Waiting for the bend; serious confusion and pre-bolusing

OK, so i’ve been on line at TuD reading about waiting for the bend on the cgm for pre-bolusing. i have noticed that for my breakfast/any morning carbs, etc, that i need to wait 15 minutes before eating. it works out great. no spiking, no elevation in BGs after eating; basically, my BGs remain the same, steady as can be. however, one other thing that happens with both lunch and dinner is that i can’t wait more than 10 minutes before bolusing and eating. what happens is this: if i wait for the bend, even after i finish eating, my BGs go lower.

i am still attempting to test my basal rates as per John Walsh’s Pumping Insulin. it has been hard for me to get through all of it. i have had some success w/ my over-night basal rate but have not been able to complete the others b/c i either go high or low while i am tracking my BGs and then i have to abort the test. i have been gradually been lowering my basal rates as i have been going, but i am shocked at how little insulin i seem to need.

i read on another post that many people who go through the basal testing recognize that they have been using elevated basal rates to account for carbs in stead of the other way around. i believe that this is what i must have been doing for all these years on my pump. otherwise, how would i recognize how little basal to give myself. i have been lowering my basals across the board since i have attempted to do this test. i also read that while doing the test, start w/ a lower basal and increase it if necessary as you go.

i am very confused about how one waits for the bend as well as the patience one needs in regard to doing fasting basal testing. help? opinions? suggestions?

Everyone is different, of course. It you are eating more carbs at lunch and dinner, you may have to use multiple strategies to avoid those lows. I’m not so good at that myself (yet?) with higher-carb meals - I missed one way or the other frequently, but the “plan” I use is to take part (half?) of the insulin I need for the meal early and the rest as an extended bolus that will cover the meal as I go. I then wait for it to start (“wait for the bend”) and start eating. Alternatively, I’ve considered splitting the bolus entirely and taking the second part as I start eating (extended?) or shortly thereafter.

Note - I have NOT gotten it right every time yet - I do better at lunch than dinner - but that’s my approach, for what it’s worth.

I don’t know what you mean by your BGs going lower. Is that in the hypoglycemic range, less than 70 mg/dl? At what BG-fingerstick level do you experience physical hypo symptoms? What I’m wondering is if the trending lower numbers on your CGM are causing anxiety or if you’re feeling low symptoms.

The “bend” on the CGM can be 15 minutes or more after an actual BG drop. Perhaps this technique is more appropriate for you only when the CGM numbers are above 80. Of course all of this assumes that your CGM is tracking your fingersticks reasonably well.

when i say i am going “low” i mean below 80 (in the 70s) when my pre-bolus BG was about 100. and yes, my cgm is very accurate to my finger-sticks. but you’re right; i do get anxious when i see my BGs start to drop. i guess i just need to have some faith that they will rise again w/out my panicking. thanks.

Or you may want to consider adjusting your lunch and/or dinner I:C ratios if you’re going lower than you’d like after your meal boluses clear.

Just watching a BG that is trending lower is an appropriate reaction. For me, I start to sense low symptoms right around 65 mg/dl. My general policy is to not take action until the BG hits 70. If the angle of descent is low and no IOB then I’ll treat with only 2 grams of carbs. If it’s steeper or I have some IOB then I might take 4-8 grams of carbs. I find many times that my line will settle in the 68-75 range and just move sideways for some time. If I’m several hours post-meal I just watch and hope to ride this trend as long as it will go.

i know i will most likely be adjusting my i:c ratios. right now i am working on my fasting basal rate testing. i have been shocked to find out how little insulin i need. as per this fasting experiment, i have been gradually reducing my basal rates day after day (sometimes even during the middle of the day when i see the downward trends on my cgm)

thanks for the suggestion. hopefully i will get there sooner rather than later.

You always have to try to interpret your CGM level and trends in as complete a context as you can. I can’t decide what to do based simply on what my CGM tells me. My CGM is a very important piece of information, but not the only one I try to take into consideration.

If I am trending slowly down and I am running on nothing but basal, then I often may choose to just wait and see, especially if I have eaten something recently.

If I am trending down and my pump thinks I still have a “lot” … it’s a relative term … of Insulin On Board, then I’ll eat some proactive carbs to counteract the drop. How emphatically I react is going to depend on how fast the SG is dropping and/or how much IOB the pump & I may think I have.

People seem to have a tendency to ask, “My BG is xx, what should I do?” But this question by itself is absurd because it has no other context. And, in my personal experience, context is everything!

With obvious exceptions for BG values at the extremes, you can’t formulate a good response without knowing more about the other factors which may be in play which could influence your BG level. And the biggest piece of the context which is hardest for us to know is how your body usually responds to food, insulin, exercise, and the phase of the moon. No? :smirk: