does this mean I have not been getting Basal?

[fairylights]

I started on my pump in August and I'm still setting things up - it probably took em about the first four weeks to get my basal set for the period from 2am until noon and now the weather's gone cold it needs a bit of tweaking, going to do lots of testing when I'm off next week. It probably took me a few more weeks to get noon until 6pm sorted, not sure I've got 6pm until 2am sorted at all. I'm still testing a trying things for exercise, have started tweaking boluses but a lot more work for me to do here ........

 

[lely]

Hi @iHs yes I've always thought I need more bolus in evening during to it being my laziest time of day and the largest of my meals carb wise. I've got my Bg target at 7 with a + - of 2.4.
I understand what it means the + or - but not sure on the impact it has on the pumps calculation. I do think I need to adjust correction dose as I had another low bg at around 4pm today had not eaten since 11.40am and a correction dose was included as I was at 12.1.
I don't know what the 100 rule is. I'm sure it must be in this book but not read all of it yet.

 

[iHs]

Until you are able to get most of your basal rates sorted ok, you might need to adjust your correction factor to suit different times of the day. Once your basal rates have all been adjusted to being ok, the correction factor will probably stay somewhere near the same unless a drop or increase in insulin is used as the TDD.
The 100 rule
http://www.dlife.com/diabetes/information/slide_show_pdf_files/The_100_Rule.pdf

If you dont want to increase your bolus for the eve meal, then you can do some corrections every 2hrs and just see how much correction dose is needed over 4hrs to get you back to your target of 7mmol.

 

[Gaz-M]

well seen my DSN and overall she was happy apart from the morning lows so these have been addressed, I set a -10% basal rate last night and that seemed to have done the trick (no hypo this morning ) but was 10.2 at 3.30am.

Seems the basal rate is set as I am really sensative to novorapid and on a tiny basal rate of 9.22 units per dayand averaging 18.4 units in total per day down from 30 units, average blood glucose is 8mmol over the last week.

This may be a better graph of the basal dosage as the other programme did make it look alot more up and down



Still work in progress and to be honest I totally forgot to ask about the basal rate profile settings

 

[azure]

That's a nice, clear graph Personally, it still looks very 'steppy', which I think is what others have said earlier. The section that particularly caught my eye is the one between 3am and 6am. Up but then down a fair bit, then up to a more average kind of amount. I don't get that.

I'm sensitive to insulin too. My total basal is 7units per day at the moment (it goes up and down a bit over the year). I don't have a graph but my basal remains the same for some hours in a row, whereas yours doesn't do that so much. My highest basals are in the early part of the morning to cover my Dawn Phenomen. So they start rising gradually and reach a high around the time I'm about to get up. Your higher rate at 3am doesn't seem to do similar. It's just a one-off almost.

How long did you run the reduced basal last night? And is the graph your new basal rates adjusted by the nurse today?

 

[tim2000s]

I like this graph from Gary Scheiner (from this article http://diatribe.org/issues/26/thinking-like-a-pancreas).

What he basically says is that most people have a peak and a trough throughout the day (note that this doesn't mean everyone does). The article is worth having a read of, but yours does seem to be multi-peaked!

Have you basal tested it?

 

[Gaz-M]

I suffer from Dawn Phenomen aswell and when I had the CGM my blood sugar was in the 30,s at that time of night, every night the CGM was on, I was up at 3.30 this morning and reading was 10.4mmol on the -10% reduction which I had running from 11pm last night until 9.30am today so that reading would be lower if the reduction was not on, as you can see my levels drop around 6am and hence the early morning hypos (these were hapening prior to the pump aswell) and lows around lunchtime which is my bussiest period in the day for me.

Yeah @azure those are the reduced ones set today, @tim2000s no not a night time basl yet, I set my alarm 3 nights in a row last week and I never woke up to do it but I did wake up in the low 2,s on these days so I was probably lower then that when the alarm was going off, as I normally only eat twice a day (a small beakfast and a large evening meal) round about 6-7pm, so I think that probably is the 2 rises on the graph, high bs middle of the night and a hefty tea. Having had a few highish readings mid afternoon will be interesting to see what they are like tomorrow when I'm back at work @ getting stressed at the thought of it hahaha)

 

[iHs]

Hi @Gaz

it's difficult to know what the basal rate changes will do to your bg until you start testing every hour. Also, as you don't know if you need to allow 2hrs for bg to change or just the 1hr as the Insight like the Combo has 24hr basal rate time slots. The only way you will know is to test bg with existing basal rate and same amount of carb (same food), same bolus and then alter the same basal rate the next day, eat same carb, same bolus and then see what time your bg starts to change. That will then give you an idea of adjusting the correct basal rate time slot.

 

[Gaz-M]

@iHs yeah that sounds like a plan, I will do this over the next few days, I started writing down what food I am eating last Thursday so I can go back to the record book and see what my readings were 2 hours after, so next time I have it I will test 1 hour after, I started writing down what I was eating so if I spiked I could change the bolus type as I have only been using the 'normal' bolus.

Thankyou all for the help

 

[tim2000s]

I suffer from Dawn Phenomen aswell and when I had the CGM my blood sugar was in the 30,s at that time of night, every night the CGM was on, I was up at 3.30 this morning and reading was 10.4mmol on the -10% reduction which I had running from 11pm last night until 9.30am today so that reading would be lower if the reduction was not on, as you can see my levels drop around 6am and hence the early morning hypos (these were hapening prior to the pump aswell) and lows around lunchtime which is my bussiest period in the day for me.

