Help with overnight/morning basal rates

[Janelle123]

So it looks like you are going low in the early evenings. Maybe setting up a chain reaction for later. My gut feeling is we are trying to solve more than one problem at a time here - and that's fruitless. My other gut feeling is the biggest problem is not your basal rates but that evening meal bolus, the carb ratio there.

What we need to do is slow everything down, simplify it, and solve the biggest problem first. I think that's the evening meal. Now probably we will have to iterate and go through everything twice: first fix the evening bolus / carb ratio (approximately), then fix the basal, then do a second fix on the ratios and then maybe a final fix on the basal again. Unless you are able to go straight to a fasting basal test? I realise you are working and having a routine and stuff but that might be best.

But, yeah, fix one problem at a time and fix the biggest problem first. Stop stacking your corrections, regardless of IOB. You can try that stuff when you have no other problems going on, when you're confident in your ratios and your basal. Stacking will make you go hypo, regardless of IOB, if your correction ratio or carb ratio are wrong. Basically your basal, carb ratio, correction ratio, and IOB duration all have to be right, otherwise stacking/IOB will not work. So let's leave that for the advanced stage.

I guess I'm confused why my carb ratio has suddenly stopped working. It has always worked for me in the past. In saying that, I just went through my records and it seems I'm a snacker. I can't find one time where I've ever eaten and bolused for only one meal. I usually have dinner followed by some sort of treat. Tonight I'll try to stick to just one meal and one bolus and see how it goes.

 

[Spiker]

I can't remember how to find the acting time on my pump but I'm pretty sure I remember it being 4hrs

If you have an Animas Vibe it is Menu - Setup - Advanced, scroll to screen 8.

 

[Janelle123]

I have to disagree. The previous night you were also going low and taking carbs at 8.39pm, 3hr 20m after your bolus at 5.22pm (which you followed up with a stacked bolus). That shows you overdosed for the meal on the previous night as well as last night.
I can only tell this because you have such great records by the way

I agree with you, but you have to admit that the drop last night was far more significant even with less insulin.

 

[Janelle123]

If you have an Animas Vibe it is Menu - Setup - Advanced, scroll to screen 8.

Thanks. It's set to 4hrs. Should I change it?

 

[Spiker]

Thanks, I will try to stick by these rules. I think I just freak out once my BG is over 8 because my husband and I are trying for a baby and I've read that the limit for 1hr after a meal is 7.8. When I'm above 8 I worry that I'm harming a potential baby.

They give some very tight limits for babies. That explains why you are so motivated to get it right!

You have a while to get the hang of it. While you are just trying to conceive, good BG helps but there is no "bad limit" so you can cut yourself some slack while you learn. Later on it will have to be stricter, but for now you can make some mistakes while you learn.

You might want to increase the IOB time to 4.5 hrs or 5 hrs. 4.0 hrs is the default but it may be too aggressive for you. But I think that evening carb ratio is the one to fix first. Before I contradict myself and ask you to try to fix two things at once. ;-)

 

[Spiker]

I guess I'm confused why my carb ratio has suddenly stopped working. It has always worked for me in the past. In saying that, I just went through my records and it seems I'm a snacker. I can't find one time where I've ever eaten and bolused for only one meal. I usually have dinner followed by some sort of treat. Tonight I'll try to stick to just one meal and one bolus and see how it goes.

Did you bolus for the after meal snacks? If not, then your carb ratio was too high in the past. If you did, then it may be the stacking rather than the snacking.

I have been there, done that. Watching your BG like a hawk tempts you to correct all the time, particularly when you have a new IOB function that supposedly makes it safe to stack. You need to relax a little with the aggressive corrections until the other basics are confirmed. It's a "walk before you run" kind of thing.

 

[Janelle123]

They give some very tight limits for babies. That explains why you are so motivated to get it right!

You have a while to get the hang of it. While you are just trying to conceive, good BG helps but there is no "bad limit" so you can cut yourself some slack while you learn. Later on it will have to be stricter, but for now you can make some mistakes while you learn.

You might want to increase the IOB time to 4.5 hrs or 5 hrs. 4.0 hrs is the default but it may be too aggressive for you. But I think that evening carb ratio is the one to fix first. Before I contradict myself and ask you to try to fix two things at once. ;-)

I've heard that right from conception its important to have the best control possible. I do tend to slack off and not worry too much about high's when I know that there is no way conception has happened yet but unfortunately once I know that its possible there is still another 2 weeks to find out if we've been successful or not so there is always 2 weeks of every month were I'm stressing about my blood sugars.

Do you think I should keep my carb ratio at 1:10 for tonight and see how it goes or change it to maybe 1:11?

