Should I Bolus after a shower and set change?

Every morning I get up and have breakfast and then go for a shower, have a shave etc… and then get ready for work. Typically I will be off the pump just before I get in the shower and re-connect after I’ve had a shave, about 20 minutes. However, if I also do a set change I am off the pump for about 30 minutes. At this time in the morning I am on a Basal rate of 0.4 U.Hr.

What I am finding, especially if I do a set change is that 2 hours after I have taken my Basal and eaten I’m getting really high readings. E.g

@ 06:30 my BG was 5.8, I ate 40g of carb and took 4 units as a Bolus
@ around 07:30 I disconnected for a shower and set change
@ around 08:00 I reconnected
@ 08:30 my BG was up at 11.5.

I know that if I don’t eat in the morning and do a series of fasting tests my BG never goes up by more than 1 mmol and I know that my Insulin:carb ratio in the morning is 1 unit:10g Carb. I also know that the breakfast I had this morning while I was on MDI would never have raised my BG by more than 2 mmol.

So what is causing the highs? Could it be that if I’m off the pump for 30 minutes I’m missing out on 0.2 units of Bolus and this combined with my BG rising, because I’ve eaten, is causing me to go high.

Should I take 0.2 units as a Basal just prior to disconnecting or just after reconnecting for the 30 minutes I’m off the pump for the shower and set change?

Another thing I had thought (but I haven’t seen on fasting days) was that at 05:30 my Basal goes from 0.325 to 0.4, could this increase in insulin in my system be triggering other hormones in my body and releasing glucose into my system.

I’d say you should try taking the 0.2 units just before going into the shower. Since you ate that many carbs (which to me is too many) you need to get ahead of it, rather than catching up with it later. Once the food is eaten it takes 20 minutes or so to start raising your bg, and waiting till later will be too late. Prevention is the key here, IMHO.

Increasing basal rates around the time we get up is usually best, since Dawn Phenomenon is fairly normal. THIS is what releases counter regulatory hormones and/or causes increased insulin resistance, either of which has the same results, higher bg level through the morning.

Yeah. What he said.

Terry

I do some insulin after getting out of the shower. I think .2 units is a good idea. One thing I have noticed after coming out of the shower is to “Prime” a small amount again. Sometimes when I check the very end of my tubing some insulin is missing. Can’t hurt to prime a little to make sure your insulin is meeting your canula.

Some questions:

When you do a set change, do you “bolus” enough to fill the canula? FWIW, my canulas need .7 units to get filled up.
Why 30 minutes when you do a set change?

When I shower/swim, etc. I generally bolus the amount of insulin that I missed, so I would agree with the .2 units, but I take it AFTER, not before to avoid going LOW, but that’s MY diabetes.

Fair Winds,
Mike

Thanks for the replies, plenty to think about.
On MDI I never suffered from a high rise in BG after breakfast, infact for the same breakfast that I had this morning I would never go more than 2mmol’s up on my BG.
I haven’t done that much testing, it’s only my 2nd week on the pump, but if i do suffer from Dawn phenomenan it doesn’t really show, I perhaps gain 1 to 1.5 mmol from 0600 to 1000.
I check the tubing and always do a prime to make sure there is no air in there.
Yes I fill the canula.
30 minutes isn’t just the set change, it’s from disconnecting, showering, shaving etc… and then puting in the new set and getting it going.

I think I’m going to try putting in the 0.2 units when i disconnect and then have a better look to see about dawn phenomanen. Incidentally on MDI I didn’t suffer from DP unless I took some insulin, to bring down a high BG for example.

Thanks.

I used to believe that injecting before my morning shower would somehow render the insulin less effective. I noticed that when I injected when I got up (= before the shower) my bg would be higher after the shower. Of course, more than one misunderstanding of how things work had to come together for me to concoct this story.

Now I have a CGM and see that the minute I get out of bed my bg starts rising. I typically wake up with a bg around 80 and half an hour later I am 120. This holds true whether I inject or not. Insulin is not fast enough to make a difference. Where it makes a difference is after breakfast. The bolus is either in time or late. I now know that showering has no special effect on my bg.