I think most of us do experiments on ourselves sometimes.
About a week ago, I lowered all of my basal rates. I felt like I was taking too much insulin, and my basals were 85-90% of my daily totals. They ranged from 2.4 to 3.6 units per hour. My blood sugars were good, A1C in the low sixes, and although I had occasional highs and lows, they were always pretty easy to understand and correct.
So for some reason, I decided to lower my basal rates by 30%. I figured my bs would be high and I would change them back. Except that didn't happen, and I can't figure out why.
I have been careful not to change what I eat (under 100 carbs/day) or when I exercise (every afternoon at the same time for 45 minutes, treadmill at steady pace with incline). My blood sugars have been great- if anything, a bit lower when fasting and in the mornings. I am testing frequently and use a CGM, so I'm pretty sure I'm not missing anything.
Can anyone explain this? I'm not thinking this is a miracle or anything, I just wonder why it is working. Thank you!
You were using basal rates as bolus rates. When you made the switch, you substitued basal for bolus. In your case, I would think, an 85% basal ratio is way TOO HIGH.
Your basal should be a much lower ratio. I am very conservative and watchful, and mine is about a 58% average, I would think you are eating the same amount of carbs, so the basal is doing the work of the bolus.
Thanks, I probably should have added that I have been pretty insulin resistant since when I was pregnant (I had my daughter in 2010). My I:C ratio is 1:7. I have kept this the same in my experiment so far.
Your basals were too high as a percentage of total daily. Your excess insulin maybe made you gain weight?
Most important will be for you to be sure you are hanging at an even target round the clock. You may see a new setting of I:C ratio over the next two weeks.
Thanks. I actually had a high for the first time since I changed basals last night. Is it possible that the excess insulin was hanging out in my system somewhere? This might be a silly question, just trying to figure it out.
Excess insulin also can mean that you are going "low" but your liver is dumping glucose to protect you from hypos. (Which causes weight gain)
I've always heard/been told that basal should be 50% of total. Like Forever's, mine runs ~60%.
Also, for me, absorption is terrible if I take too much at once. I can't every take a bolus that is more than ~3u, if I need more than that I take 3u, then the rest as a square wave - you may have been having absorption problems at your sites. 3u/hr sounds like a lot. I'm 40ish, overweight, been diabetic for over 30 yrs, and my highest basal rate is 1.2u/hr - most people who mention basals here list <1 u/hr. Based on what you've said here, I'd recommend finding a good diabetes educator and starting over from the beginning! Minimed has representatives that go around sometimes, and your doc should know someone or be able to help him/her-self. Good luck.
one more thing - sounds like you are taking upwards of 100u/day total, if that is true, you may need to discuss additional treatment, such as the addition of a glucophage or something.
I think that the large boluses sort of have the "square wave" built into them? Berstein's book discusses his research that shots of > 7U will be absorbed irregularly. I think they get absorbed but "play out" over a longer period while the bigger bubble is absorbed? I did a very short (like 1 month...between when I started getting a pump and when I got it...) where instead of taking my big NPH shot 20-25U (I was very flexible...) all at once, I'd split it into 3-5 shots. It seemed smoother but was a totally small sample size and I have since mislain my notes. I recall it seemed to work smoothly but my recollections may be skewed by the rosy glow of having a pump?
I'm a pharmacokineticist - absorption, distribution, metabolism, and excretion of drugs/chemicals is what I study/do for a living. For me, it's part of risk assessment, not therapy. So I don't know how to respond to your post - as a geek that does it for a living, you are way off. As an individual, I suspect you have some good ideas, but I I'm not smart enough to speak non-pharmcokineticist. (we are a bunch of surprisingly stupid people who are often unable to speak with other's, pathetic really).
Once something is injected - in the case of insulin subcutaneously, it's in the body. Being absorbed irregularly is not the same as infusing something (which is what the square wave more or less does). So, you are either right or not, LOL.
I agree about the rosy glow of the pump. With what I do for a living, and with being a diabetic, I think all MDs who don't put their diabetics on pumps are irresponsible.
Unfortunately, I can't find my copy of Dr. Bernstein's Diabetes Solution but he cites a study and his own experience and also mentions that he's rx'ed the multi-shot thing to some of his patients. I don't agree with him about everything but, in my *very* small sample size, it seemed to work. Although w/ shots of N, the other thing that might've figured in is more smaller peaks spreading that out?
I understand the idea about the square wave boluses but I have had generally poor results from them. Lately, when I run up a bit (and I may have OCDiabetes...), I "cover" it with an increased basal rate for an hour or two and that seems to work great. The iOB is still there to "catch" the impending high but the extra "whiff" of basal seems to help stave off higher numbers. It's sort of the same thing but on the back end which is probably not quite as good as catching it up front but seems to do ok?
Yes, I think you are doing exactly what I am, just coming at it from a different end - an increased basal and a square wave could be calculated to do the exact same thing (ie result in the exact same dose). I think you and I just think about it differently - but as long as it works, great!
I do use the increased basal when I do something I shouldn't - like go out for a big Christmas dinner. I'll just increase my basal by 50% overnight. this is in addition to a square wave, or protracted, bolus.
I agree that I worry about "chasing the tail" as I call it - reacting instead of stopping the highs in the first place. But, I have postprandial highs lower than 150 using this method, so I'm happy.
I read Bernstein's book years ago, before I went to Grad school, guess I should read it again. So, by years ago, I mean 20 years ago! I wander how much his occasionally updates have changed it.
Wow, thanks so much. I have been pumping since 1997, and have seen CDEs and endos millions of times, but I feel like you just educated me more than they ever have. I'm also in contact with my Minimed rep and have met with her a few times about the CGM, but she is much more sales-oriented than helpful.
I think you're absolutely right about my liver dumping glucose. I've been asking about why I seem to use so much insulin, and the answer I seem to get continues to be that as long as my numbers and labs are good, I shouldn't worry about it.
Sometimes I go about 100 units per day, which concerns me. I have tried Symlin but I just can't deal with the throwing up. Even at 15 micrograms, I vomit and then my eyes started to hemorrhage from it...I've asked about metformin but my doctors say it isn't safe because it can harm the kidneys?
I've shopped around for endos since we moved here in 2007. I'm pretty happy with the practice I go to now. I have to drive over an hour to get there, but I feel like I'm in the right place. My endo had gestational diabetes, and her NP was a CDE for years before going back to school. Maybe I'm just asking the wrong questions.
Again, thank you!