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Help with overnight/morning basal rates

Discussion in 'Insulin Pump Forum' started by Janelle123, Apr 29, 2015.

  1. Janelle123

    Janelle123 Type 1 · Well-Known Member

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    How much should I increase my overnight/morning basal rates considering the following:
    • Blood sugar was 4.0 when I went to bed at 11pm. I had 10g of carb (I know, way too much but I was worried my levels would continue to drop because I had miscalculated the carbs in my meal and over bolused). 10g should have theoretically taken me to 7.0.
    • At 3:20am I was 10.6 and took 1 unit (which should have lowered me to 7.6)
    • At 6:00am I was 12.0 and took 2.15 units
    • By 6:20am I dropped to 10.5 and continued to drop down to 7.0 and have stayed between 5-7 for the rest of the day.
    I'm pretty happy with my basal rate during the day (0.650) as it seems to keep my levels very stable but I'm not confident on how I should change my night time rates.

    Last night I had it set to:
    00:00 - 03:00 = 0.600
    03:00 - 04:00 = 0.750
    04:00 - 05:00 = 1.000
    05:00 - 06:00 = 1.100
    06:00 - 07:00 = 0.900

    This is what I'm thinking of changing it too:
    00:00 - 03:00 = 0.900
    03:00 - 04:00 = 1.100
    04:00 - 05:00 = 1.200
    05:00 - 06:00 = 1.300
    06:00 - 07:00 = 0.900

    Is this too much of an increase?? It seems like I need a lot more considering I needed an extra 3.15 units but I'm wondering if I'm going a bit over the top with the increase. What do you think? What are your overnight rates compared with during the day?
     
  2. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Hi Janelle the test is irrelevant as you ate carbs, so you need to redo it sorry :(
    Roughly and this is a very roughly 0.050 will drop you 3 points.
    Did you not buy pumping insulin by John Walsh? If you didn't do invest in it as it's worth it's weight in gold with all the info in it.
     
  3. donnellysdogs

    donnellysdogs Type 1 · Master

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    You need to have a clear run of not eating or bolusing 5 hours before bed to know of changes to make overnight.

    The only thing you can gain from last nights testing is that your correction factor is wrong and / or your acting time as you should not have had to have continuous corrections. So you would be better off considering it as a night as a correction test rather than adjusting your basals.
     
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  4. donnellysdogs

    donnellysdogs Type 1 · Master

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    On a note for your changes there is no way that I personally would consider changing all my insulin basal hours by the increases you are suggesting. I would be going into hypo land by doing that. However, We are all different.
    My doses are increased 3 hours before I get up -and they can be double some of my day time rates. Some go up to 1.10 an hour but the maximum change I would do at any point is 0.03 and ut certainly would not be every hour.

    I think you need to read the book suggested and contact your DSN.
     
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  5. RuthW

    RuthW Type 1 · Well-Known Member

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    You may need increases because you are new on your pump, aren't you? That means any long-acting insulin you were on has worked its way out of your system. But you should make changes slowly, not all at once. One factor at a time! Then give it two or three days. Then another factor. For example, you don't actually know that you "over-bolused" for the evening meal. It could have been that it was very fatty, or that you absorbed the carbs slowly for some other reason. That may explain the rise in the night, rather than a low basal rate. Take it slow and wait for the pattern to emerge.
     
  6. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

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    Janelle, repeat the basal test but make sure you have a low-fat evening meal and wait 4 hours after you finish the meal before you start recording your bg results, with eating carbs just before bed its difficult to say how this effected your bg levels last night, when you do make sure to test 2 hourly as this will give you a better picture of how your bg behaves throughout the night.
     
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  7. Janelle123

    Janelle123 Type 1 · Well-Known Member

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    Thanks for all of the advice. I'll have a look into buying that book. I don't want to contact my DSN as she seems to know nothing and during the pump course last week I had to correct her multiple times. I'm honestly better off asking strangers on the internet lol. Unfortunately, I didn't see any of your responses until this morning, after already going ahead and trying the new rates. Maybe I'm too eager to get this right and have to realise it will take time. Fortunately I didn't go hypo but I still think the rates/times will need adjusting some.

