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How often do have to change all your ratios?

RobertJ

RobertJ

Well-Known Member
Messages
259
Location
Cambridgeshire, United Kingdom
Type of diabetes
Type 1
Treatment type
Pump
I have had several months of pretty good control but now I am struggling to get below the 10/11/12 range throughout the day.

Some weird situations are happening. Yesterday, more than once it kept creeping up after initially heading down. I don't even know how many injections I did yesterday but it was at least fifteen.

Today, after breakfast it rose all the way to 15.7 then came down at 11.6 and levelled out at that. I had a regular cappuccino (about 1.5CPs) and gave four units (2 + 2 corrective). At the time of writing (12:43pm) it has now come down to 7.1 but I five hours above target between one meal and the next.

I am therefore going to consider raising my ratios from 1:1 to 1.2:1. It is weird when my requirements suddenly change. Does this happen to other people?
 
@RobertJ have you done a basal test?
If your levels are creeping up, it is more likely to be a basal issue.
You may also then need to tweak your bolus ratios but trying to manage your complete insulin dose when your foundation (basal) is unstable will make life very challenging.
 
There are unfortunately about 5 million things that can mean changes are needed, warmer weather means I have to change mine, any slight illness, any anxiety, any of lots of things :(

Or have you tried changing your pen/cartridge/vial in case its not quite doing what its supposed to be doing?
 
In Response said:
@RobertJ have you done a basal test?
If your levels are creeping up, it is more likely to be a basal issue.
You may also then need to tweak your bolus ratios but trying to manage your complete insulin dose when your foundation (basal) is unstable will make life very challenging.
Click to expand...

I should do a basal test, it just looks like such an upheaval. In the book, How to Think Like a Pancreas, the instructions on how to do are basal test are so complicated. You have to dedicate such a big chunk of the day to it. What would you do for a basal test?
 
I do sometimes get days and runs of days just like that, sometimes they are because I'm not doing much and haven't done much exercise in recent days, sometimes I'm brewing something (though I usually know this is the case as I'll run low for a day before I start running higher), sometimes I just don't know, I feel fine, and it's really annoying (and I'm hungry!) The difficult thing as I'm sure you know is trying to work out whether it should be a temporary fix (i.e. more bolus today) or more long term (i.e. implement basal dose changes).

I've never done a proper basal test and have just Googled to see what it entails, and it does look like quite a bit of faff to setup all the conditions. I think the stress of sorting all of that out and then being hungry might skew my readings anyway ;)

While a proper controlled test is probably the best thing to do, you could look at the underlying trend having subtracted food intake and bolus, using nominal/historic expected carb:insulin and carb:bg rise ratios (assuming yours don't vary too much normally), and go with that.

What I would actually do is simply up my basal by one unit at each end of the day (for a 2 unit rise) and then make sure I have sufficient carbs stashed everywhere just in case I've messed it up. I have the "advantage" that my blood sugar tends to start rising in the morning, so as long as I go to bed toward the top end of my desired range I am fairly confident I won't go low, or if I do it won't be too terrible.

I upped my basal from 9+9 to 10+10 over the winter as I was trending higher (and up to 11+11 + lots of bolus when I had various man-flus during the winter), I'm now in the process of reducing it as I'm tending to run low, I'm not sure why it's at this particular point in the year though.
 
Mine change twice a year, luckily quite predictably.

In spring my basal seems to rise by a few units... and at the start of winter drops a couple of units.
I, occassionally, basal test, maybe twice a year, but generally use my waking number to confirm my basal is right. There's a caveat with this method, that I don't suffer dawn phenomenon, which I don't.
 
First, use the temp settings on your pump to verify that your changes will help to control your BS, then you quickly revert back if needed.
My first thought when you see unexplained high BS levels is to verify your infusion tubing has not been bent or damaged during the insertion.
When you extract the infusion set then use a magnifier to examine the end of the tubing as it should be a perfect round shape on the end of the plastic. Any damage done during the insertion of you infusion set can lead to your condition with highs, the pumps use stepper motors which are ultra reliable and deliver the exact amounts of insulin requested by the pump. The damage can result in backpressure that may cause leakage at the infusion site connection or possible even leak back thru the pump. Although, you would normally get a blockage error from the pump if the trigger pulse used cannot extract the insulin into the tubing.
I have spent months studying problems with my 770G and came to the conclusion that my problems were not related to the pump.
If the tubing rides up on the needle before insertion, that will constrict the opening on the end of the tube when inserted into the skin causing back pressure that can affect the insulin delivery.
Since you did not specify the brand of pump being used, I cannot speak to your infusion set.
 
I find my insulin needs discouragingly variable sometimes. As I'm on MDI (no pump) and my basal insulin is lantus, I can't vary my basal rate during the day/night, so I just try to get it right overnight, on the grounds that I can always do daytime corrections. So for me it's a question of having a reasonably flat line at night if I go to bed long enough after my evening meal so that is bolus and carbs are no longer in play.

And don't talk to me abiut dawn phenomena. Usually I have it, but sometimes I don't.
 
Like@jackois I find I need more basal in spring than summer. Like @ellie M DP is sometimes there, sometimes not and like @Antje77 the same ratios for food over a sustained period is just a pipe dream. I wing it every day. Some days are more frustrating than others, but I take each one afresh.
 
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