does this mean I have not been getting Basal?

Don't worry to much Gas,I was like that for the first couple of weeks ,it took me 3month to get organised .Now after 7 month I am very happy with my B/S but still have to make small adjustments to my basal rates every no and then.Good luck,I think you have made a good start.

You shouldn't be dropping 10mmol in 30mins so check that the towel you are drying your hands with after washing them, hasn't been contaminated by something that might cause bg levels to rise or that you yourself handled something that might affect bg. Also, open up a fresh tub of strips just in case some might be faulty.

Gaz-M said:

Bloods are all over at the moment and my DSN asked me not to change any of the time blocks until I see her on Teusday as alot of them already have been adjusted and she wants to see what is happening.

BS at 12.10 18.1 no bolus and 12.25 8.8 !!! it is like this all day and getting annoyed with it now, just wish it was Teusday

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Does look like the 18.1 was a false reading, can't see how your bg would drop by 9.3mmol/l in 15 mins, don't get downhearted @Gaz-M.

Gaz-M said:

Bloods are all over at the moment and my DSN asked me not to change any of the time blocks until I see her on Tuesday as a lot of them already have been adjusted and she wants to see what is happening.

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I've been waiting for someone else to comment about what I assume was your basal profile as shown by the graph in your original post. On the one hand, I don't want to cross some line since all I am going on is my own personal experience and what I have read. But on the other hand, if that graph is a relatively accurate representation of the basal profile that your DSN has implemented for you, then I truly don't understand what the heck is going on.

It has been my understanding that the current prevailing approach when starting people on the pump is to start with only one basal rate for 24 hours. In the context of your graph that would be a fixed, flat horizontal line from 00:00 to 24:00. I believe this approach is taken for at least two reasons.

First, the person starting on the pump was most likely previously using one of the basal insulins such as Lantus or Levemir. Because of the characteristic lifetimes of these insulins, the basal is usually given only once or twice a day. So many people are coming from a background where they essentially had a single 24 hour basal rate. I believe the intent when starting a person on a pump is to mimic their previous treatment regimen, so usually a single basal rate is chosen to start with and then refined in small, incremental steps.

Second, it is easier to try to dig out the patterns such as Dawn Phenomenon or other quirks in a body's insulin requirements when there is only one or at least a small number of rates. It is easier to see what is going on when there is not a lot of "noise" muddying the picture.

The basal rate settings indicated by your graph are not what I would expect.

It's not just that you have multiple rates during multiple time periods. It is more that the rates jump/jerk around so much. I have never seen that before and it makes no sense to me. Most people's BGs do not instantly respond to sudden changes in basal rate. So dropping the rate for one hour and then immediately raising it again is over complicating things and I would think it would hinder getting a clearer picture of your body's basal insulin needs.

The graph below, stolen from this Gary Scheiner article, is an example of a more typical set of basal rates during a 24 hour period. Notice how it tends to flow smoothly when it rises and falls.


Is this excessively busy and jumpy basal setup truly what your DSN wants? I can't help but believe that there is some unexpected communications misunderstanding going on here. The way these basal rates bounce around just seems weird to me.

But if this is what your DSN has specified, I would be very interested to hear what her rationale for this approach is.

Has your endocrinologist (consultant?? not sure of your terminology) seen this?

Hi @Gaz-M. It's confusing at the moment isn't it. I've not even tried to use the diasend that was in the box, so well done for that. Ive started on a.flat rate basal. Hypos on Friday and sat morning at around 10-10.30. So.reduced my basal from this morning from 7am-11am. Mornings tend to be my busiest time of day activity wise so I've started with that. Was all set to do an overnight basal test tonight but had to change set and fill cart so apparently not appropriate to do.
I also think my correction dose needs recalculation as I had pizza last night that caused a spike this morning at 4.30 of 18. I had bolused for it but I suppose the high fat content had affected it. when done a correction dose for it was hypo 1 hour later. I guess in future, since I will eat pizza again using an extended bolus may be useful.
It sounds like your spending most of your time scratching your head like me.
Just think this time next year we will know what we are doing. And you know how quick a year passes by.

Since having a pump, I've always used a pump bg monitoring logbook - AccuChek and now Animas. These are excellent for logging the bg levels, the bolus, the correction bolus, the carb eaten and the hourly basal rate being used. I can look at the readings and spot where I need to start making a basal adjustment so I recommend that you both use them as then when you write everything down, its easier to see what you need to do instead of using some internet programme and maybe scratching your heads even more. I only use Diasend to see the full picture of how my bg levels go during the night with cgm and decide from looking at a graph printout showing the time whether I need to alter the basal rates or not.

Gaz-M said:

yeah @lely confused.com here plus I am off work which will make a huge difference to my blood sugars levels with being a chef

for the time being I am trying to stick to food I know the carbs well of and not tried pizza yet unlike you hahaha, I know I have tried most brown/seeded bread out there and I like toast for breakfast and found a good 7 seeded bread that does not spike me but its terrible toasted and the white bread (even though it has only 10 carbs in per slice) holds my sugar up for a good few hours so may need to find an alterative breakfast food, As for your bloods from the pizza it does sound like it could be from the fat in it (which is not good as a pizza treat I love)

I can't wait until next year and so happy your doing so well (apart from the pizza misery )

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Lidl Hi Protein, low carb rolls are lovely toasted with loads of seeds in them and are about 11g carb per large roll

@irrationalJohn, that does seem to be a very busy graph. @Gaz-M , what insulin were you on prior to going on to the pump, and how much, and what time was it administered?

