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Quick Question: Basal or Bolus?

V

victry77

Well-Known Member
Messages
260
Hi, for the past couple of day my BG levels have been brilliantly stable, so something is obviously working right.

Example yesterday;
Breakfast - 8.9
Lunch - 9.0
Dinner - 8.6
Bed - 8.6

Today (so far);
Breakfast - 8.9
Lunch - 9.9
Dinner - 9.9

Now they're consistent but just that bit higher than my target range. I don't mind for the minute as it's a welcome respite from all the hypos, but it would be brilliant if I could get them from the 8/9's into the 6/7's.

What do I need to tweak? Would it be my basal or my bolus? I am using the Bolus Wizard and it is applying corrections each time to bring me into target (my DSN set my sensitivity at 4.1) but obviously I'm not getting to my target.

So, just wondered what I should look at tweaking? Thanks
 
Your fasting bg level (pre-breakfast) is slightly high so if you get that down you should stay around the same level at lunch provided you get the I:C ratio right, overall your bg levels are running stable (although a little high as you say).
 
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Thank you very much, noblehead!

I currently have three different basal rates. My highest is my overnight one at 0.37 (from midnight to 6.30am), I then go to 0.35 (6.30am to 6pm) then finally 0.30 (6pm-midnight). The last one was suggestion by my consultant as I had a tendency to hypo between dinner and bed.

Now, would I just look at tweaking that overnight dose to get the morning levels down or would I also need to apply the same tweak to the other settings?
 
If your look at your first set of bg readings your over-night bg levels only went up by 0.3 which is extremely good, so your basal rates at night are spot on, you just need to get your pre-bed levels down a little so you wake up lower the next morning without the risks of hypo's, hopefully the more experienced pump users will advise.
 
Ah, OK, I understand what you mean. So it will be that 6pm-12am period I would need to consider.

Thanks for your time
 
victry77 said:
Ah, OK, I understand what you mean. So it will be that 6pm-12am period I would need to consider.

Thanks for your time
Click to expand...

Ideally yes, but if you had a tendency to hypo on a evening before your consultants recommendations then its a difficult one, I'll tag some other pump users like @Spiker & @donnellysdogs to help you.
 
You need to do some basal testing.

From the figures above as well its not possible to see what is happening two hours after a meal.
Just 4 tests is not much idea to be able to give any advice to be honest.
If you are correcting on a 1 unit to 4g then you can adjust it tonhive yourself a little more insulin by changing it to 1 to 3.9. Test for a day and then see if you need a 1 to 3.8 the next day.
You should try to keep your meals 5 hours apart and correct only once in those 5 hours and you need to test more. 2 hours after a meal, when you wake.
Basal testing with a minimum of 2 hourly tests over night is essential to find out if you are dipping around 3-4am and then rising. This means that you would need to eat your last meal about 5 or 6pm and then start testing at 10pm, midnight, 2am, 4am and 6am.
If weekdays activities are different to weekends you need to do this for the two separate occasions overnight.
When do you see your DSN?
 
This could be as simple as a one off correction dose to get your BG down to your target level. Your basal looks to be almost perfect.
 
I increased my (6pm-12am) ratio from 0.30 to 0.32 and hey presto.... a hypo at 8pm

To be fair I may have over-estimated the carbs in my meal. I leave it as it is and see what happens tomorrow.

Thank you Donnelly. I haven' done any basal testing yet, but am planning to within the next couple of weeks. I was meant to have a DSN appt next Monday but had to change it due to work, now it's not till next month.

Spiker said:
This could be as simple as a one off correction dose to get your BG down to your target level. Your basal looks to be almost perfect.
Click to expand...

Thank you, Spiker. Could you possibly dumb that down for me more, though? Where would I be applying a correction dose? Bolus Wizard factors in a correction for me, what should I be doing in terms of correction?
 
I disagree with Spiker because all the test results are pre meals you do not know how yourbresults are after meals which is why you should not increase your bolus's until you have done basal testing. Your levels are too high at night but you do not know if your are rising at all or dropping at any point.

