Opinion Please:Newbie and first basal profile change

[Picci]

My nurse changed my basal profile even though I said I was not happy with her decision, she gave me strict instructions to sit on my hands. Her mission was to eliminate the odd hypo I was having, but she ignored the highs. The below profile did eliminate hypos, but the highs are still there and even worse.

00.00 - 10,00 0.60uph
10.00-22.00 0.50uph
22.00-24.00 0.60uph

For two weeks I have been waking up in target, but throughout the morning and into mid afternoon I just keep on rising upto 13 or 14 mmol on average. For example waking 6,8mmol at 8am and rising to 13,8mmol by 2pm.


I figured I needed to raise my basal between 6am to perhaps 3pm in the afternoon, and put it in to practice last night. So I changed it for the first time ever to this:

00.00 - 06.00 0.60 uph
06.00 - 15.00 0.65 uph
15.00 -22.00 0.60 uph
22.00 - 24.00 0.50 uph

So far today, I have seen an improvement.

I woke at 5.4mmol at 8am. 25carbs 2.5units + 0.05 correction = total 2.55u
Lunchtime 7.4mmol at 2pm. 25carbs 2.5units + 0.70 correction = total 3.20u
Dinnertime 6,5 mmol at 7pm

I know I should do a fasting basal check but I thought I could give it ago based on the patterns I am getting not fasting.

Any pro pump users opinions / advice will be greatly appreciated!
Thank you,
Christine,
PS I have just tagged some of my favourite heros who I follow! Hope you don't mind!
@Chas C @Books1 @Neoncat @Sandymcat @robert72 @Medusa41

 

[robert72]

Hi Christine Not sure I can help much - I'm still on MDI

 

[Picci]

Hi Christine Not sure I can help much - I'm still on MDI

Oh Robert, I do apologise! I've been following you for some time now due to your great advice when I was also MDI, I've only been on the pump 4 weeks! Thanks anyway, Christine

 

[Books1]

Did you remain flattish in afternoon too? I don't see a problem with tweaking if you get better results but I would suggest it's worth doing a fasting basal test to check whether it still needs tweaked or whether your carb ratios change during the day and need tweaked for different meals - don't do both at the same time!
I fell totally of the wagon before Easter but am back on the straight and narrow so basal testing will be next.
I totally understand the nurse wanting to get rid of hypos but it's no use if it's making you unhappy with the highs.
You might not have to run it at the higher level til 3pm as the dosing works a couple of hours ahead. You might be able to stop the higher dose earlier if you see what I mean.
Let us know how it goes

Frances

 

[robert72]

Oh Robert, I do apologise! I've been following you for some time now due to your great advice when I was also MDI, I've only been on the pump 4 weeks! Thanks anyway, Christine

Great - I hope it works out for you. I understand they take a bit of setting up to begin with. I did borrow one off a mate down the pub for a few weeks, but didn't like being attached

 

[Picci]

Great - I hope it works out for you. I understand they take a bit of setting up to begin with. I did borrow one off a mate down the pub for a few weeks, but didn't like being attached

I shunned being attached to a pump for 39 years, so I understand completely. I cannot believe I have actually gone and done it! Giggling at borrowing a pump from a mate down at the pub!

 

[Picci]

Did you remain flattish in afternoon too? I don't see a problem with tweaking if you get better results but I would suggest it's worth doing a fasting basal test to check whether it still needs tweaked or whether your carb ratios change during the day and need tweaked for different meals - don't do both at the same time!
I fell totally of the wagon before Easter but am back on the straight and narrow so basal testing will be next.
I totally understand the nurse wanting to get rid of hypos but it's no use if it's making you unhappy with the highs.
You might not have to run it at the higher level til 3pm as the dosing works a couple of hours ahead. You might be able to stop the higher dose earlier if you see what I mean.
Let us know how it goes

Frances

Hi Frances, glad to hear you're back on the straight and narrow again, we all do it.
Yes, I remained flat all afternoon up to 7pm when I had my evening meal! So day 1 went well. I will see how it pans out in 3 days. Then I may tackle the dreaded basal testing.
I was so determined to get my day time lower, I have been fed up feeling rubbish and sitting on my hands.
When the nurse made changes to eliminate hypos she disregarded my high day times and even reduced the basal rate for then too.......That was bonkers if you ask me!
I must say, I am so happy to have finally made the change to the pump. Things are no where near perfect yet but they are so much better than my latest MDI control.
Christine xx

 

[Chas C]

Hi @Picci fasting basal's are a pain but very much needed, I found if I spread them out over a week or so, night time, morning, afternoon, evening. Only starting each if my levels were good at the beginning.

So much easier if you have a CGM or can afford one.

