Help with overnight/morning basal rates

[Spiker]

That's a great rant Janelle. I totally identify with it. I think you were probably one of their 'difficult students'. ;-)

It's really bad that the DSN got the IOB example exactly the wrong way round. IOB is hard to understand and potentially dangerous if you get it wrong, so they really need to work harder to make sure they teach it correctly.

 

[Janelle123]

That's a great rant Janelle. I totally identify with it. I think you were probably one of their 'difficult students'. ;-)

It's really bad that the DSN got the IOB example exactly the wrong way round. IOB is hard to understand and potentially dangerous if you get it wrong, so they really need to work harder to make sure they teach it correctly.

Haha I think I was definitely one of their 'difficult students' and I'm sure the others attending the course thought I was a know-it-all lol. I tried to keep my thoughts to myself but sometimes I just couldn't keep my mouth shut.

Yeah, I couldn't believe it when she just carried on with the example without an explanation!

 

[donnellysdogs]

Perhaps we should have a posting " daft things our pump nurses have said". One of a friends pump nurses told her to raise the basal on the hour of the high occuring!!!

 

[Janelle123]

Update from this morning:

Rates:
00:00 = 1.000
03:00 = 1.050
05:00 = 1.300
06:00 = 0.900
08:00 = 0.600

10:48pm = 8.2 - 0.4 units
11:16pm = 7.9
2:26am = 7.4
5:17am = 7.1
6:28am = 6.3
7:23am = 5.2

Based on this, I think that I need to change the 05:00 rate. Is that what you would suggest?

 

[donnellysdogs]

Yes I agree. If it was me with your rates ( practically identical to mine!!) I would lower by a further 0.05.
I would also be considering a separate 4am of a slight lowering too. Keeping the 3am at 1.05 but the 4am at 0.025 less as their is a small drop there too.

How did the morning pan out did your levels rise a little from 8-10am (I'm hoping not) but wouldn't be surprised as most people find insulin impacts 4-5 hours so by reducing last night it may have impacted up to 5 hours later.

Again, this is based upon my experience only.... Lol!!:;

 

[donnellysdogs]

Oh and well done!!! Fantastic results for a very short time...

By the way.... Was the 0.4 a correction? If so after 5 hours it hadn't actually brought you down that much....again, just me experience if I was 8.4 and needed to do an overnight test, I would have done it without correcting... Just for the one night as it would have been a totally true picture.
However, it has enabled you possibly to consider your correction factor as well?

 

[Janelle123]

Yes I agree. If it was me with your rates ( practically identical to mine!!) I would lower by a further 0.05.
I would also be considering a separate 4am of a slight lowering too. Keeping the 3am at 1.05 but the 4am at 0.025 less as their is a small drop there too.

How did the morning pan out did your levels rise a little from 8-10am (I'm hoping not) but wouldn't be surprised as most people find insulin impacts 4-5 hours so by reducing last night it may have impacted up to 5 hours later.

Again, this is based upon my experience only.... Lol!!:;

Thanks, I'll try that tonight. I'm started to get excited that my night time rates are almost sorted! I think I'll need some adjustments from 8pm too because my BG starts to rise at about 10pm but I'll tackle that one once I've got the correct night rates.

It's 8:20am and I'm... 9.7!! I did have a coffee at 7:30am (which I bolused for) but that still seems like a huge rise!

 

[Janelle123]

Oh and well done!!! Fantastic results for a very short time...

By the way.... Was the 0.4 a correction? If so after 5 hours it hadn't actually brought you down that much....again, just me experience if I was 8.4 and needed to do an overnight test, I would have done it without correcting... Just for the one night as it would have been a totally true picture.
However, it has enabled you possibly to consider your correction factor as well?

Yes, it was a correction. I've increased my correction factor from 12am to 6am to 1:1.5 but other than that it's set to 1:3 which works during the day. I might need to change the time of the increase to 10pm - 6am

 

[donnellysdogs]

Yes, next step is to get your pre bed levels sorted. Why did you increase correction qty so much? Is that the minimum your pump will change by?

I always change my corrections by the smallest amount possible....for example if mine wasn't bringing me down enough to my target level within 5 hours and it was set at 1 unit brings my levels down by 3ml bg. I would be changing it to 1 unit bringing down by 2.9ml.

Your 10.48pm didn't bring down enough so that timing does need to be changed really.

You are going great guns. Well done. Pleased as punch for you.

 

[Janelle123]

Yes, next step is to get your pre bed levels sorted. Why did you increase correction qty so much? Is that the minimum your pump will change by?

I always change my corrections by the smallest amount possible....for example if mine wasn't bringing me down enough to my target level within 5 hours and it was set at 1 unit brings my levels down by 3ml bg. I would be changing it to 1 unit bringing down by 2.9ml.

Your 10.48pm didn't bring down enough so that timing does need to be changed really.

You are going great guns. Well done. Pleased as punch for you.

I calculated it based on a few nights of corrections and found that 1 unit was bringing me down approx 1.5mmol/l. I guess it's not too surprising considering my overnight basal rate is almost twice that of my day rate. I've only needed to do an overnight correction once since I changed it and it seemed to work.

 

[donnellysdogs]

So long as you not over calculated to get a night low. Thats my only concern that you get back to your target by 5 hours during the night and not earlier. Thats my only concern.
As you say-like me.. Your levels double like mine do, so I understand your reasoning.
You are analysing and adjusting very well indeed.

Your previous postings regarding comments and nurse etc made me chuckle...

