Does your basal rate suddenly "step down"?

[RuthW]

I use a pump. This question applies, though, to anybody on a basal-bolus regime, especially if they exercise.

I have been trying to improve my muscle:fat ratio, largely by walking and weights, and so at the same time improve my insulin sensitivity and reduce my Total Daily Dose. That's the plan, anyway.

Of course, the hazard with this kind of plan is hypos, so using info gained from these boards again, I have also worked to flatten my profile. It's all going quite well. My TDD is down by 5 or 6 units a day, I've lost a few kilos over six months, my blood sugars are usually in the right range.

One thing I am finding odd/ annoying/disconcerting and I would like to know if other people have this experience.

Twice in the last six months I have had this experience where it seems as if on a particular day my basal requirement decides, of its own accord to suddenly "step down" quite abruptly. So, for example, through last night I kept getting up to test and ending up putting on a TBR at dawn, plus extra carbs, I got up, had my relatively high carb breakfast (porridge and two coffees) with 1:11 bolus, sat around on my backside reading the paper for an hour or so, get up, went to my workroom and started sewing - hardly aerobic and then hypo again, even with a TBR on. I know this will that keep happening all day if I don't change ratios and put on a TBR

I did no exercise yesterday. And the day before I only walked for about half an hour. So it's not my muscles grabbing glucose back after exercise.

I am happy if I need to reduce my basal because that's my aim. But it feels weird, the apparent suddenness of the change. Overnight my blood sugar went down by 125 mg/dl. (I pushed it high before bed because I felt this was starting last night.) And a sudden series of hypos is always a bit alarming. So far it has always happened when I am at home and able to deal with it easily, but it could happen at less convenient points.

Does anybody else experience this "step effect"?

 

[CarbsRok]

My basal changes every 5 or 6 weeks. I can drop 5 units of insulin then 5 or 6 weeks later it goes up again. Problem is the basal pattern increases and decreases are never in the same spot.

 

[RuthW]

Gosh, that's a huge change! Is there any identifiable reason (like mine is clearly my new exercise regime)? Does it change all of a sudden like mine?

 

[ewelina]

Ive just started on a pump. I've spent last 3 weeks working on my basal. Please dont tell me I will have to do that again in two weeks

 

[-Artemis-]

I have had this happen... I'm afraid I don't know what caused it though so can't offer a solution...

I do have a continuously fluctuating basal / carb ratio though, but this is related to my cycle and it relatively steady/stable enough that I now know the pattern and know which weeks to adjust... What I mean by that is I don't have, and imagine till I'm post menopausal, won't have, a steady basal or bolus pattern -- it changes every two weeks... Which is always fun... ;-)

 

[noblehead]

Yes I've had this happen too and there's no rhyme or reason to explain why it suddenly occurs.

TBH @RuthW if this is only the second time its happened in 6 months I wouldn't worry too much about it, sometimes diabetes throws these things at us just to keep us on our toes.

 

[RuthW]

Ive just started on a pump. I've spent last 3 weeks working on my basal. Please dont tell me I will have to do that again in two weeks

LOL. No! I'm not saying that, fortunately. My rates are not stable because I've got a "project" going to change the ol' body for the better. I was expecting my rates to change, just strange the way they do it when I'm not actually doing very much. I'm looking for a pattern.

If your daily routine is stable, then you won't need to change your rates. Some people have different patterns for different days.

 

[RuthW]

Yes I've had this happen too and there's no rhyme or reason to explain why it suddenly occurs.

TBH @RuthW if this is only the second time its happened in 6 months I wouldn't worry too much about it, sometimes diabetes throws these things at us just to keep us on our toes.

Yes, I'm not too worried, but I am a bit curious. I am looking for "rhyme and reason in fact, aren't I?

I am wondering if it is the actual "rest days" from my exercise routine which are the key because they coincide with these "steps". I would expect my need for basal to go UP not down with inactivity generally.

 

[ewelina]

LOL. No! I'm not saying that, fortunately. My rates are not stable because I've got a "project" going to change the ol' body for the better. I was expecting my rates to change, just strange the way they do it when I'm not actually doing very much. I'm looking for a pattern.

If your daily routine is stable, then you won't need to change your rates. Some people have different patterns for different days.

Im going to start on exercising and to be honest I dread to think how my basal rates will change. Its a hard job to get them right and I know any gym session will change the whole pattern.

 

[noblehead]

Yes, I'm not too worried, but I am a bit curious. I am looking for "rhyme and reason in fact, aren't I?

I am wondering if it is the actual "rest days" from my exercise routine which are the key because they coincide with these "steps". I would expect my need for basal to go UP not down with inactivity generally.

Yes you would expect to see your basal needs increase on non-exercise days.

