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Basal rate changes

Discussion in 'Insulin Pump Forum' started by Jeannie3, Jul 8, 2019.

  1. Jeannie3

    Jeannie3 Type 1 · Active Member

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    Hi everyone

    I was lucky enough to have a Libra freestyle glucose sensor supplied about 16 days ago.

    It seems to have settled now and I am trying to scan every 15 minutes. My bolus has been changed and this has helped in my target range goal .... but am having problems now as it appears my basal rate from about 10 pm until the following morning at 7am is totally incorrect e.g. last night 4 hours after my tea and test was good at 6.5 and steady.

    At 11.30 it was rising to 9.9 ...then through the night I did a scan at 4 am and it was 16.9.

    Obviously I need to up my basal rate but am unsure of how much to increase it at what rate as it is currently at 17.00 - 24 hrs 0.500 u/hr and midnight to 4 am at 0.600 u/hr. Seems to be shooting up and I'm not sure how much to increase it by to be safe!!!

    Any recommendations please would be great :happy:
     
  2. helensaramay

    helensaramay Type 1 · Expert

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    We cannot make recommendations of dose as we are all different.

    When I have seen a need to change my basal rate, I do it by the smallest increments possible and then let it "bed in" for a few days and continue to adjust until it seems right.
    I have also added an extra basal rate if I see a jump which my current steps do not account for. You may want to think about this between 17:00 and 24:00.

    However, don't forget about your evening meal. If you are eating something high carb and/or high fat this may be causing your highs.
     
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  3. Jeannie3

    Jeannie3 Type 1 · Active Member

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    Thanks for your advice Helen, much appreciated .... yes think changing things slowly at the lowest adjustment rate is best and then you can get an idea of the effects it makes and get an idea of how much you need to adjust and slowly get there ........

    I had pasta for tea and ate just before 6 pm so the reading at 10 pm at 6.5 BG reading should give the impression that the mealtime insulin was ok ....OR do you think the Novorapid doesn't react within 4 hours???
     
  4. helensaramay

    helensaramay Type 1 · Expert

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    @Jeannie3 I have found pasta with a creamy sauce takes longer to absorb than 4 hours and, for me, needs a combo bolus over 5 hours. Without doing so, I find I go high at night.
    We are all different so you may be fine after 4 hours.

    However, I suggest trying a lower carb evening meal, if possible, as you tweak your overnight basal rate so you are sure the food is not impacting you overnight.
     
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  5. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @Jeannie3 ,
    Well done on setting up and using your cgm!
    Perhaps if you could contact your nurse or doctor and see what they suggest?
    They may be able to suggest perhaps slightly bolder dose adjustments to get things sorted sooner.
    There is a thing called the Dawn Phenomenon (DP ) for short. If you type that in the search box upper right of the Forum or Home page you can read a description of it.
    One of the beauties of the pump is being able to program in a basal program which helps to deal with DP, or whatever the cause of the about 4 am bsl rise is due to.
    Best Wishes.
     
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  6. helensaramay

    helensaramay Type 1 · Expert

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    @Jeannie3 I've just remembered something else (sorry for the multiple messages).
    I found it useful create a new profile when I changed my basal profile. This meant that it was easy for me and my diabetes team to see the differences and, if I made a mistake, I had something to go back to.
     
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  7. Marie 2

    Marie 2 LADA · Well-Known Member

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    I was always taught to make small adjustments at a time and like @helensaramay has said, I find it useful to start a new basal program if I am making a few changes, so I can reference back to it.
     
  8. Mel dCP

    Mel dCP Type 1 · Well-Known Member

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    I recorded all my basal programmes by either screenshotting, photographing the control unit screen or entering in into a spreadsheet, so I can easily go back to a setting I know. Small corrections are key!
     
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  9. jackois

    jackois Type 1 · Well-Known Member

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    Just a small additional point, each change should be made and then given two or three days to settle before making another.
     
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  10. Jeannie3

    Jeannie3 Type 1 · Active Member

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  11. Jeannie3

    Jeannie3 Type 1 · Active Member

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    Thanks for your reply - I am waiting now 3 days before changing - it does take a while to get an idea of reaction!

    I will contact my diabetes nurse helpline re the 4am basal rise and what they suggest.

    Also think I may need to change my breakfast as it is spiking up really high after porridge - think Greek yoghurt and fruit is a good recommendation!

    Thanks :)
     
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  12. Jeannie3

    Jeannie3 Type 1 · Active Member

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    Thank you Helen

    What is a combo bolus??

    Breakfast e.g. porridge is giving really high spike for hours and BG still 15 after 3 hours - may need to change breakfast to say Greek yoghurt and fruit - all other meals seem to be ok and not doing this - upped the basal but from mid afternoon then too low for about 8 hours !!!
     
  13. helensaramay

    helensaramay Type 1 · Expert

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    @Jeannie3 I think different pump manufacturers call "Combo Bolus" different things.
    Although Animas and my current, Medtrum, pumps both called in Combo.

    It is splitting the dose over a number of hours.
    The Extended Bolus option will spit the dose equally over the next x hours.
    Whereas the Combo allows me to give myself a percentage now and then the rest over the next x hours.

    For example for pizza I give myself 40% now and 60% over the next 5 hours.
     
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