Don't Jack with My Basals
I'm high, which means I'm also very cranky at the moment.
My well-intentioned CDE suggested a LOT of changes to my basal profile today and asked me to be both brave and patient, reworking my 23 units of basal into 21 units and redistributing those units across the board into a profile she thought better matched my overnight and post-meal needs. She changed my sensitivity from 1:32 to 1:20 and changed my insulin:carb ratios from 1:8 to 1:6. She felt that my post-prandials at lunch and dinner were showing that my basals were compensating for low boluses on the meal and correction side. Okay, I get that. I've always had that problem to a degree - keeping high basals to compensate for bad carb counting or inaccurate fat/protein consideration.
So I leave the office with all my new settings loaded.
BG = 79. Bolus. Wait 20min. Lunch = 53g of carb (a large but otherwise modest wheat turkey wrap).
1 hour PP = 116. Uh-oh, maybe I'm going to go too low. Let's watch. 2 hours PP = 177. WTF?
I do a correction with the new sensitivity factor, thinking "this is why my basal was higher here."
1 hour later = 163. Okay, give it time, Melissa. Takes a while to correct a high. 2 hours = 54. WTF (again?)
The correction factor seems too intense now.
I pop 4 glucose tabs and am starving, so I then bolus for a 26g snack on top of that. (I'm pregnant. I eat a lot...and often.)
2 hours later = 200. ARGH!!!!!!!!
Seriously, why mess up basals that were producing nearly flat lines and give me this? My standard deviation yesterday was 18. EIGHTEEN. My avg BG was 117. If you could hear me now, you'd hear growling. You'd probably even hear my baby growling. She doesn't need her blood sugar to be 200.
I will give it two more days...unless overnight goes much worse. At least my CGMS warm-up period is over and I will have my beautiful wavy lines in front of me.
In the words of a great piece of literature: "It has been a terrible, horrible, no good, very bad day. I think I'll move to Australia."
(In all fairness, if I'd had these numbers 5 years ago, I wouldn't have seen anything wrong with it.)
My well-intentioned CDE suggested a LOT of changes to my basal profile today and asked me to be both brave and patient, reworking my 23 units of basal into 21 units and redistributing those units across the board into a profile she thought better matched my overnight and post-meal needs. She changed my sensitivity from 1:32 to 1:20 and changed my insulin:carb ratios from 1:8 to 1:6. She felt that my post-prandials at lunch and dinner were showing that my basals were compensating for low boluses on the meal and correction side. Okay, I get that. I've always had that problem to a degree - keeping high basals to compensate for bad carb counting or inaccurate fat/protein consideration.
So I leave the office with all my new settings loaded.
BG = 79. Bolus. Wait 20min. Lunch = 53g of carb (a large but otherwise modest wheat turkey wrap).
1 hour PP = 116. Uh-oh, maybe I'm going to go too low. Let's watch. 2 hours PP = 177. WTF?
I do a correction with the new sensitivity factor, thinking "this is why my basal was higher here."
1 hour later = 163. Okay, give it time, Melissa. Takes a while to correct a high. 2 hours = 54. WTF (again?)
The correction factor seems too intense now.
I pop 4 glucose tabs and am starving, so I then bolus for a 26g snack on top of that. (I'm pregnant. I eat a lot...and often.)
2 hours later = 200. ARGH!!!!!!!!
Seriously, why mess up basals that were producing nearly flat lines and give me this? My standard deviation yesterday was 18. EIGHTEEN. My avg BG was 117. If you could hear me now, you'd hear growling. You'd probably even hear my baby growling. She doesn't need her blood sugar to be 200.
I will give it two more days...unless overnight goes much worse. At least my CGMS warm-up period is over and I will have my beautiful wavy lines in front of me.
In the words of a great piece of literature: "It has been a terrible, horrible, no good, very bad day. I think I'll move to Australia."
(In all fairness, if I'd had these numbers 5 years ago, I wouldn't have seen anything wrong with it.)
-
Comment by Sarah on September 23, 2009 at 6:51pm -
It's frustrating, isn't it? I have a hard time letting go and giving control up to someone else to make decisions... funny thing is that my CDE suggested nearly the same changes to me to day.. she wanted me to cut back on my basal a bit and increase my I:C's across the board.. I was like, uh NO! My basal/bolus is already like 40/60!