 

[donnellysdogs]

The other thing I do. Others probably don't do this though...
I do not bolus for my coffees. I actually basal test with drinking coffee as I drink so many and so regularly.
I honestly would have to get my pump out an extra 12 times a day at least if I had to bolus for coffees.
If you regularly.. I mean always... Have a coffee around the same time each night it may mean that you could alter your basal to accomodate this.

I am not suggesting that you do... But it maybe something to consider in with your lifestyle.... My lifestyle of caffeine fixes allows me to do this.. Yours might not.

Would be interesting actually to hear how others handle a coffee in the evenings?

(I have started to reduce my coffee today but my bloods have stayed static).

 

[Janelle123]

So long as you not over calculated to get a night low. Thats my only concern that you get back to your target by 5 hours during the night and not earlier. Thats my only concern.
As you say-like me.. Your levels double like mine do, so I understand your reasoning.
You are analysing and adjusting very well indeed.

Your previous postings regarding comments and nurse etc made me chuckle...

Just out of curiosity, what are your basal rates and correction factors?

Haha, it was a long week. All I wanted was for them to show me how to use the pump. I knew there was going to be more to the course than that since it was a week long so I had accepted the fact that I was going to be taught things I already knew but when they started feeding us incorrect information it was so frustrating!

Do you have to go on week-long courses in the UK for a pump?

 

[Janelle123]

The other thing I do. Others probably don't do this though...
I do not bolus for my coffees. I actually basal test with drinking coffee as I drink so many and so regularly.
I honestly would have to get my pump out an extra 12 times a day at least if I had to bolus for coffees.
If you regularly.. I mean always... Have a coffee around the same time each night it may mean that you could alter your basal to accomodate this.

I am not suggesting that you do... But it maybe something to consider in with your lifestyle.... My lifestyle of caffeine fixes allows me to do this.. Yours might not.

Would be interesting actually to hear how others handle a coffee in the evenings?

(I have started to reduce my coffee today but my bloods have stayed static).

That's a good idea. I have coffee at 7:30am, 10:00am, 12:00pm and 2:30pm and usually another in the evening.

 

[donnellysdogs]

I got a 2 hr training session and that was fixing it up in myself with insulin and given a week I think before went back. Thankfully iHs here helped me enormously.... Members here are so fantastic.

Thats for AM shift patterns of getting up at 5am.

Totally different for PM shifts as get up 3-4 hours later..

The Insight pump allows up to 15 minute slots.. So a lot more fine detail than others. However it lets you see how getting up doubles my insulin needed.... And thats not me working the shifts either, its my hubby!!! I work gardening later when he is on lates so this again flat lines my basal level needs.

Its lovely to be able to fine tune like this.

 

[donnellysdogs]

Corrections are all different from 1 to 3.4 to 1 to 3.8. I actually need less during the night to correct. Mine run from 11pm to 6am.
However if due to a set failure I get a level above 12.0 I do double the correction it tells me to give!!

These are my normal blood running levels. As you can see though I don't eat during the daytime.....so again, I'm quite different to most people....

I'm probably overloading you with info. Take it step by step. Also give yourself time to relax away from monitoring.

I got told off by my consultant for being too obsessive. She was right to be honest. Since relaxing (although still testing alot) I rarely have to change rates etc.

Give yourself time to breathe.... Very important for your happiness and wellbeing.

 

[Janelle123]

That's all I wanted. It seemed ridiculous to have a week-long course. When the DSN first told me the course was from the 20th to the 24th April I responded with "Oh ok, so is that just an hour each evening?" but no, it was 5 full days...

Wow, it's crazy how much getting up at different times changes the basal rates!

 

[Janelle123]

Yay for stable levels!

That's funny you don't eat during the day because neither do I lol

I've also been told I'm too obsessive since I test about 30 times a day. I try to limit myself to 1 test an hour but after I eat I can't help but test every 15-30mins for the next 2-3 hours...

 

[donnellysdogs]

I cannot imagine doing a 5 day, full on course!!! I got my pump very quickly due to a driving incident so didn't even have to do a carb counting course because I could prove I carb counted. Although it was a horrible, awful incident that will stay with me forever, I am forever grateful to my DSN at the hospital that had never met me but helped me so much on my very 1st appt at that hospital (it was due the day after my driving incident!(.
Howver most people have to attend a carb counting course in UK but then may get a saline pump for a week to try. Some just like me get launched straight in with a 2 hr training session.

My DP could never get sorted on MDI. So a true benefit. Just like you....

Well done. I know I keep saying it but you are getting on fantastic.

 

[Janelle123]

I cannot imagine doing a 5 day, full on course!!! I got my pump very quickly due to a driving incident so didn't even have to do a carb counting course because I could prove I carb counted. Although it was a horrible, awful incident that will stay with me forever, I am forever grateful to my DSN at the hospital that had never met me but helped me so much on my very 1st appt at that hospital (it was due the day after my driving incident!(.
Howver most people have to attend a carb counting course in UK but then may get a saline pump for a week to try. Some just like me get launched straight in with a 2 hr training session.

My DP could never get sorted on MDI. So a true benefit. Just like you....

Well done. I know I keep saying it but you are getting on fantastic.

Sorry to hear about your driving incident. If you don't mind me asking, what happened?

We are also required to do a carb counting course before getting a pump which is why I thought it was weird that they spent 2 hours the first day teaching us how to count carbs. I didn't actually do the carb counting course though because my dietitian was satisfied that I was already competent at it.