I only ask as I set my pump up to use a basal profile that mimicked the basal doses I was taking as my start point, which were generally giving me a flat fasted blood glucose level. Setting it up using a CGM based on your CGM plot is an interesting idea. Were you given that CGM when you started on a pump with a flat basal rate or is it compared to using a basal with a variable absorption rate, like Lantus?

If you are having problems, I'd be tempted to suggest to the DSN when you see them that it might make sense to set a single rate for 24 hours and to run basal tests (or borrow another CGM) that show you when your glucose varies up or down. With a flat basal rate it would be much easier to determine when you needed more or less basal insulin than with your current set up.

Yes I too am using the record logs for BGs etc. it's very clear to see patterns with it. I wish they were a little bigger though I find it hard to fit my handwriting in. Also keeping notes on how I feel site positions etc.
Done the Basal test overnight, although I had changed cart and site last night I decided to just go with the plan. Was 10.1 going to bed and 7.6 on waking so a 2.5 dip. I think I'd like to try get that a bit tighter. Gonna try that again tonight without changes.
Well it's been 7 days and We are still OK, although I felt like crying most of yesterday. But renewed hope this morning due to a great nights sleep.
I do love reading all this. It's all an education.

lely said:

Yes I too am using the record logs for BGs etc. it's very clear to see patterns with it. I wish they were a little bigger though I find it hard to fit my handwriting in. Also keeping notes on how I feel site positions etc.
Done the Basal test overnight, although I had changed cart and site last night I decided to just go with the plan. Was 10.1 going to bed and 7.6 on waking so a 2.5 dip. I think I'd like to try get that a bit tighter. Gonna try that again tonight without changes.
Well it's been 7 days and We are still OK, although I felt like crying most of yesterday. But renewed hope this morning due to a great nights sleep.
I do love reading all this. It's all an education.

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Basal rate testing is as short as it is long, as any time is ok to start the test as long as bg levels are in an ok range and no bolus has been used and food eaten in the previous 5hrs leading up to starting.

If you are always on 10mmol before bed and thats with food and bolus for eve meal, then ideally you need to give a bit more bolus with the meal so that 5hrs later, bg is about 7mmol and then go from there onwards through the night until breakfast. Once you work your way around the clock, doing 5hr basal rate stints at a time and adjusting as you go along so that bg levels will be a bit better when food is eaten the next day, you will be able to get around to changing the eve meal basals to get to the 7mmol range before bed.

What target bg level target are you aiming for in the settings menu on the Vibe? Mine is set to 6.0mmol with no + or - Are you using the 100 rule based on the TDD that you are using at the moment?

I started on a flat basal rate, which was worked out by my pump trainer and was pretty good for a place to begin, with the exception of two hours of lower basal in the early hours of the morning as I always go low then. I only had to adjust ever so slightly.over the first few days

I do think it can make a big difference in where you start from. If your basals are really off then it'll be harder to nudge them into line. So what I'm saying is don't blame yourself @Gaz-M My BS was very good very quickly, but that was largely down to the skill of my trainer in correctly estimating what would work best for me. If he'd been less good, I'd have taken much longer to get sorted.

Once you get that basal right, you'll be flying

Gaz-M said:

I was on humalog, average daily dose of 19.8 units and Tresiba 11 unints at night before bed. I am now on (9.47 basal) and around 20 units total for the day of novorapid.

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I hadn't heard of Tresiba before now so I am not familiar with it. After Googling around a bit, it looks like a much longer basal insulin source. After using it for 8 days or longer it appears to remain active for up to 42 hours (a day plus 18 hours).

I grabbed the graph at the end of this post from this PDF of the "highlights of prescribing information" leaflet I found online. To my untrained eye it seems "flatish" rather than flat. There is peaking between 6 to 12 hours after injection and then trailing off slowly after that. So ... probably not too much different than Lantus or Levemir other than the dosage specifics and lasting longer?? Perhaps?

I apologize for still not understanding the situation, but I am still not clear one whether that previous "busy" graph is a reasonable approximation of the basal settings Gaz-M is currently using or not. But I wanted to attempt to make it clear why I don't think anyone should ever use basal settings similar to what that graph seems to imply.

My main concern with "busy" basal settings is that, in my opinion, it obscures what your actual (effective) pump basal settings might be. You simply can not turn around the dynamics of subcutaneous insulin infusion in 15 minutes or even a 1/2 hour. Programming settings into a pump which jerk like that simply do not give an accurate impression of what the glucose lowering effect of the pump's basal actually is. So what's the point?

The actual glucose lowering effect is going to work out to be some mushed out average of the programmed rates. For example, a rate of 0.525 U for an hour followed an hour of 0.475 U is most likely indistinguishable from two hours of 0.500 U, no? And what would setting 0.350 U for 45 minutes followed by 15 minutes at 0.300 accomplish versus an hour at 0.325? So why do it?

It seems to be adding pointless complexity to a matter which is already hard enough to sort out.

As mentioned earlier, the more common (?) practice appears to be to start people off with a single basal rate. This may be partly an effort to mimic the single basal insulin of the previous MDI treatment. But I also believe this approach is taken to reduce complexity and make it easier to get a better idea of what your body's basal insulin needs actually are. When the pump basal settings jump around like that you just don't really know what your basal settings are. So how can you then "fix" them?

Anyway, I look forward to hearing about what happens on Tuesday (tomorrow).