Just to give you an idea, my basal was set like your's to start with but now its different, for example here is my latest one:

I find its best to make adjustments at least two hours before your fasting basal shows you need them to be active.

There is a danger changing your Basal without fasting, as you will be making adjustments on top of the food intake and the food bolus too.

 

[Picci]

Great information and feed back Chas, I really appreciate your advice and it's interesting to see your basal profile! So far I'm stable today, but running a tad higher, I'm just thankful I'm not 13mmol.
I'm having shoulder impingement surgery tomorrow, (had it on my right shoulder a few years ago,) and opted for a block, I wanted to avoid being high.
Thanks again, Christine

 

[Sandymcat]

Hi! Sorry I’ve not been in here for a while. Glad you got the advice you needed and good luck for tomorrow xxx

 

[Books1]

Hi Christine
Looks like you had a good result with the change. Like #Chas C I've got more changes of basal than just your 3 so you may need to tweak your basal times as well as amounts. Like you I'm not quite there on the pump but def don't want to go back to mdi.
Hope surgery goes ok tomorrow you may still find that your bgs are higher cos of it but will keep fingers crossed.

Frances

 

[Picci]

Thank you everybody, I woke up 8.5 today and was 8.3 at lunch time, just tested now to drive and I'm 7.8 but I only ate 2 hours ago.
I'm so happy not to be 14mmol at lunch time and into the afternoon. I won't be basal testing until a few days after surgery, but I will certainly take on board all advice and begin to finely tune my rates,

Thank you,
Christine x

 

[Neoncat]

Hi @Picci, sorry I am a bit late to the party! I can only repeat what @Books1 and @Chas C have said. My profile also has more than 3 changes in it, I start ramping up at 3am to deal with the dawn effect then an upwards blip in the afternoon and then trailing down to the evening. I am still tweaking mine a year in (I suspect because I lost a lot of weight after going on the pump) so I know it can be frustrating but it sounds like you are on the right track. Have you read the book pumping insulin? It has some good advice on setting basal rates.

Good luck with the surgery!

 

[Chas C]

Hi @Picci good luck with the surgery, I've also had this done too about 15 years ago.

 

[Picci]

Hi @Picci, sorry I am a bit late to the party! I can only repeat what @Books1 and @Chas C have said. My profile also has more than 3 changes in it, I start ramping up at 3am to deal with the dawn effect then an upwards blip in the afternoon and then trailing down to the evening. I am still tweaking mine a year in (I suspect because I lost a lot of weight after going on the pump) so I know it can be frustrating but it sounds like you are on the right track. Have you read the book pumping insulin? It has some good advice on setting basal rates.

Good luck with the surgery!

Thank you for your reply, and yes, I have read Pumping Insulin, it's a fantastic resource. x

 

[Picci]

Hi @Picci good luck with the surgery, I've also had this done too about 15 years ago.

Day two post surgery and my bloods are running at 14mmol. I assume the pain is causing the results so I have a TBR of 20% running as of 8am today, here is hoping things settle down. Surgery went well, and my bloods on the day were reasonable, now I'm home and the block has worn off I'm finding it tricky.
Thanks

 

[Neoncat]

Glad to hear the surgery went well @Picci! When you say you have a temporary basal rate of 20% do you mean 120%? Otherwise you'd be taking less insulin not more!

 

[Picci]

Yes! 120%,just increased to 130%because I'm bloody 14now pre meal....... I've got mild ketone in my urine too.

 

[donnellysdogs]

Hi @Picci fasting basal's are a pain but very much needed, I found if I spread them out over a week or so, night time, morning, afternoon, evening. Only starting each if my levels were good at the beginning.

So much easier if you have a CGM or can afford one.

Just to give you an idea, my basal was set like your's to start with but now its different, for example here is my latest one:

View attachment 26036

I find its best to make adjustments at least two hours before your fasting basal shows you need them to be active.

There is a danger changing your Basal without fasting, as you will be making adjustments on top of the food intake and the food bolus too.

My basal ran pretty much the same pattern on a pump... which is wht I have to have insulatard at 3.30 am so it kicks in at full strength when I nedd it niw I'm back on MDI.

Basal testing is needed and I urge you stronglt to do it. I had to basal test immediately following my connection to puml in 2010... well worth it and also making your own tweaks asap.

 

[Neoncat]

A short period of slightly higher bloods won't hurt you so try not to let it upset you as you try to bring it down (easier said than done I know!). Are you eating? Sometimes if you have skipped meals you can get "starvation" Ketones rather than "oh cr*p my insulin isn't going in" Ketones, but keep an eye on them and if they go up take yourself off to A&E. Hope you start to feel better soon!