-
Comment by MelissaBL on September 23, 2009 at 7:28pm -
My basal/bolus was 45/55 and she wants it closer to 40/60 - so yeah, I hear you. How much tighter does she want yours?? I remember when docs were bugging me to shoot for 50/50.
I feel like a sloppy juggler. I hate for anybody to grab a ball out of the air when I've got a rhythm going - even if it looks like I'm going to drop one.
-
Comment by Gerri on September 23, 2009 at 7:39pm -
Congratulations on your baby!
Geesh, why do they want to mess with success? Did CDEs all get a memo stating that 40/60 is the ideal regardless of how well we're doing?
-
Comment by nel on September 23, 2009 at 8:48pm
-
I have difficulty with the acceptence of the numbers of basal /bolus ratio...if I sit in the car being driven to my app't I need to put a temp basal of 165 percent in place...when I walk a lot ( as presently ; training for a half M ) I put my temp basal sometimes : 45 percent ...I know a chap , who cycles for miles and miles and his ratio is NOT 50/50 ...why not keep basals /bolus ratio if ultamitely the result is GOOD for YOU ..or Excellent for that matter???.
Time to ask the writer, John Walsh of Pumping Insulin once again ?
-
-
I forgot to congratulate you MelissaBL on " being with child " ...please accept ..N.
-
Comment by Kristin on September 24, 2009 at 4:40am -
Grrrr.... we are here and growling with you.
How absolutely frustrating.
Also 1:32 to 1:20 is a pretty big change (by almost 40%). Was there lots of evidence of highs not coming down?
In my (oh so humble) opinion, you are a pro. You know what you need to do. So do it.
(Your CDE would love me!!)
-
Comment by Terry Keelan on September 24, 2009 at 7:26am -
Geez. Why change so many things at one time? Now neither you nor your CDE will know which one set off the roller coaster. Personally, I'd go back to my original regimen for a couple days, then change one item and see what happens. I'm surprised you were so complacent with your CDE. You must really like her. :)
Hey, great news about the pregnancy. I hadn't heard. Congratulations!!
Terry
-
Comment by Sarah on September 24, 2009 at 8:24am
-
Melissa, mine actually suggested I go with less basal (less than the 40% I use now) and lower all my I:C ratios. Her reasoning was I tend to be a little high after meals, but I usually go back to normal... however I am reluctant to follow her advice because if I lowered by basals I'd surely go high without eating... I don't want that. The whole point of being on a pump IMO is to stay flat without eating.
I am going to either try bolusing earlier before meals more consistently, or using more super boluses.
-
Comment by Scott on September 24, 2009 at 8:35am -
lol, reading that reminded me of an old adage
Those who can, do. Those who can't, teach
present company excluded, of course... /wink
-
Comment by John Smith on September 24, 2009 at 8:56am -
I use my doctors as prescription writers...stopped trusting them to tell me how to adjust my doses long ago. And with the pump and CGM, I feel I'm the best judge of how to adjust my basals and stuff.
Too bad that you CDE made you change so many parameters all at once. I would reset everything back to how it was and tweak my settings one at a time to see if it helps.
Advertisement
REsources
Groups
From the Diabetes Hands Foundation blog...
Congratulations Diabetes Advocates Scholarship Recipients!
The Diabetes Hands Foundation and Diabetes Advocates Program is proud to announce and congratulate the members of DA who were granted scholarships to attend diabetes conferences in 2013! Thanks to a generous grant from Novo Nordisk, in 2013 we were …Continue Reading
La Familia de EsTuDiabetes Sigue Creciendo
El Centro Nacional de Prevención de Enfermedades Crónicas y Promoción de la Salud en el Estados Unidos encontró que a partir de 2002-2009, el 11,8% de los hispanos mayores de 20 años, que viven en los EU, viven con diabetes …Continue Reading
TuDiabetes Team
DHF STAFF
 Manny Hernandez(Co-Founder, Editor, has LADA)
|
DHF VOLUNTEERS
Lead Administrator
 Bradford (has type 1) |
Administrators
 Lorraine (mother of type 1) |
 Marie B (has type 1) |
|
|
|
|
|
|
LIKE us on Facebook
Spread the word
This site complies with the HONcode standard for trustworthy health information: verify here.
© 2013 A community of people touched by diabetes, run by the Diabetes Hands Foundation.
You need to be a member of Diabetes community by Diabetes Hands Foundation: TuDiabetes to add comments!
Join Diabetes community by Diabetes Hands Foundation: TuDiabetes