I’m waiting for a phone call back from my pump trainer right now, just so you know.
I am wondering how long it takes for your basal rates to stabilize. I have done the basal testing and know that they are on spot right. However, in the last week or so I seem to be dropping rapidly after some meals. I purposely had pop tarts and bolused according to the info on the box,73 carbs for 2 pop tarts. 3 hours later I dropped to 51 BS. I started at 133 fasting this morning after having to treat a 47 BS last night after 45 carbs and 4 hours later. I know it’s not by basal because the tests are perfect ( i did those this weekend). My current ratio is 1:7 at 7am,1:13 at lunch, and back to 1:7 for dinner.
My trainer is great but sometimes I feel like she dismisses some questions that seem important to me. Any answer and advice is welcome!thanks
Is it possible to need your I:C readjusted after getting basals stable? Even if the ratio was working before? Also I have had a weight loss of around five pounds in 6 or 7 weeks which is not out of the norm for me as I fluctuate in that department.
Hi, Tracy. The two rates are strongly related. Once you establish accurate basal rates, then you need to adjust I:C ratios to obtain desired results. Have you looked at the book Pumping Insulin (Fourth Edition) by John Walsh? It is a BIBLE of pumping information – including testing/adjusting basal and bolus rates. I purchased it shortly after obtaining my pump and find it worth much more than the purchase price.
(Please note: I am NOT related to Mr. Walsh!)
No, I haven’t looked at the book yet. I will be looking it up on Amazon though because this first 6 week has been full of crazy ups and downs. Thanks!!
What tests did you do that you say that your basal tests are perfect?
I did basal testing, beginning with a normal fasting BS (for instance mine was 98) and then testing every hour for 4-5 hours while continuing to fast and not needing to treat a low or correct a high. Mine for several days and at different fasting times stayed within 5-10 points of my starting BS. It was great to know that if I chose or had to miss a meal I would not end up in trouble. However when I do eat it apparently sucks to be me right now!
Then it’s definitely your I:C ratios and insulin sensitivity. Have you tested those also? When you eat very high carbs like 70+g in your case you should be very careful about taking large insulin doses. Anytime your meals require 7+ units of insulin, it’s better to split the carbs so that you don’t take that much insulin in one bolus.
never thought about splitting, like an hour apart or so? that might be good for future reference. I don’t know if there is a way to test I:C and sensitivity. its changed since the pump start and will prob change a few more times!
Are your physical activity and stress levels the same during the week compared to the weekend? I had a problem that during the week my physical activity was higher so I had to lower my basal during the week.
Click here to order the book through Amazon and a small donation is made to TuD (you pay regular Amazon rates).
Hi Tracy!! I can relate. It took a while for me to get my pump settings right in the beginning, but keep at it. It’s worth it.
It is possible that your I:C ratio will be different than when you were doing injections. Because on injections sometimes we are actually using extra bolus to cover at a time of day when you would need more basal.
When is you basal rate the highest? Usually you need more insulin to cover the same amount of carbs at the time of day when you also need the most basal. (i.e. a time of the day when you are more resistant to insulin).
Yeah, my I:C is way different than when I was injecting. I highest basal is in the am from 7 to 1:30. According to my trainer ( who was in a training all day along with everyone in both offices so I have not heard from her yet ) my basal’s are so small that any missed carbs or over bolusing is going to cause me some problems. When I first started on the current basals things were good and my numbers were pretty close to target. Thats why I am wondering if there is an adjustment period. I think I am an alien and need to go back to my home planet.
I’m calling in my BS to my endo tonight, maybe a different person looking at things will help.
Thanks for the info about Amazon too!!
I know that the policy my current endo uses is to reduce people’s insulin by 20% when they start on the pump. His theory is that we need less insulin on the pump because we are not ‘feeding’ the long-acting insulin.
Not sure if it is true, but an example that for some things really do change!
I just thought I’d mention a trick my trainer taught me in order to test I:C ratios throughout the day - she called it the turkey sandwich test. Basically the idea is to eat the exact same thing for breakfast, lunch, and dinner for a day or two (her example was a turkey sandwich, but you can obviously choose whatever you like as long as you know the amount of carbs) and bolus for the same amount each meal. Then test 1-2 hours after eating and again about 4 hours after eating - but don’t bolus until after the 4 hour mark if needed. She said doing this for a day or two will tell you if you need to increase/decrease your I:C ratios, how your ratio might change at different times of the day, and also will give you an idea of how quickly you metabolize the meal & process the bolus. Of course, it only works if you eat the same thing for all meals - which is a little boring, but makes it easy to determine I:C ratios.
