Advice

[Jess1D]

Good morning
I am using the Medtronic 640
I have 2 different basal rates set up- 1 for work the other for days off
This am 7am woke up & was 8- gave pre bolus of 1.8 units for coffee (oat milk)
Half an hour later Dexcom read 9.1, so had my coffee as it was needed
40 mins later after bolusing again - 1 unit I was at 11.4
Had walked the dog for 30 mins
I then bolused for breakfast 22nd and carbs & have continued to rise despite correcting

Feeling really stuck with this

Is it my basal rate that needs changing or what?

Many thanks

 

[Chas C]

Did you try changing your cannula ?

 

[Hopeful34]

It maybe worth also changing your insulin to a new vial/cartridge

 

[Jess1D]

Thanks I only changed my site yesterday
Numbers are in range now- just frustrating as felt that they were stuck at 12 for ages
Any advice??

 

[Juicyj]

Hi @Jess1D

Is this a one off or has this happened a few times ?

Personally I wouldn't touch basal rates from a one off experience, if it was a regular pattern then yes, you could do with doing some basal fasting tests to check your background ratio is correct, using a pump this is important to review regularly anyway. As a female we have the additional delight of hormones to interact with our ability to manage t1d, this can cause levels to rise as well as illness/infection/stress/heat etc. Just be mindful that many things can affect our ability to stay in range, but unless it's a regular event then it's best to correct/change insulin first.

 

[Jess1D]

Yes it has happened more than once

 

[Juicyj]

Hi @Jess1D

In that case it's best to do some basal fasting tests, have you done this before ?

In case not, here's a guide: https://www.mysugr.com/en/blog/basal-rate-testing/

 

[Jess1D]

Yes I need to look at this. Thank you. Another question so with my job I am finding I seem to stick anywhere from 10-14 about 10am onwards - trouble is I commute by bike to work so normally by the time I get home I’m crashing really low
Even though I correct at work (tends to be sticky if I am stuck on til - work at Lidl) it doesn’t seem to budge yet by the time I get home I’m dropping
So frustrating

 

[Juicyj]

Hi @Jess1D

Insulin sensitivity can vary through the day as again with exercise, so being sat down all day would push me into double digits but as soon as I am on the move and picking kids up from school/shops etc I drop low, it's a case of reviewing your quick acting ratios in line with the time of day/activity levels, so more insulin in the am and less in the afternoon, an idea would to be have a carby snack before you set out on your bike too, say 10-15g of carb to help cushion the fall and no quick acting insulin for it.

 

[In Response]

@Jess1D do you suspend or reduce your basal for cycling home?
I find a temporary basal perfect for exercise. I can set it 30 to 45 minutes before I start exercising to last until 30 minutes before my exercise ends,
In fact, this was the main criteria used for me to get a pump in the first place.

 

[Jess1D]

Thanks for the reply
I’ll be honest no I haven’t thought of reducing my Tbr for cycling home.
I’ll see how today goes
It doesn’t happen everyday but most
Just don’t like the fact that I will have corrected & it just doesn’t budge
When I got back yesterday I was 5.4 & dropping 2 arrows - bit scary

 

[Jess1D]

Please can anyone advise? So this am started at 5.8 upon waking- gave 1.5 units for coffee (which is more than enough) about 15 mins after coffee it’s showing 9 so I then bolus for breakfast -now have 5.5 units on board
So went for gentle bike ride with dog for 10 mins to get my body moving & still sitting at 10.3 what is going on? Now in fact at time of posting it’s 10.7 see attached

 

[Jess1D]

 

[Chas C]

One of the best bits of advice my consultant gave me was to deal with and eradicate the lows first, its the bounce back from these that can cause unexpected highs. Once the lows are fixed then work on the highs. So I'd adjust basal to remove the early morning low at 7am first, give it a few days and see what the mid morning looks like before adjusting it.

 

[mentat]

So went for gentle bike ride with dog for 10 mins to get my body moving & still sitting at 10.3 what is going on? Now in fact at time of posting it’s 10.7 see attached

10 min is not enough to get your muscles fully in exercise mode. Sometimes (especially with lots of insulin on board), 10 minutes of exercise can have a big impact on your sugar but other times it may not have much effect at all. Mornings are often the worst in terms of insulin resistance. On top of that the CGM has up to 15 minutes of time lag! You can use it to understand how a meal affects you over a 2 hour period but using a CGM to manage things in 15 minute increments is going to leave you jumping to the wrong conclusions and chasing your tail all the time.

I wouldn't panic about sugars of even 12 or 13 while you work this stuff out. Iron out the wrinkles gradually.

If, however, you are finding that things that work well for a while stop working, and this keeps happening... I'm the person to talk to.

 

[Jess1D]

Hi
So it seems my nighttime blood sugars are increasing & also in the am- I am planning to make adjustments to my basal rates- does anyone have some advice please? (Emailed my DSN over 3 weeks ago about help with menstrual cycle high numbers-no response)
I seem to be sitting around 10-13
Should I just increase by 0.25 or 0.50
Many thanks

 

[Jess1D]

Accepting I've got no experience of dealing with same issue, I would look at your insulin sensitivity - how much insulin you need to drop you by 1 mmol. Then about 2 hours before it goes high you need to increase your basal, if your sitting stable at 10-13 then you probably don't need to adjust for whole night, maybe just few hours. I normally adjust by 0.1 to 0.2 but this depends upon your normal level settings, mine are around 1 unit per hour (so between 10 and 20%). I would add this is for normal adjustments and not sickness where I sometimes need to go much higher.

Thank you. I’ll be honest I’m a little unsure

 

[Jess1D]

Thank you. I’ll be honest I’m a little unsure View attachment 57835View attachment 57836

As in how much I should increase
Mornings can be a right mare to be perfectly honest

 

[Chas C]

Hi @Jess1D I have different pump, it allows me to set 14 timeslots, so most are every 2 hours with a couple set at 1 hour. I think you can add more ?. You seem to have only 6 slots set, if you add another 6 then you have 2hr slots. You can copy exactly the one before - when filling in the gaps, so no change. Then once you have this you can adjust in 2 hr timeslots to suit your BG readings.

 

[Jess1D]

Hi @Jess1D I have different pump, it allows me to set 14 timeslots, so most are every 2 hours with a couple set at 1 hour. I think you can add more ?. You seem to have only 6 slots set, if you add another 6 then you have 2hr slots. You can copy exactly the one before - when filling in the gaps, so no change. Then once you have this you can adjust in 2 hr timeslots to suit your BG readings.

Thank you but what would you recommend I should increase it by
I’m hoping to set it up tonight