    Here are the results from last night (went to bed at 11pm with BG 4.7):
    1:00am = 5.1 - Even though I wasn't low I had 5g carb because I was paranoid I had overdone the basal rate
    5:45am = 7.3 - looks like I didn't need the extra 5g
    6:30am = 6.1 - maybe 5-6 rate is too high?
    7:18am = 5.4

    I may lower the rates slightly (just to avoid any hypos) and try again tonight with no food before bed. What do you think?
     
  8. donnellysdogs

    donnellysdogs Type 1 · Master

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    Pay particular attention to stop the drop from 5.45 to 7.15. .....
     
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  9. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Looking at those results I would leave well alone as no where nr hypo. Results are very good :) Just check at 2am and 4am to see what is happening then.
     
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  10. Janelle123

    Janelle123 Type 1 · Well-Known Member

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    Yea, I'm thinking about reducing the rate from 5-6 to 1.200
     
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  11. noblehead

    noblehead Type 1 · Guru
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    Basal testing is a pain especially during the night, but agree with CarbsRok that you should also include a 2 & 4am test.
     
  12. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    That's quite a drop from 1.300 down to 1.200
     
  13. donnellysdogs

    donnellysdogs Type 1 · Master

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    As you are dropping sometime between 5.45 to 7.15 I would if it was me be changing the 4-5am rate not the 5-6am rate.
    I would also be testing at 2,4 and 6am.
    I alternate 2 nights in a row if I basal check.
    I do one night at 1,3,5 and 7am and the next night at 2,4,6 and when I get up.
     
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  14. Janelle123

    Janelle123 Type 1 · Well-Known Member

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    Thanks :)
     
  15. donnellysdogs

    donnellysdogs Type 1 · Master

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    Aah but there was 10g of food pre bed... So although not near a hypo.. Without that small eat the levels may not have gone up to 7.0 and could have been 5.0 which would have meant hypo afterwards.

    The drop from 5.45 to 7.15 has to be addressed.
     
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  16. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    5gms :) but see your point.
     
  17. donnellysdogs

    donnellysdogs Type 1 · Master

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    Apologies.. 5g!!:):)...
     
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  18. Spiker

    Spiker Type 1 · Well-Known Member

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    Janelle I don't think your approach was that bad, you only increased total insulin about 1.0u overnight despite needing 3.15 of correction doses the previous night. So that was cautious.

    But as others have said there were too many unknowns really to have been making a basal rate change. It sounds like you are still uncertain about your carb ratio and correction ratio, still using the theoretical values rather than values that you know are right for you personally. And you took, not an unreasonable amount of carbs by any means, but enough to make it difficult to draw too many conclusions about those two nights of data.
     
  19. Janelle123

    Janelle123 Type 1 · Well-Known Member

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    Thanks for everyone's help so far.

    Last night I went to bed with no food and no active insulin (ffinally!), and here's how it went:

    Current basal rates:
    00:00 = 1.000
    03:00 = 1.100
    05:00 = 1.300
    06:00 = 0.900
    08:00 = 0.600

    10:44pm = 5.7
    2:00am = 6.5
    4:39am = 5.3
    6:29am = 3.6

    Based on these results, should I change 05:00 to 1.200?
     
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  20. donnellysdogs

    donnellysdogs Type 1 · Master

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    Me personally I would be changing 4am. As you do not know for sure in that 2 hour period when your levels started to drop.
    If you change 4am by the time it is fully delivered at 5am it then has up to 11/2 hours to all be fully impacting. So by altering your 4am dose you will be gradually lowering the full impact of the insulin from 5.30 to 6.30am.
    I like testing myself on the hslf hour slots but I alter the basal amount 21/2 hours before this.
    Novorapid bolus's are most active 2-3 hours after the bolus and I was told to apply the same rationale to my basal changes...
     
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