It may not work for everyone, but I found it really helpful after starting on my pump because my I:C ratios changed quite a bit after MDI’s - so I hope this helps!
Nono, I just meant that you only eat the same thing for those 1-2 days, just to measure your carb ratio to see if it should be raised/lowered at certain times of the day - not that you should eat the very same thing day after day after day forever and ever. I could only manage that for one day, not even 2! O.o
I think she just recommended it for me because I always used to guesstimate my boluses while on MDI’s, and hadn’t seriously carb-counted before going on the pump. But insulin needs changed after starting on the pump, I was feeling a little lost and was having trouble figuring out my I:C ratio at first. So this just helped me to find a good starting point before adding in activity/stress/time of day/etc.
But I agree 100% that eating the exact same thing day after day is crazy talk…and a bit depressing, too. I’m definitely a foodie, so just 1 day of that was hard enough for me
I would have to agree with the others that “IF” your basals are good, then it must be your INSULIN:CARB ratios that are causing the grief. You lunch/afternoon ratio of 1:13 is almost double the ratio for the morning and evening, which seems odd to me (I’ve never really tried to figure out my I:C sensitivity throughout the day, so maybe this is normal…I have a 1:20 ratio that seems to work pretty well for me throughout the day).
I would guess your morning I:C ratio is too low, from my view here in the peanut gallery. But that’s just my guess. If you started at BG=133 and wound up at BG=51 3 hours later, that means you had a net drop of 82 BG points. Assuming you used the 1:7 carb ratio for you breakfast, you would have bolused about 10.4 units of rapid acting insulin. So if those 10.4 units pushed you 82 points south of where you started, that means each insulin unit dropped you “roughly” 7.9 BG points lower than what you wanted/intended.
I’d try raising your I:C ratio to 1:9 or 1:10, eat a similar sized meal and bolus according to the new I:C ratio, then retest at 3 hours (and perhaps earlier too), to see what happens. If it works, try it again the next day to see if you get a repeatable, good result. If it doesn’t work, adjust your I:C ratios up (if your BG still goes low) or down (if your BG stays too high) and keep testing.
Wishing you the best figuring out this “D” puzzle,
Regarding basal insulin: Timing of the peak of the insulin does not match the digestion of food. You have one of three scenarios: Food digests before insulin has finished working, so you will continue to drop the amount “insulin on board” in the pump (or Using Insulin book) indicates; insulin cannot handle the high glycemic index carbs well, so even though the carb amount is correct, you will need to give more insulin to handle the food eaten; or, rarely, at the four-hour mark, you will be in range. After the first year and the honeymoon ended, our endo told us to test two hours after each meal and adjust from there, giving either more carbs or insulin as needed. One gram of carb raises her blood sugar five points, so it is easy to do the Math. Basals also change for us (she is in puberty). Was hoping to hear that basals remain more stable in adults. Sadly, that may not be true. In our case, she has certain patterns that she usually adheres to for the most part. Basals will increase and decrease within these time periods. She is relatively stable and flat from 3am to 3pm. Starts rising after 3 p.m., incredibly heavy and extremely variable basals during the hours 6pm to 12pm and usually a somewhat high basal until 1:30 or 2:30 p.m., when she drops to a flat rate. The 6pm through midnight basal needs tweaking and adjusting every two days it seems. There are small basal changes (0.5) and variations during the hours of 1:30 or 2:30 am. and 3 p.m. Unfortunately, at the time of great basal variability, that is the time we should be getting our sleep! Excercise, heat, etc. changes the rates as well. You will get to know your own body. And I hope the artificial pancreas comes out soon because I cannot imagine her staying up and doing all this on her own as an adult. Diabetes is another part time job!
I like 2 cent’s. They are helpful!! I also never carb counted before so it’s totally new for me!!!
Everyone thank you soooo much! This was helpful in figuring things out and helping with the confusion!! It’s soo appreciated as I am sure you can all relate to.
Typo: First sentence should read “Regarding BOLUS insulin,” not basal.
It sounds to me that you insulin to carb ratio is off, or, that your sensitivity numbers are off. As a rule, Joslin Diabetes Center in Boston Mass (Where I go for all my diabetes health needs) started my I:C ratio at 1:15. They said that that number is the basic syandard they start at. Good Luck!!