Totally open ended question

What does this data say to you? Basal problem? Bolus problem? Both? Any strategies?

I can no longer see the forest through the trees. Totally stuck. I wont even comment unless someone asks a question because I don’t want to interfere with your instincts about it. There is correction bolus all over the place, so I didn’t even include it.

Without knowing more, gut reaction is your basal is too high to compensate for not being aggressive enough on your carb ratio.

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How far in advance do you bolus before eating? A few of your meals are high glycemic index foods. You may be dosing the correct amount for these meals, but by the time the insulin kicks in you’re already high.

For many people, once you’re high, you require more insulin to bring you back into range. Whereas if the insulin had kicked in at the right time, then the dose may have been correct.

Just my initial guess. Basal doesn’t look like as big of a problem as bolus. It’s difficult to say what the bolus problem is for sure.

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Generally I look for patterns over several days where my food, activity and schedule is somewhat constant. Does this represent a typical day ?.

Do you have thyroid or hormone fluctuations, or high stress ?

Was that some sort of sensor problem this morning between 7AM and 11AM? Looks like you were below 50 for 4 hours.

My gut feeling is your morning basals are too high. Myself, I HAVE to eat breakfast or else my bg just climbs uncontrollably all morning, and trying to deal with that through high basal rate just has worked out disastrously for me in the past. It’s just completely unstable in random directions unless I eat breakfast in which case my bolus for breakfast really helps stabilize me for the whole morning.

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@katers, I am administering bolus and then eating immediately. I do not currently pre-bolus.

@MM1, I would call these typical days - activity typical and BG results are typical (They have been doing this for 2-3 weeks.)

@Tim12, I don’t believe there was any sensor problem. I stand by that data. I woke up at 2:30am and started working on something. I ate some toast and didn’t feel great (BG was high), so I went back to bed for a few hours (hoping the correction would kick in and I would wake up feeling better). Woke up pretty symptomatic and hypo 9:30am. Over bolused on correction.

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I think what happened, is that your toast and bolus “reset” any dawn phenomenon and reduced your basal needs for the whole morning. (Others would write that as “enhanced your insulin sensitivity” but I’m less judgemental than that.)

I have ridden that rollercoaster so many times!!!

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This pattern likely gave you a rise rate alert. For me, a rise rate alert indicates that I didn’t bolus early enough. If you’re hoping to avoid these postprandial spikes for high glycemic index foods, then dosing a little in advance can make a HUGE difference. Even if it’s just 15 minutes. Of course, be careful to check to see if you’re already low or heading in that direction :slight_smile:.

I’m not sure if you’re familiar with timing your dose according to a food’s glycemic index. I’ve linked a few references below, but YDMV so it may be good to keep that in mind as you read these. For instance, ADA says that fruits are low glycemic index foods, but I’d place that food in the high glycemic index category. Also, keep in mind that if you eat protein or fat with carbs, you may not want to prebolus as early because protein and fat often slow down the digestion of carbs. A really good resource on this is “Think Like a Pancreas” by Gary Scheiner. Some people don’t eat high glycemic index foods at all, but I think this is more of a personal choice than a requirement (some of these links may state that though).

Also, the pattern below likely gave you a fall rate alert. Sometimes I’ll bolus too much so that I can get my blood sugar down quickly, but when I get close to the right range I’ll eat something to offset that drop and aim for a landing around 100. Looks like you did this better the day before at 12 PM. It’s hard to do this during the night though- maybe your cgm alerts didn’t go off?

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Those are a lot of carbs and some high GI.
I think the timing of when you bolus for that amount of carbs is causing the spike and drop.
I know if I am going to have a high carb meal, but don’t know how much it will be, I will give a smaller pre-bolus to get the insulin working in time, then give the larger bolus when I have a better idea of how much I really need.

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I don’t know if this would work for you, but when I’m completely lost about my BGs, I try to work on things systematically.

First I try to get my overnight blood sugars relatively flat. This means eating a really early dinner or skipping dinner entirely to see what happens overnight, and adjusting my basal rates to get a relatively flat line.

Then I’ll work on boluses for food and correction boluses.

I personally eat a low-carb diet to avoid carbs, because I’ve never figured out how to calm the collercoaster that results when I’m eating high-carb foods. I do agree with others that pre-building for meals can make a HUGE difference (I used to be able to pre-bolus for a moderate-carb meal and get a perfectly flat line, but then my physiology changed and that doesn’t work for me anymore).

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What it says is, “I have Type 1.”

This is not enough data to get a good idea what is going on, but I would suggest doing one thing: choose one meal to eat the same thing every day. (It’s breakfast for me). You don’t have to do it forever like I do, but having some area in your day that the food itself can be considered a constant may give you a deeper insight into your overall pattern.

