Started seeing a CDE on 12/18; unable to control low BGS. Was taking total basal of 8.6u at my first visit and a total of about 12-14 units per day. She had me reduce the basal to 8.05u and the fun started. Within days, my total insulin daily went up to 17-20 units, due to corrections. I was not correcting until meter BG was 180 or above. In most cases it was well above 180–250 and higher. Then things got crazier. I am now taking a higher–much higher–basal of 10.35, based on changes she instructed. My CGM graph on my pump looks like a roller coaster.
Overnight, I am going to 230 to 280 about 12-2AM. I correct. Then 2 hours later, I wake up and test at 375 and higher. I then correct by injection, as I am following the protocols she gave me, and use the bolus wizard for all dosage calculations. No ketones. Then I test at 8AM below 70. Then morning starts and by 10:30-11 AM I am up over 250 again.
I am changing my infusion site nearly everyday. I am stressed out, not sleeping well, afraid to really do anything out of the hose, and everything is so variable. These BG swings upset my stomach. I am stressed to the max. I am not ill–no cold, flu, etc. No med changes or other obvious causes.
I had problems with lows before going on a pump - in fact that was why I went to the pump. For me the solution involved carefully setting several basal segments – more during times when my BG was otherwise rising, less at other times. Overnight, my BG is now nearly perfectly flat. Daytime BG’s vary more, but that has more to do with meals, activity, stress, etc. Sounds to me like you need to do some basal testing to get things right – without that, I think you’ll be chasing your tail all day long and only ending up frustrated. Note - I am not a doctor, but you should talk to your endo about basal testing, as the currenty plan is clearly not working for you.
At breakfast this morning, BG meter said 52. Ate two slices bread and used the bolus wizard to calculate the dose at 8:21. At 9:49, meter BG was 219, a 167 point rise in about 1.5 hours. New infusion set, new vial of insulin, corrected.
Thanks. I have suggested basal testing to the CDE, as well as my endo, but have not gotten a positive response. May just consider doing it on my own. Something has to change.
Just a passing thought–the bolus wizard is only as smart as the data fed into it. Might your I:C ratios be out of whack? That would cause it to give calculations that don’t work well.
@Sue27, what a mess! Your total daily basal at 8 units is very low. That’s only about 0.33 units average per hour. When you say “unable to control low BGS,” before the CDE 12/18 appointment, did that mean that low treatments did not bring up lows or that you were having lots of lows? Did you understand why the CDE reduced your basal profile? What time segment did she reduce?
It’s been my experience that when things get crazy, I need to start with the basal rates. While you do appear to respond wildly to the upside with any eating, not being confident about your basal profile makes any analysis difficult. Also you mention eating two slices of bread. It may help while you are trying to sort things out to try to use less challenging food. Since you’ve dealt with this for a long time, you’re probably aware of what kinds of foods don’t drive up your post-meal BGs as much.
If I were you, I would go through a formal basal setting protocol like Gary Scheiner’s as posted on his web site. This means some limited fasting. Are you up for that?
You’ve already been stressed out so much, perhaps basal testing is the last thing you want to do. I’m thinking that you have two things that need to be adjusted: the basal profile and the insulin carb ratio (I:C). The I:C number may need to be based on time of day also.
When was the last time you tried a different infusion set? I ran into problems like you describe when I used Inset 30 degree sets. I had been using them for years when my body decided it didn’t like them anymore and went wonky. All of your difficulties could be explained by erratic and overall poor absorption. Have you ever tried steel sets?
Sorry if I’ve added too many variables to think about. Maybe you could just start with one idea, like basal testing, and follow through with that. Fasting has always calmed down erratic BGs for me. Good luck. I know this is hard, even harder with out-of-range BGs. You will figure this out!
Thanks, Terry. All good thoughts. I was having a lot of low numbers, but they reacted well to treatment.
I have changed my infusion site and gear everyday for the last three days, trying the most unused sites I have remaining after 12+ years on a pump and CGM. Was confident about the insulin, as it lowered BG through injection. But I will try anything right now, so even broke out a new bottle this morning.
My I/C and correction factors have been in place for years, so maybe that is the problem. I upped my overnight basal today, and want to see how that plays out, then I will play with those two factors. Great thoughts!
I:C ratios and correction factors do change with time, age, and a zillion other variables. It’s important to revalidate them every so often. Certainly warrants checking into.
Just a point of information. I’ve been changing my basal profile several times per month. I’ve discovered, for me, it is not a set it and forget it pump setting. I also recently changed a long standing I:C setting.
Last year, I found that my ISF or correction factor needs to be more aggressive the higher it is. For me, I use 1:40 for BGs => 240 mg/dl and 1:50 for BGs < 240 mg/dl.
I also change basals a lot. I have been advised to allow them to work for at least three days before additional changes are made. I have been trying to follow the protocols and learn some new things, so I am giving them a shot. For now. I need my D to improve, as my life is revolving around it right now.
When my BG meter test is over 200, I add a bit to the correction, as I have always needed that extra boast.
My I/C is 1u to 17 c; correction is 1:65. These are the next things I am going to try. You guys are so smart!
I agree… I wish it was that easy, but my basals are anything but a “set it and forget it” scenario. Depending on where I am in my cycle I might need as much as twice as much basal as other times (or more accurately, after my period starts I drop my basal to less than half of what it was just before or I’ll fight lows almost constantly for the first 3 or 4 days) while my my I:C and ISF vary only slightly.
If I “waited” 3 days to make changes each time I’d probably end up in the hospital.
While I understand the motivation of our medical advisors to be patient with pump changes once they are made, I find that I need to be more nimble than that sometimes. I see their advice as more cautious than needed probably intended for less seasoned users.
My hat is off to you for surfing around a monthly hormonal flux that I’m grateful doesn’t affect me!
Sorry you’re having such a miserable time. I’m amazed that you’re able to sleep at all.
I agree with you that you need a round of basal testing. If you can smooth your overnights out (at least somewhat) you might then be able to make some progress on other segments of the day. When do you go to bed and what is your blood sugar at that time?
Your new basal is less than 30% higher than the 8.05u. Every winter I end up bumping my basals by about 20% to level out much smaller highs,
I am not on a pump but suffer from extreme fluctuation with BGL. I have to change mainly my basal which is Levemir (twice daily) to match my day’s activity. I keep good records and the majority of nights I wake up between 2 and 4am. I always test during this period because this is the time when my Cortisol levels are the lowest and when my BGL will be the lowest (while I am sleeping).I use this reading to adjust my PM Levemir injection. For me Cortisol causes DP if I have high Glycogen reserves (when I have been inactive for a few days) and if I have not had enough PM Levemir. The rise in Cortisol levels of a morning raises BGL and is what makes you wake up and ready to face the day.
I have had to classify my foods into High, Medium and Low GI categories. I have another category called Rocket Fuels. These are the 5 P’s; Pizza, Pies, Processed Potato (Deep Fried), Pasta and Processed Foods with heat involved with their manufacture. Heat especially above 130 Centigrade, breaks the branching bonds of starch allowing more sites for enzymes to break down the saccharides into glucose.
When things start going wrong for me, I have to
Keep good records
Make sure BGL are below 6 mmol/L(108 mg/dL) and falling before eating breakfast
Match morning injections (Bolus and Basal) and food GI for the day’s activity
Adjust PM Basal according to 2 to 4am BGL
I target a lower BGL and have to test a lot to make sure I am not in the hypo zone. Bad days 20+, good days a minimum of 5 but usual 8.
I had to work out what works best with different conditions for me to achieve the good results.
