How do I run higher blood sugar on a pump?

[Flowerpot]

I have been told to run my blood sugar higher as I have been having too many hypos. I try to keep my blood sugar as low as safely possible as I have serious complications so want to limit any further damage but I also have no hypo awareness.

What is the best way to run slightly higher blood sugar across the board on a pump? Do I reduce every basal rate slightly, target specific basal rates where I'm more likely to hypo, increase my carb ratios? Just wondered if anyone has done this and what method they used. It sort of assumes I have total control over every blood sugar and can just tweak a few things and my blood sugar rises uniformly by 1.0 mmol at every reading but I know from years of trying to get my basal rates correct that even reducing a few hourly rates can have a big knock on effect. I'm tempted to reduce every basal rate by 0.025 as a starting point and see where that gets me .

 

[donnellysdogs]

My bg's can change quite dramatically with my insulin needs whenever the clocks change! Initially I drop my levels every other hour by 0.01 and then tweak further by doing more tests.
As I do not eat regularly all the time, its easy for me to count my non eating moments as basal testing and I test every hour, not every 2 hours as this gives me more information than the nhs recommended 2 hiurly basal testing. This is specific to clock changes that I do this for the following few weeks.

Not a NHS recommended way but for me it works.

Also make sure you are adjusting the hours pre lows correctly for YOUR body. Some people change the hour before the low occurs. I don't, mine are 3 hours and 2 hours before the low occurs.
For example:
7am 6.4
9am 5.3

As I know I am dropping significantly by 9am, and it started after 7am, then I would change my 6am and 7am basal lower. The next day I would do my tests at 6am and 8am.

I work to my body needs, I learn from others, take advice from others but I figure out my own body requirements. I've tried just changing the hour before a low.. It didn't work for me.

However, this is just my way of me managing my bloods...

 

[Flowerpot]

Thanks, I reduce the basal rate 2-3 hours before I am having lows if they are occurring regularly but my pump consultant advised me to run my sugars higher generally for a bit. I did run them higher years ago when I was trying to regain some hypo awareness but can't recall if I reduced all my basal rates at once or reduced a couple at a time to see the effect. I just need to shift the generally good control I've got upwards about 1mmol each hour.

 

[sofaraway]

In the past I have done this by reducing my whole basal rate by 0.025 even hour, and gone from there.

The other thing I have also done is slightly adjust my target range. So that if I am running below 5.5 say a small bit will be knocked off my boluses.

 

[Flowerpot]

Reduced everything by 0.025 across the board and it had very little effect until 5pm, since then I have been in the 9's so need to go back to the diabetes drawing board to change my afternoon basals a little. It sounds such an easy request just to increase blood sugars slightly but trying to do it without veering into high blood sugar isn't so straightforward.

 

[donnellysdogs]

Did you do any basal testing today or were these figures with bolus? Do you know what your bolus/basal rate is running at?

 

[Flowerpot]

I use CGM and didn't manage to eat until 3pm so I was only running on basal until then, my bg stayed pretty stable in the 4's and 5's. On the plus side I didn't go below 4 mmol today so that is an improvement. My 7 day average bolus /basal rates are 25% bolus 75% basal. Not sure why it started to climb upwards in the late afternoon, perhaps just a carbohydrate under estimation, it has fallen back to 7.0 now. I'll see what happens tomorrow.

 

[donnellysdogs]

That basal bolus ratio is top heavy, is there a reason why?

 

[donnellysdogs]

Actually it is just proving that you having too much basal...

 

[donnellysdogs]

Did it climb 2-3 hours after your bolus then this afternoon?

 

[Spiker]

Actually it is just proving that you having too much basal...

I wouldn't agree with that actually. The "rule" that basal and bolus should be 50/50 is just one of those rules of thumb for when a doctor hasn't got any data to go on. Flowerpot has loads of data.

My suggestion would be stick with the same slightly reduced basal for a few days and see if it levels out.

 

[donnellysdogs]

I don't run on 50/50 myself.. But 40/60 is the limits to which my consultants want me to run at. Just talking from my experiences of my consultants.. Sorry, should have said that.....

 

[donnellysdogs]

I wouldn't agree with that actually. The "rule" that basal and bolus should be 50/50 is just one of those rules of thumb for when a doctor hasn't got any data to go on. Flowerpot has loads of data.

My suggestion would be stick with the same slightly reduced basal for a few days and see if it levels out.

Do agree Spiker I would personally leave another day, but I also just wary if the creep upward could be due to a bolus?

 

[Flowerpot]

I have the bolus/basal ratio debate every pump clinic, they want to see it around 40 bolus/60 basal but I only eat twice a day and don't eat that many carbs, my carb ratio is 1:20 and my maximum daily bolus is about 4 units. It would appear my basal rates are a little too high as my reductions so far have made little difference.

 

[donnellysdogs]

Which if you adjust the basals would then bring u more towards 60/40...