I think sometimes, try as we might we look for the answer and can't always find it, I had a hypo the other-day after my lunch and it took 50g of carbs to correct it, I've had very few hypo's since changing to a pump (didn't have a lot before on MDI) and this one took me by surprise as I'd done nothing out of the ordinary and ate the same meal that I often eat at lunch, I thought I'd be high pre-evening meal but was sitting at 5.8mmol/l which didn't seem right, usually with low bg levels 2-3 Jelly Babies is sufficient but as I say it took 50g to correct this one, despite checking my pump information and looking for an explanation I couldn't find one for the life of me

 

[noblehead]

Im going to start on exercising and to be honest I dread to think how my basal rates will change. Its a hard job to get them right and I know any gym session will change the whole pattern.

The advice I was given was to set a TBR 2 hours before and 2 hours after exercise and see how it goes from there, although it depends on what effect a gym session usually has on your bg levels @ewelina.

 

[ewelina]

The advice I was given was to set a TBR 2 hours before and 2 hours after exercise and see how it goes from there, although it depends on what effect a gym session usually has on your bg levels @ewelina.

How much would you reduce by? For a 2 miles walk I reduce to 60% and it seems to work (an hour before and for a walk). I suppose for a gym session (lets say cardio) it would be much more?

 

[noblehead]

How much would you reduce by? For a 2 miles walk I reduce to 60% and it seems to work (an hour before and for a walk). I suppose for a gym session (lets say cardio) it would be much more?

Stupidly I'm still just reducing my bolus dose beforehand and having a snack(if necessary) as I did before on MDI, however I did ask my pump nurse again a few weeks ago about using a TBR for long walks and that was the advice she give me, this is something I need to address myself over the coming weeks.

I'll tag @ElyDave @phoenix as both of them are experienced pump users are are into their sport/exercising.

 

[RuthW]

How much would you reduce by? For a 2 miles walk I reduce to 60% and it seems to work (an hour before and for a walk). I suppose for a gym session (lets say cardio) it would be much more?

How much you reduce by is affected by a lot of factors. Oddly, the fitter you are, the less you have to reduce your basal. (but your basal will already be low). The more familiar the exercise, the less you have to reduce. It also depends when you exercise and what type of exercise. So for aerobic exercise generally you will reduce your basal and/or bolus (depending on the timing of your exercise relative to bolus) and for anaerobic (e.g. HIIT) you don't reduce, and may even need a little extra.

It is individual to some extent, but there is a lot of help in books like Pumping Insulim, Think like a Pancreas and Diabetic Athlete's Handbook.

So, for example, right now I still have a few kilos I would like to shed, so I am choosing the "reduce your insulin, then exercise" route. And I keep changing the type of exercise so I don't get familiar with it. According to Think like a Pancreas, the only way to lose weight is to reduce insulin. And of course the safest way for us to do that is to increase our energy output and insulin sensitivity.

Both ElyDave and Timx000 seem to be already fit so they're not trying to lose weight. Tim follows a ketogenic diet and has been working on putting on muscle. ElyDave does lots of endurance sports and takes carb corrections. But I am sure they can tell you all about their routines.

Once I get to my target weight, I intend to try to build a bit more muscle and then switch to adding carbs when I do endurance stuff (otherwise I guess I'll disappear ).

 

[RuthW]

Stupidly I'm still just reducing my bolus dose beforehand and having a snack(if necessary) as I did before on MDI, however I did ask my pump nurse again a few weeks ago about using a TBR for long walks and that was the advice she give me, this is something I need to address myself over the coming weeks.

I'll tag @ElyDave @phoenix as both of them are experienced pump users are are into their sport/exercising.

It's not stupid. It's one strategy. It's way smarter than not exercising at all! And for people on MDI who cannot plan their exercise the day before, it's the only strategy! It's not AS helpful if you are trying to lose weight, but it still increases insulin sensitivity and will lead to lower doses in the long run, bigger muscles (better "glucose sink"), and it's absolutely fine if you are not trying to lose weight.

 

[RuthW]

Yes you would expect to see your basal needs increase on non-exercise days.

I think sometimes, try as we might we look for the answer and can't always find it, I had a hypo the other-day after my lunch and it took 50g of carbs to correct it, I've had very few hypo's since changing to a pump (didn't have a lot before on MDI) and this one took me by surprise as I'd done nothing out of the ordinary and ate the same meal that I often eat at lunch, I thought I'd be high pre-evening meal but was sitting at 5.8mmol/l which didn't seem right, usually with low bg levels 2-3 Jelly Babies is sufficient but as I say it took 50g to correct this one, despite checking my pump information and looking for an explanation I couldn't find one for the life of me

This kind of unpredictability is very wearing, isn't it? The only thing that consoles me is that these days when I make an alteration to my settings, I DO actually see a fairly predictable result. When I was on MDI with Lantus all my best efforts were like banging my head against a brick wall!