If you can, do some overnight basal testing. Going really high and really low are often “rebounds.” If you don’t know where the initial event is, it’s hard to correct it.

A word about pre-bolusing. Pre-bolusing is a very powerful tool for getting your BG back in range. These three moments in your day are your largest concentration of insulin all day. This has been the #1 thing that I have done to get control of my numbers.

Unfortunately, the way you learn how to do it is by doing it. But here’s a few ideas about it and about food in general:

  1. Do you have a number you’re aiming for before you eat? I am aiming for 90, so if I’m above it by 30 points, I wait 5 minutes before eating after bolusing. (I also keep an eye on my CGM, but when I am going to bolus, I test)

  2. Do you have a certain carb count in mind for every meal? I am NOT low carb. My number is 60g of carbs per meal, but I am 6’3" and 174 pounds (and have been for quite a while). I may go a little above, but not much.

  3. Are you making sure you get protein with your carbs? Protein helps regulate the uptake of glucose from your carbs (as does fat). I find, too, that protein without carbs can do weird things to my BG.

  4. That leads to your diet. What I mean by diet is “what I eat.” Sitting down with a nutritionist was extremely helpful in finding the right amount of carbs and balance in my diet. Plus, the nutritionist helped me become a carbohydrate whisperer©. An accurate count will determine how well you bolus.

  5. Consider the nature of your food. I have heard some say that carbs are carbs. In a sense, yes, but some carbs are more carby than others. You will discover, if you pay special attention, that some foods are your Kryptonite. Bananas are a wonderful fruit-- but they just don’t work for me anymore. Grapes are glucose hand grenades. I can eat them, but it makes control more difficult.

You may find ways around that. Brown rice instead of white. Whole wheat bread instead of white. The Beatles instead of the Stones.

Good luck.

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Lot of good information here.
I like to have a mid morning snack bar.
I need to have the fat content about equal to the carbs. Protein about 50% or more compared to carbs.
If I have higher carb meals, I personally need to have a lot of fat content.
And if I have a protein only meal, I can go into DKA with normal BG numbers. (rarely, but has happened more than once.)

I did a lot of what you mentioned. And it worked great when I was trying to get a grasp on my basals and what to actually dose for what. Same meal at the same time of day. I shoot for 30 to 60 carbs per meal.
Fruit and veggies kill me though. Which is a shame cause I love them, and need more of them.

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I totally agree with katers 87. Mohe0001 I have been going through a phase very similar to yours lately and I’m at my wits end with it. My brother who is also a diabetic told me to take my meal bolus 15-20 minutes before I eat. That has really seemed to help me stay under 150 after my meal, which I’m thrilled about as they were going up to 250 after breakfast and dinner.

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If I were you I would start removing as many variables as possible to get a clearer picture. For me that would mean to cut carbs from the diet to a bare minimum, eat only the food I know from previous experience is safe for my bg, take it easy on bolusing, make sure I’m somewhat healthy (no colds, flue, etc). The bg will stabilize within a certain range over a few days and it will be possible to make some conclusions and adjustments about the basal. Then I would carefully introduce carbs back into my diet to make sure the ratio haven’t changed and is still the same. Everything would be back on track within a week with predictable and explainable highs and lows now.

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Thanks so much, everybody. Very helpful. This is what the data looked like on Feb 6th, before any basal adjustment.
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So, at least the morning DP is improving. Gotta look on the bright side, I suppose.

One question: I have never implemented this many basals - currently six. I’m finding it difficult to run tests on all of them and its taking many days to get a good handle on what each one is doing because there is day to day variation.

If I start running a 1.25 u/hr basal at midnight, but I only run it for three hours, can I even get good data off that? Or, is the previous 1.45 u/hr basal still in effect for a couple of hours? If so, I might only be able to see the effect of that basal right around the 2-3am point. I see a rise there at the 3am mark. Is that suggesting that 1.25 is too low???

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It really depends of course, but it usually takes about an hour, or more, for the different rate to show up.
I would start the increase in basal rate about an hour before you are seeing the increase in BG levels. Then adjust from there.

Well, would ya’ look at THAT!!! Seems to have been a bolus timing problem. This is the first day of relatively stable AM data that I’ve seen in some time. I should have asked you all sooner. I ate 2 pieces of lower glycemic bread, pre-bolused by one hour, and increased my bolus from 2 u/15g to 3 u/15g…just to be on the safe side.

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Prior morning meals have all looked like this (at least a 200 point increase):
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It kinda makes sense, in retrospect, that I might see a 100 point increase for every 15g of carbs if I didn’t take any insulin at all. So, a 200 point increase in postranials, after eating 2 pieces of toast, might be expected if the sugar was beating the insulin on the race into my bloodstream.

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I’m glad you’re seeing better results :smile:. Prebolusing can take some fine-tuning, but it looks like you’re already on your way to figuring it out. Congrats!

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