Replies to This Discussion

Permalink Reply by Capin101 on April 13, 2012 at 9:27am

I applaud your effort for tight control and think that there is no real black and white answer that you can recieve.

For background (that your post makes it sound like you are already aware of) to make basal rate adjustments go back usually 2 hours (the amount of time it takes your insulin to peak). So if your BG is spiking at 8:00, then you would need to make adjustments at 6:00. I would suggest that after making any adjustments to your insulin management that you wait 2-3 days to get some data before making further adjustments (assuming that your adjustment is not grosly off). I would also recomend that you make small adjustments because small adjustments can have a bigger effect than you might guess.

My gut feeling is that increasing your basal by 100% would be too much, but there is only one way to find out... Make sure to keep hypo treatment and a meter handy if you decide to up your basal rate.

I would guess that you are experiencing some form of Dawn Phenomenon. The basic theory is that growth hormones released during sleep cause some insulin resistance causing a greater need for insulin while sleeping (my case). Or more accurate for you: when you wake your liver dumps some sugar into your blood stream. For normal people this may allow them to go fix (or hunt) breakfast without experiencing a hypo. For a diabetic it results in an increasing BG when waking.

The two most common ways to deal with DP are to adjust your basals my method since I wake up around the same time every day. Or some take a small bolus before even leaving their bed to counteract their expect BG spike. I would think this method may be the best for your circumstance?

Dawn Phenomenon can be quite variable from day to day and I encourage you to exercise caution and not expect the same results every day.

• ▶ Reply

Permalink Reply by Benjamin McLaughlin on April 13, 2012 at 9:53am

Yeah, I appreciate your reply. Since I the increments of basal is only .05, I guess just dealing with it is probably best for now. Being a math teacher, I am just a perfectionist. I want that CGM to be a straight arrow...haha. Guess I should get over that with this disease...

• ▶ Reply

Permalink Reply by t.clayton on April 13, 2012 at 11:26am

You can do an increase for the morning, the nice thing about the pump is you can have the increase be for only a couple hours and then drop it back down to the lower rate to help deal with the morning spike, just remember to make the change about 1 1/2 hours before the increase or decrease is noticed due to the time it takes to insulin reach peak activity.

• ▶ Reply

Permalink Reply by EllasMom on April 13, 2012 at 10:52pm

Your basal rate seems fine. How high is your breakfast spike? You might want to try adjusting your I:C ratio first & see if that works. That being said, my daughter who is 6, very tiny & very sensitive to insulin started the omnipod about 3 weeks ago. She is also newly diagnosed w/a TDD of around 10. She started at .05u/h and was having high numbers post breakfast, even with reducing I:C ratio from 1:22 to 1:18. I up her basal rates by .05u/h as needed and she is currently at .20u/h from 6a to 9a. You could try upping your basal from 6a to 9a to 1.0u/h and just keep a close eye on BG...an increase of 0.5u/h is still a very, very small increase. Being newly diagnosed, you should have a CDE or endo you can contact to discuss as well if you're hesitant to make changes on your own. Best of luck - let us know how it works.

• ▶ Reply

Permalink Reply by acidrock23 on April 14, 2012 at 5:09am

I agree about wanting to hit the 120 too. One way I think of it is to break the basal down into chunks of insulin and maybe 1-2 hours of an increase of 100% might be enough to "Cover" the bump from DP? I've had a hell of a time lately w/ DP, it was running low in the AM for awhile, then I turned by basal down last night (really in the morning, but the rates didn't go into effect until the night...) and it was up again this AM.

• ▶ Reply

Permalink Reply by MyBustedPancreas on April 14, 2012 at 10:32am

The only way to know is to try. Everything with T1 is so trial and error. I would give it a go, but test every couple of hours and keep juice and other treats handy in case you go low.

• ▶ Reply

Permalink Reply by olu Oog on May 9, 2012 at 3:02pm

I change basal when my CGM still shows an upward trend 2 hrs after i eat, in addition to when my IOB is nearing zero. +20 is often what i do.
Haven said that,I think the essence of putting a number on BG, Carb etc is to help us stay within a range where future complications will be minimum. It definitely is not an academic, empirical competitive exercise. In my opinion, deciding to stay around 100 at all times will not decrease your chance of complication much more than someone with an average of 145 or 150 at that.
the truth is that T1 people are not anatomically normal regardless of how much carb- hermit a life we choose to live

• ▶ Reply

Permalink Reply by Zoe on May 9, 2012 at 3:08pm

I know that's how Pumping Insulin describes it, but I don't think so much in terms of amount of rise (or drop) but staying in target.

I see you are very recently diagnosed, Benjamin. While I admire that you want to have the best possible numbers, you might be setting yourself up for unrealistic expectations once you get past your honeymoon. "Staying around 100 most of the time" is not something many Type 1's can aspire to.

If your basal is making you start out too high and then spike after breakfast, you have a couple options: you can do the basal change you are contemplating (you won't know if it works until you try, just test to make sure you don't go too low and treat it if you do). If you are higher than you like before breakfast you can add a correction. (Like my target is 110 so if I am 120 before breakfast I will add a small correction to my bolus). Or you can change your I:C ratio for breakfast to reduce spikes.

• ▶ Reply

Permalink Reply by olu Oog on May 9, 2012 at 3:16pm

Zoe. I think staying in an absolute target is not natural for the human body. For even normal people (folks w/out diabetes)have spikes after they eat. There is often a lag time. What i think we should aspire to is taming the spikes. spike w/out being too spiky!

• ▶ Reply

Permalink Reply by Zoe on May 9, 2012 at 3:50pm

Oh definitely; I was commenting on your "I'd like to be around 100 most of the time". For me if I could be between say 70 and 135 most of the time I'd be in heaven! Of course, Type 1 often has its own ideas.I think it's important to qualify the use of the word "spikes" - sure we go up when we eat, but the idea is to minimize that rise by matching insulin to carbs and to ultimately stay under whatever your personal target is for pp. (Mine is under 140, some people use 120). One thing I've also found to be important is testing and correcting promptly. Since it is the amount of time spent at high numbers that can lead to complications I "nip it in the bud" pretty promptly (taking into account the IOB of course)

• ▶ Reply

Permalink Reply by acidrock23 on May 9, 2012 at 3:48pm

I aspire to staying around 100 most of the time. I guess I don't hit it as my A1C is > 100 but I still ASPIRE to it? I suspect I'm closer to hitting it by aspring to it than if I aspired to 140 or whatever the ADA/ AACE goals are? I don't want to "do OK" w/ diabetes, I want to kick its ass.

• ▶ Reply