG. The higher the number, the slower and milder the changes. The lower the number, the faster and more extreme the changes are. (Edited, because I suck at proofreading. Thanks @irrational_John ) Too low is a bad thing, though, as it will overcorrect at both highs and lows, leaving you on a wicked roller coaster ride.
Too change it, you need to learn about your “personal profiles”. This is where all your background insulin settings are. You can have up to six different profiles, because our insulin needs aren’t the same everyday. You might need/want a different profile for high activity days, sick days, weekends vs weekdays, etc… It’s fine to start with just one, though. You don’t know yet when that particular profile isn’t working for you until you have more time with it. (Personally, I have 3. My regular profile, one that delivers extra insulin for sick days, pms, etc…, and 1 that delivers less insulin for really high activity days when I otherwise might fight lows a lot.)
Click on Options > My Pump > Personal Profiles.
The first item on this list is “pump settings”. There’s nothing too important in there other than it lets you customize how much insulin is delivered if you “quick bolus”, which I’m guessing they didn’t teach you about either. I have mine set to 0.5 units. If you hold the silver button until it beeps or vibrates (depending on your sound settings), you will see the Quick Bolus screen pop up. Every further click of the button will tell the pump to deliver some insulin. Since I have mine set to 0.5 units, if I want to deliver a 2.5 unit bolus, I would click the button 5 times. The pump will then repeat 5 beeps or vibrations back at me and I will long press the silver button to confirm. It’s easier than it sounds. Do it a few times watching the screen and you’ll catch on quick. This allows for discreet bolusing without even removing your pump, because you don’t actually have to see or touch the screen.
The second item on the list will be the only basal profile you currently have set up. It should say “on” next to it. Go ahead and click on it. If you scroll down to the second page, you can rename that profile to something more helpful. I would suggest “starter”, because you want to save the initial settings your doctor gave you.
Now scroll back up the first page and click “duplicate”. This will initiate a new profile great you can tweak without affecting your doctor’s settings. Click the check mark to confirm you want to do this. I would call it something like “testing”.
Click anywhere in the box labeled “timed settings”. This is the heart of your pump. I’m guessing you only have 1 segment at the moment, starting at midnight. Eventually, you will want to add other segments where you need different amounts of insulin, such as a higher one in the early am to account for dawn phenomenon, and then a reduced one the after the DP passes and you don’t need the extra. You can see right in that 12:00 am box what the basal rate, correction factor, insulin:carb ratio, and target BG are set at. If you want to edit it, click on that box. Click on “correction factor”. Whatever that number is, reduce it by 5%. You can use a calculator if you want, (current correction factor value) x 0.95 = new correction factor value. Once you enter the new value, click the ✓ to confirm. Click the check again to save the new timed segment information.
Now, you need to actually turn your new “testing” profile on. Click on “testing” (or whatever you named it), and then click on “activate”. ✓ to confirm. You’re now running your newly adjusted profile.
Note, I feel comfortable guiding you on this because it’s a SAFER option than the inadequate starter settings your doctor set you up with. It will make Control-IQ better at preventing both highs and lows. I also think it’s an option most professionals, except the very best, ignore. Generally, they only change insulin values, even though it’s only one of many factors that influence pumping. You should confidence to make small 5% changes, and see for a week or so how they work for you.