 

[Spiker]

Thanks. It's set to 4hrs. Should I change it?

If you take our advice and switch to no food or correction for 5 hours after a meal bolus, and keep up your excellent testing, you will be able to see for yourself how long your insulin continues to act in you for. You will also be able to thoroughly check your carb ratio, and then your correction ratio.

When they switched you to a pump did they tell you to reduce your ratios by about 20%? The pump is more efficient, or whatever the reason, insulin needs often go down when you go on the pump.

 

[Spiker]

Do you think I should keep my carb ratio at 1:10 for tonight and see how it goes or change it to maybe 1:11?

If you are going to change one thing, I suggest it's your carb ratio. Particularly if you didn't reduce it when you started with the pump (recently right?)

 

[Janelle123]

Did you bolus for the after meal snacks? If not, then your carb ratio was too high in the past. If you did, then it may be the stacking rather than the snacking.

I have been there, done that. Watching your BG like a hawk tempts you to correct all the time, particularly when you have a new IOB function that supposedly makes it safe to stack. You need to relax a little with the aggressive corrections until the other basics are confirmed. It's a "walk before you run" kind of thing.

Yes, I did bolus for the snacks.

I know I need to relax. It's hard for me to ignore when I see a high reading though. The best thing would be for me to not test so often but I seem to be failing at cutting back.

 

[Spiker]

I've heard that right from conception its important to have the best control possible.

It is, but as the baby is conceived and develops it gets more and more important. Now, not so much as later. They want you to do your best from the start but they know it's a learning curve.

Do you have a DSN? Here in the UK some of the very best DSNs work with women who are pregnant or trying to conceive.

 

[Janelle123]

If you are going to change one thing, I suggest it's your carb ratio. Particularly if you didn't reduce it when you started with the pump (recently right?)

I was only told to reduce my basal by 20% not my carb ratio :/

I've only had the pump for about 2-3 weeks.

 

[Spiker]

Yes, I did bolus for the snacks.

I know I need to relax. It's hard for me to ignore when I see a high reading though. The best thing would be for me to not test so often but I seem to be failing at cutting back.

One good rule I used to follow is: if you can't stop yourself from correcting (before 4-5 hours) then don't test. But I think you have the willpower. Your frequent testing is teaching you loads about how all this is working, so stick with it if you can.

 

[Janelle123]

It is, but as the baby is conceived and develops it gets more and more important. Now, not so much as later. They want you to do your best from the start but they know it's a learning curve.

Do you have a DSN? Here in the UK some of the very best DSNs work with women who are pregnant or trying to conceive.

To put it in the nicest way possible, my DSN seems to know nothing. I talked to my diabetes doctor about a year ago and since my HbA1c is in range she said I could start trying whenever I'm ready as long as I'm taking folic acid.

 

[Spiker]

I was only told to reduce my basal by 20% not my carb ratio :/

Yeah, because pumped insulin called "basal" works differently from the identical pumped insulin in the same pump and the same infusion set that's called "bolus". :-/

Not!!!

I think reducing first your carb ratio and then your correction ratio is a good idea. But to makes sense of any of it you need to follow DD's rules - no snacks and no corrections for 5 hours after each meal bolus. OK?

 

[Janelle123]

One good rule I used to follow is: if you can't stop yourself from correcting (before 4-5 hours) then don't test. But I think you have the willpower. Your frequent testing is teaching you loads about how all this is working, so stick with it if you can.

I will try my best to not do any corrections tonight. Though I have a feeling if it's still over 10 or so after 2 hours I won't be able to stop myself Unfortunately my husband has already decided on nachos tonight which I know is going to make my BG spike :/

 

[Janelle123]

Wow, actually typing out what I eat makes me realise how unhealthy I eat lol

 

[Spiker]

To put it in the nicest way possible, my DSN seems to know nothing.

Oh dear. Hopefully they will assign you a better one once you get pregnant.

 

[Janelle123]

Oh dear. Hopefully they will assign you a better one once you get pregnant.

Thankfully, I'm pretty certain they will refer me to a specialist at the hospital.

Edited because I think I was over-sharing

 

[Spiker]

I will try my best to not do any corrections tonight. Though I have a feeling if it's still over 10 or so after 2 hours I won't be able to stop myself Unfortunately my husband has already decided on nachos tonight which I know is going to make my BG spike :/

If you are going to do corrections after 2 hrs for 10+, which is understandable, then try injecting only three quarters of what the wizard suggests? Just until you get a better handle on it?

It's always better to err on the side of injecting too little insulin rather than too much, at least while you are feeling your way forward.