Hey all-

I've recently been fiddling with my basal rates to eliminate a nasty spike in morning blood sugar.
Trouble is, it seems to goes from goal, to high, to less high and then back to goal, all in the space of 3 hours. (8am to 11am). (8 am is goal, 9 am is high, 10 am is better, 11 am is goal)

I am trying to decide when to increase the basal rate to affect this-
Should I increase 2 hours before (say 7 am) to affect 9 am?
or Should I only increase the rate at 8 am to affect 9 am?

Thoughts? I know you guys have been pumping WAY longer than me, and are far far better at this :)

Tags: action, basal, insulin, pump, rates, settings

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More questions than answers:

Are you sure the rise isn't caused by your breakfast? How big is the spike?

What time do you eat? What do you usually eat? Do you get the spike every morning?

Assuming you eath breakfast, there's nothing inherently wrong with a spike in bg after a meal. Even non-diabetics get them.

Terry
I'm wondering if you're bolusing enough insulin to cover whatever you are eating. This could be the issue, not your basal.

Try taking a bit more insulin with your meal and see what it does. When in doubt, call your doc.

Good luck!
let us see...
this morning I did a basal test- it was fasting, since the previous night at say 8pm.

the results were something like this:
7 am: 136
8 am:130
9 am: 164
10 am: 148
11 am: 126


goal is 120 + or - 10, so 130 to 110.

obviously there is a problem from 9-10 that appeared to resolve itself by 11 am.

My question was when to increase the basal rate- only at 9 and 10 am since those were the hours with the issues, or should I increase the rate at 8 am (assuming that is what really affects the 9 am slot, etc).

or

should I increase at 7 am?
How many hours ahead should I increase the basal?

I was planning on increasing the basal rate a smidge during the night anyway, so that while it is at goal or nearly at 7, it would be lower- more like 110-120.


Thoughts?
To me it looks like DP (dawn phenomenon) where your hormones cause an increase in blood sugar as a response to getting the body ready for the day. If true yours hits you later than it does me. To affect the 9-10 am period, you would need to adjust your basal 1.5 to 2 hours before that or about 7 am or 7:30. Adjust by a small increment (i.e. 0.1 or 0.2 per hour) and see what happens.

Good luck
I'd consider testing again. It's not a very big bump in my estimation. If you've been up for two hours before the bump I don't think it would be dawn phenomenon, that usually kicks in as we are awakening.

The timing also suggests you were starting work or perhaps commuting just before nine. True or false? Stress can raise BG.

After testing again, if you see the same pattern there may be something there. but raising your basal rate to take care of a temporary bump sounds tricky. I mean just to take care of this bump you'd raise your basal temporarily by a small amount starting two hours ahead of time and then send it back down within an hour. If you keep the basal raised, you'll be dropping after 9:00 a.m.

Maybe there's another solution besides playing with your basals. Examine what else you do in the a.m. that might contribute to the rise.

Terry
I agree. Test again. I always use 2-3 basal test to make changes (in reality this means that I very rarely make changes because I am a basal test procrastinator!).

From the info you posted, I would increase between 7 and 8. Or even just 7 to 7:30. You are clearly dropping after 9am.

Are you working with your endo or pump trainer on setting basal rates?
thanks, guys.

I ended up slightly increasing the basal rate from 7 am to 8 am, then dropping it a bit at 9, and maintaining the rest.
I will test again tomorrow and or friday to see how this works out.

I have not yet met my new pump trainer. I saw my new endo (I moved in june) and I will be seeing him and the new CDE/RN who deals with pump setting, etc in December.

Unfortunately, since I moved, my blissful honeymoon state is coming to a rapid end. I was getting by with beautiful a1cs with only a trickle of insulin- now in the past 4 months I have to keep increasing the amount (up 50% in some cases), and I have ended up changing the basal rates every 3 weeks or so- because just when I seem to get it stable and in goal- it changes all over again.

THANKS.

Lane

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