Yeah @azure those are the reduced ones set today, @tim2000s no not a night time basl yet, I set my alarm 3 nights in a row last week and I never woke up to do it but I did wake up in the low 2,s on these days so I was probably lower then that when the alarm was going off, as I normally only eat twice a day (a small beakfast and a large evening meal) round about 6-7pm, so I think that probably is the 2 rises on the graph, high bs middle of the night and a hefty tea. Having had a few highish readings mid afternoon will be interesting to see what they are like tomorrow when I'm back at work @ getting stressed at the thought of it hahaha)

You say the peaks coincide with food. Interestingly, that's what Scheiner says we shouldn't be doing with basal and indicates substitution for bolus...

 

[Gaz-M]

You say the peaks coincide with food. Interestingly, that's what Scheiner says we shouldn't be doing with basal and indicates substitution for bolus...

my bolus needs on a teatime have been 1/2'd by doing this or I pressume that is why the blocks rise at the times they do

 

[tim2000s]

my bolus needs on a teatime have been 1/2'd by doing this or I pressume that is why the blocks rise at the times they do

Which suggests that your basal is substituting for bolus.

 

[Gaz-M]

who knows............. I know next time I go I need to write things down to ask as my memory is not the best

 

[irrationalJohn]

I know next time I go I need to write things down to ask as my memory is not the best

I think that's true for almost all of us. Part of the problem is that while a question may seem well poised in our mind before we go in for an appointment, we get distracted by the Q&A exchange during the actual meetup. I also am trying to keep a list of question or concerns to bring up at future appointments.

Does your DSN also use an insulin pump? Or is she navigating this with "book learning"?

 

[Gaz-M]

I don't think she is Diabetic, but she is well trained and have been seeing her for the past 16 years or so. She does know what she is doing and I trust her 100% and if it was not for her I would have not have gotten the pump as my A1c was good @48 down from the 70,s in January, but this being a false positive due to many many hypos and highs and like you say, we have all the intension of asking questions but can sometimes get side tracked/forget easy.

 

[lely]

I started on my pump in August and I'm still setting things up - it probably took em about the first four weeks to get my basal set for the period from 2am until noon and now the weather's gone cold it needs a bit of tweaking, going to do lots of testing when I'm off next week. It probably took me a few more weeks to get noon until 6pm sorted, not sure I've got 6pm until 2am sorted at all. I'm still testing a trying things for exercise, have started tweaking boluses but a lot more work for me to do here ........

Have you seen an Improvement in A1c since starting on pump. It's really starting to dawn on me how much work this is going to take and there's a lot of variables to take in to account. But to know there is an improvement coming makes it worth while.

 

[fairylights]

Have you seen an Improvement in A1c since starting on pump. It's really starting to dawn on me how much work this is going to take and there's a lot of variables to take in to account. But to know there is an improvement coming makes it worth while.

I haven't had an A1c done since starting on the pump as they had to change my appointment as the one I had was too close to starting. I am going to the clinic next week so I'll find out then, I am really hoping that it will have come down a fair bit, I did another proper basal test last night as I think for the last few weeks I have been fiddling around making changes that are not tested properly and my BGL stayed level from 10pm last night until noon today (from 6.1 to 6.7) apart from one dip at 1am, and this was the rate I changed without doing proper testing. So I am happy that my basal rate is good for most of the day (as I was already happy with noon to 6pm). I probably still need to test the 6pm to 2am one properly but that's the bit I find hardest.

So my task now is to test my boluses and different types of food and also exercise. I find that exercise is fine if I do it before dinner - not so good if it's in the evening, so I need to work on that. Also alcohol, going out tonight so might test beer and curry! LOL! I still haven't thought about dual or wave boluses or super boluses or any of these things, but I really want to try and even out my after food spikes next. And days off and holidays and .....

It is definitely worth it for me because waking up with 5 or 6 instead of 16 or 20 just makes me feel so much better, I am like a different person, I can move faster, my concentration is better and my stomach upsets have almost gone away. I would hate to go back to injecting now!

 

[irrationalJohn]

It's really starting to dawn on me how much work this is going to take and there's a lot of variables to take in to account.

So, how do you cope with all the work involved with riding a bicycle? I mean keeping your balance is complete nightmare! First you two right and then almost immediately left, right, left, right, left And the never ever ending wobbling back and forth ... The constant fear of falling over!

Let's not even start about traffic, the signals and signs, and the endless confusing rules & regulations!

It's really too much, no? Amazing that everyone does not give up on it immediately and just go back to walking everywhere. Walking is so much simpler and you don't stand out as much. I'm not sure using a bicycle is really worth it.

By the way, how long have you been using the pump? Less than two weeks, right? Things do become more routine and reflexive after you repeat them a few times. Unfortunately I can't really tell you what my experience starting out was like because, at this point, I just don't remember much of what it was like.

 

[lely]

Yes it's all a bit much at the moment @irrationalJohn, I will not quit, but I may rant on a bit while getting there. Some day I hope I can be as much help and support to newbies as you lot on here are to me.

 

[Gaz-M]

On a different note I changed my cannula tonight and have a tasty purple bruise where the old one was, I knocked it at work this morning and was feeling a little tender so I think it must have been the knock that caused it