Replies to This Discussion

Permalink Reply by onesaint on May 16, 2011 at 4:18pm

Thanks for the kind words, Heather! I hope the LCHF management style works for you.

That protein glucose is a long lasting oddity isnt it? I use square boluses to cover it.

It sounds like you just us the minimal basals and pay close attention to it. Low carbing will make that easier, just because the PP trends last so much longer (I find).

Thanks for sharing! Also, if you feel up to it, post some shots of your CGMS trends over on the flatliners group. It has seemed to inspire a few of us to try and keep our BGs as tight as we can. Its fairly addicting as well.

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Permalink Reply by 1type2go on May 15, 2011 at 9:07pm

Hey Just my Two bits but I'd suggest you set your 5:am - 12 noon way down and I'd say same dose...just 5:am until 9:30 and see what happens with the rest of your day ,you should never need to address a low even if you skip a meal.This skip-A-meal is actually a technique to see if your basil is set right .That being said ,missed meal doesn't imply never eat ...Also exercise = eat=bolus.

Donovan

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Permalink Reply by onesaint on May 16, 2011 at 4:28pm

Thanks Donovan. Im toying with it now, adjusting the whole time period (5:30-12pm). Then once my ducks are in a row, I will break that up into smaller groups for more effectiveness. Or at least, thats the plan right now. I also have a down trend before lunch that needs addressing as well. Im pretty familiar with the basal concept (fasting insulin) as well as basal testing (the skip-a-meal thing you mentioned). That is the reason behind my asking of this question and address the basal changes. Appreciate the input.

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Permalink Reply by KiwiRox on May 16, 2011 at 10:33pm

Currently i have 6. I'm in nursing school and do rotations, etc. Every day is different so sometimes I need to do 24 hour temp basals based on percentage changes. Here are my rates:

12;00 - 2:00am 0.35
2:00 - 7:00am 0.45
7:00 - 10:00am 0.35
10:00 -3:30pm 0.45
3:30 - 8:30pm 0.65
8:30 - 12:00am 0.35

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Permalink Reply by onesaint on May 17, 2011 at 9:22pm

Thats wild regarding your rounds. Do you use the patterns feature on the MM at all? You might be able to map a days basals to that days rotation if there is any consistency. I have a neighbor who just graduated with from the program over here at SMC. He is in the ER and his schedule is all over the place. When you set your temp basals, how does that work out BGs wise? How do you set them?

Thanks for the input!

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Permalink Reply by Capin101 on May 17, 2011 at 10:10am

I seem to have more basal rates than the average insulin dependent diabetic.

midnight to 1: 1.65u
1-3: 1.6u
3-6: 1.55u
6-9: 1.4u
9-11: 1.2u
11a-2p: 1.05u
2-4: 1.25u
4-5: 1.6u
5-8: 1.5u
8-11:30: 1.4u
11:30-midnight: 1.55u

Thats 10 different basal rates for 33.5 units daily. I seem to mess with one or two of the basals every week or two trying to tweek my system even better. If I am running consistently high or low at a specific time that is not attiributed to a bolus I will make, add or change a basal rate. One thing I have noticed: My BG daily averages are great at 33.5 units per day and I run low if I have more than 33.5 U/day and run high if I have less than 33.5 U/day (no matter how or where I put the basal rates). I also have a decent DP that I slowly gear up for in the early morning hours and then slowly drop my basal rates as well. Currently I am about 66% basal and 34% bolus for my TDD.

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Permalink Reply by 1type2go on May 17, 2011 at 11:35am

Where are the lows popping up ??It seems you have a spike starting on the incline at 11:30 pm with 1.4u and plateaus for an hour and a half from midnight till 1:30am at 1.65u. Then I see very little for the dawn 6am tapering to 1.05 through 2pm

Let us know your waking hours and most activity time

Donovan HOLD IT do you work nights??

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Permalink Reply by Capin101 on May 17, 2011 at 12:24pm

1type, I am not sure if you are speaking to me (capin) or Donovan. I guess I am also not sure if I got my message across clearly. First I work 1st shift and wake around 7 during the week. My comments about 33.5 basal units a day was a general comment. My body seems to be a fine tuned machine at 33.5 basal units a day. If I am running low in the late mid-morning and drop my basals to 33.4 basal units per day, then I will be running higher than I want for a good portion of the day and need correction boluses. If I am running a little high in the late mid-morning and gear up my basals then I will need to correct a few hypos throughout the day. For some reason 33.5 u/d is what works for me and devieating from this causes more highs or lows (and for a large duration of the day) then I can mathematically understand. When bolusing I expect a 0.1 unit bolus to drop my BG by ~3.5 mg/dl and this just is not the case with basal increases/decreases away from 33.5 units/day.

The spking basal rates that you mention above are to gradually combat my DP and then gradually decreasing my basals as the DP resides.

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Permalink Reply by 1type2go on May 17, 2011 at 9:49pm

Wow Capin it's interesting to see another persons basil rates to compare with.
My own dawn phenom starts after 5:30 am any morning I test at 4:00 am....my BG is 'bout 5 or 6 mmol.
Before I was started on the pump ....at 6:00am I be up to 12 to 15 mmol.(Canada) then fight with it for the day and that would turn into the week fighting it .

GREAT Thread !

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Permalink Reply by onesaint on May 17, 2011 at 9:35pm

Capin, I use less rates, but my daily insulin is about the same. 68% and 32% with Basals at 29u & 14u respectively. How do the small hourly rates work for you? Do you notice differences when adjusting a 1 hour time slot?

Thats wild about the exact basal amount. I guess the body konws what it wants, eh?

Thanks for posting.

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Permalink Reply by Capin101 on May 18, 2011 at 8:26am

The small hourly basal rate changes usually work pretty well. If I am consistently going high as per my CGM at say 4 a.m I will bump up my basal at 2 a.m. and it will help with the higher reading. I use the hourly rate change as an easier method to fine tune my control, instead of maybe starting over and re-inventing the wheel? I will occasionally add anther basal time slot or I will adjust one to be the same as an adjacent rate. My endo periodically requests that I add a time or make an adjustment as well. My best guess would be that if I decrease a basal rate by 0.05 due to hypos I will consistently run maybe 10-30 points higher (depending on how large the basal rate is). I frankly cannot imagine good control with 3 or less basals, I just dont think it would work well for me.

I have no explanation for the exact total basal daily amount. Just an observation that diabetic life is easier at 33.5 basal units a day. I have had some success with decreasing one basal rate while increasing another to stay at 33.5 u/day.

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Permalink Reply by 1type2go on May 17, 2011 at 11:12am

So I hit it hard in the early am (with 1/3 more insulin as basil) and then there is a slight fluctuation at 4:30pm till 10:pm in the tapered daily basil.

12-4am- 0.375 My bolus is about 50% more before 9:30 am,(3.5u) then it is during the rest of the day (dawn phenom)
4-6am- 0.475
6-9;30am- 0.50
9;30-4;30pm 0.425 then my meals only require 1u maybe 2u per meal
4;30-10pm 0.45
10pm-12midn. 0.37

If I plan my day as an exercise day will then use a temp basil from 5:30AM reduced by up to 50% and cut mt boluses down as well.


I hope you will look at these as percentages,also use the basil rate increase if you are sick (I increased to 140% for temp basil.

I just went through a very sick week and ended up in the hospital with high key tones.I thougfht my higher BGs were as a result of the sickness but not so .......improper infusion setting and it was crimped.

Looking forward to getting back to health.


Donovan

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