Constant hypo's

Sarahfergo

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Messages
109
Hi I'm T1 on the accu check combo pump and I've been having hypos all week I've gone through about ten bottles of lucozade! I've reduced my basal by 0.01 every hour twice this week instructed my my diabetic nurse and I'm still having them I've even started to loose awareness of having them! I'm doing everything by the book and my ratio is 1-1 my basal totals up to 29 units why could this be? I'm even having snacks like a banana with out taking insulin and I'm still going low there is no pattern either. Any help would be great thanks :)


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mrman

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2,419
Type of diabetes
Type 1
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Pump
Going so low especially without bolusing for snacks means your basal rate is too high. Have you tried doing the fasting tests to check. You could try using the temp basal rate and reduce basal by 20%. See how that goes and if ok you know to reduce your rates by 20%. The temp basal rate lasts for 4 hours and beeps when finished. Every 4 hours put the temp basal rate on 80% (20% reduction) during a 24 hour period. Alarm handy to wake at night and test. See how u go.

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mrman

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2,419
Type of diabetes
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Basically you have to not eat for 4 hours before starting the test. Then not eat for another 4 hours whilst testing every hour to see what happens to your bloods.

So, when you get up in the morning test your levels at say 8am. As you have been sleeping obviously not eaten you can start your morning basal test at 8am. Do not eat and test at 8,9,10,11,12. this ous the end of the basal test for this period of the day. From this you can see if you need more\less basal insulin at these times. If you start going hypo, treat and abandon test. Reduce basal rate next time to retest. Same if you go above 10, insulate to get back down , abandon test. Next time try slightly higher basal rate for these hours and repeat test. Only do one meal a day as going too long not eating can disrupt levels.

For your midday test, eat breakfast at 8am, no snacks after, if levels ok miss lunch and test at 12,1,2,3,4. End of basal test for this period eat tea as usual. Again from these readings you can adjust basal rates.
Repeat for tea, eat breakfast, lunch at say 12 midday, no snacks after record levels at 5,6,7,8. Have late tea

This is the first thing to do when on a pump as if base is wrong you wil be ask over the place. You should of received a book with a detailed time scale of fast tests with your accu chek pump kit. If whilst trying a basal test and you go too low after a meal try reducing bolus for that meal and try the test on a different day. It does take alot of time and effort to do these to get basal correct but it must be done. Once your baal rates are correct you can start to focus on your boluses.

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mrman

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4 years lol, can't believe your dsn not explained this to you!
Once you've done that you will see a big improvement hopefully. Good luck.

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mrman

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2,419
Type of diabetes
Type 1
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No lol only miss one meal out. One day.
Miss breakfast, have lunch and tea

Different day
Have breakfast, miss lunch have tea.
Different day
Have breakfast, have lunch miss tea.

Overnight, have all 3 meals no food after 7pm start recording levels from 11pm and test through the night this is the hardest one lol


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mrman

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2,419
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Pmsl, no problem, if you phone accu chek when re ordering supplies ask for the information booklet explaining about getting your basal right. I'm sure they would send u one and explains about it alot better than I can and has a basal diary with instructions in it.

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mrman

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Type of diabetes
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Yvw

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iHs

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4,595
Hi
Sarah

I too have got the Combo like yourself.

A fairly good rule to follow is some advice that another pump user was given by her consultant and that was if your bg levels are high or low 2-3hrs after eating food, then adjust the insulin to carb ratio accordingly but if bg levels are high or low 1hr after eating food, then adjust the hourly basal rate 1hr before eating food and if bg levels are high or low 4hrs after eating food, then adjust the basal rates 1hr before the 4hr mark. Adusting my basal rates by 0.01 usually makes my bg levels alter by 1mmol and altering them by 0.02 makes them alter by 1.5mmol so hope that helps you out a tiny bit but everyone is different. Have a look at what your total daily basal rate is and then look at what your total daily bolus is and see if you can aim firstly for a 50/50 approach and then go from there with your basal testing so if your daily basal equals 12u does your total daily bolus also equal 12u or is your total basal much higher than your total bolus?
 

mrman

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2,419
Type of diabetes
Type 1
Treatment type
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My basal is set at 6.5 units per day, but my bolus insulin is at 15~20 units a say so more of a 70/30 split. though you can adjust depending on levels I really think the first thing on a pump to do is fasting tests to get an accurate picture.

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Faith*

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Yes basal testing is very important. I'd been on a pump for 4 years too before I'd even heard about it. My dsn never even mentioned it. The only way I found out about it was through the book 'Think Like A Pancreas' since I've done all the tests though I'm pretty stable, needs tweeking a bit more but I'll get there.

Another option to consider is the heat, during the hot weather I tend to go hypo a lot more than in the cooler weather, not sure if anyone else finds this?
 

Sarahfergo

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Messages
109
3-4am is 1.05 4-5 is 1.05 then 5-6am is 1.10 6-7 am 1.15 and 7-8 is 1.20 units. My sugar at 8 am was 5.0 and at 8.50am was 3.8 what would you recommend to refuse and how much? Very grateful for any help :)


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mrman

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Messages
2,419
Type of diabetes
Type 1
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Hi, sorry u had to cancel the test, its a right pita. If they we're my readings I would try setting the basal rates at 6~7 am to 1unit and 7~8 to 1 unit. Try again next time then with those ratios. This is whats frustrating with basal tests when they have to be canceled and re~ done on a different day. Stick with it, great that u r trying.

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