If you basal tested overnight. Got yourself a good starting ooint for day times it would help.

You do need to test 2 hours after meals everyday at the moment.

Get some bg results to look at.
 
donnellysdogs said:
I disagree with Spiker because all the test results are pre meals you do not know how your results are after meals which is why you should not increase your bolus's until you have done basal testing.
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The lady's got a point.

My take on your data, assuming those are all pre meal readings, is that both your basal and your bolus ratio are fine, and you need a one off correction to get your very level blood sugars into your target range, whatever that is. But yes it's also possible that your basal and carb ratios are both wrong, but are exactly cancelling each other out.

Generally it's deemed "good enough" for a pre meal reading to stand in for the successful dosing of the previous meal. While many on here run a tighter ship than that, I think it's more than adequate. It's orthodox NHS advice.

To do a correction dose, just enter your BG into your bolus wizard. With zero carbs I guess. You should have set a target BG range in your bolus wizard already. It's not 9.0 is it? If it is, you are perfectly on target, but might want to consider lowering your target.
 
victry77 said:
What do I need to tweak? Would it be my basal or my bolus? I am using the Bolus Wizard and it is applying corrections each time to bring me into target (my DSN set my sensitivity at 4.1) but obviously I'm not getting to my target.
Click to expand...
Again I must respectfully disagree with my esteemed colleagues.

Your sensitivity (ISF) is set too high and that's why your correction boluses are not bringing you to target. If it was a basal issue or a carb ratio issue you would see oscillations not this straight line. I am very unwilling to believe that you have got hidden oscillations that are so perfectly timed that they conveniently disappear just before each meal. Possible, but very unlikely.

Also your ISF of 4:1 or 4.1 (?) is out of wack with a carb ratio of 0.30, in my view anyway.
 
ISF of 4:1 is a conservative, safe value that a DSN might set at the beginning of using a pump, but the likelihood is it will need to be titrated down based on experience. Which you now have.
Have you talked to the DSN?
 


I don't disagree eith your thoughts on corrections Spiker... Just that a full picture should be gained. I unit to 4 is not enough.. I agree but I cannot see why bolus ratio was changed??? By OP without doing proper basal testing first.

Most respectfully....-lol
 
 
victry77 said:
I increased my (6pm-12am) ratio from 0.30 to 0.32 and hey presto.... a hypo at 8pm

To be fair I may have over-estimated the carbs in my meal. I leave it as it is and see what happens tomorrow.
Click to expand...
0.30 to 0.32 - Are you talking about a carb ratio or a basal rate? I'm not sure.
 
Spiker said:
0.30 to 0.32 - Are you talking about a carb ratio or a basal rate? I'm not sure.
Click to expand...

Sorry, I mentioned this in my second post. 0.30 is one of my three basal rates. This was brought down from 0.35 by my endo last Tuesday who noticed a pattern of mid evening hypos.

donnellysdogs said:
I don't disagree either your thoughts on corrections Spiker... Just that a full picture should be gained. I unit to 4 is not enough.. I agree but I cannot see why bolus ratio was changed??? By OP without doing proper basal testing first.
Click to expand...

I haven't changed my bolus ratio. A few tweaks went on in the first week of the pump but my ratios have stayed the same for the past three weeks. It was only until last week that I had a flat basal rate over 24hrs, now that has been tweaked to three basal rates.

I will get to basal testing after next week, I assure you I will also look into altering this sensitivity factor when I do so.

Anyway, all thrown to pot today! Morning BG was 8.4. I tested 2hrs later and was 10.1. Then about half an hour before my lunch (4.5hrs after breakfast) I went down to 3.1....
 
victry77 said:
Sorry, I mentioned this in my second post. 0.30 is one of my three basal rates. This was brought down from 0.35 by my endo last Tuesday who noticed a pattern of mid evening hypos.

I haven't changed my bolus ratio.
Click to expand...
OK I think we were confused because you used the word "ratio" not "rate".
 
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