Two days ago, I came down with a nasty viral infection. I had been having a great trend of overnight BG control. I use a CGM so I'm able to monitor this. Two nights ago, my Dex alarms woke me up to 200+ BGs. Even though I made three high BG corrections during the night, this persistent 200+ high greeted me in the morning.
Since the BG correction insulin doses did not seem to matter, I decided to set a +200% temp basal and see what happened. Over two to three hours my BG flattened out at about 110 and proceeded to travel sideways.
After about 4 hours of this temp basal, I let it time out. What I observed was a slowly climbing CGM line. I decided to forego my usual late morning meal in the interest of keeping my BGs in a good range. That evening, I was able to eat and the post-meal BG line was normal.
Today is day three of this illness and I've been alternating between +200%, +100%, and normal basals, with the majority of time under some temp +basal % rate. My BGs have been controlled very well.
Another TuD member, acidrock, has mentioned his use of temp basals in his bag of tricks. I would have been timid to try the +200% without his experience. I caution anyone interested in trying this out to be extra vigilant monitoring their BGs with a CGM or at least an hourly fingerstick. This includes setting multiple alarms if you run them overnight without a CGM.
It's kind of amazing to me that the elevated temp basal can pull down a high BG when the correction dose doesn't seem to have any effect.
The doc told me last night that I probably wouldn't feel better for six days. Oh well, at least I can expect to feel better in the not-too-distant future. People with a working pancreas have no idea the advantages they have!
Terry, I have been seeing the same effect with carb miss counts for meals as well. I get a better response to a temp basal then a correction.
I'm using a t:slim and a Dex G4, I'm only 8 months into pumping and a year plus from dx but I find the micro delivery helps tremendously with control. It may be because I'm still making some insulin, so I don't need as much to help out, but the slow trickle works better/absorbs better than the big bolus.
Had to drop my rates by around 50% when I changed from MDI to the t:slim.
I have done the basal testing so I know my basal rates are good when I do not eat. And my carb factors are good if I have accurate carb data, and my correction factor checks out as well with defined situations. But when the meal time carbs are a guesstimate a temp basal works so much better than bolusing for additional carbs. If your pump lets you dial in a percentage and a time frame then go for it for mealtime corrections as well. Especially if you have a reliable CGM that lets you see what your trends are.
I've been able to get my A1C down to 5.5 without lows using this approach, granted YMMV.
When I changed to a lower carb diet almost two years ago, I started to bolus for fat and protein as well as carbs. The fat and protein bolus is always delivered over time with a max delivery rate of 1.2 units/hour. I've had great luck with this regimen.
If I need to make a correction post meal, which is not often, I still use the single correction dose and that works well for me.
You're so smart to make strategic use of the partial help you get from your pancreas. I wish I knew some of these techniques when I was at one year post diagnosis. I suspect that your techniques will extend your honeymoon period. Good for you!
