Basal vs. bolus adjustments

[poper77]

So the past few days I am about 70-100 pts higher than i should be after breakfast. I am waiting for the minimed nurse to get back in touch with me, however she is not too good at answering questions or responding to my email/phone calls. What is the general rule about which to adjust first? I am thinking it is the carb ratio that is not working, but not sure how much to go changing it....

[Funnygrl]

The first thing to do is basal testing. Then one you know your basals are right, you can look into carb ratios.

Learn about basal testing here:
http://integrateddiabetes.com/pump_bt.shtml

[duck]

You have to determine if your basal is good otherwise at that time. (In the PERFECT world) To determine this, you would have to skip breakfast and basically test every half hour and see how your blood sugars are at this time...Basically:

You wake up, check your sugars. If they are 100-140, you can proceed (I am assuming you did not eat or bolus in the last four hours of your sleeping)...

No eating, no bolusing.

Test every half hour for as long as you can hold out, hopefully for at least 4 hours.

If your sugars stay between 100-140, your basal is good. If they rise, you need to up your basal, and you need to quit the test. If they drop, you need to perhaps lower the basal, and you need to eat and quit the test.

If you do this test and your sugars remain "perfect", then it's your carb ratio that needs adjusting, which is not unusual for the breakfast time of day.

There's more to it than what I posted, but that's the basics for testing in the perfect world. If you have Dawn Phenomenon or you liver dump when you are hungry, then that will skew things a bit. But we can burn that bridge when we get to it.

[poper77]

Thanks guys! I will try this tomorrow.:thumbsup:

[rzrbks]

I do an 18 hr test (as diagramed by duck) every 6 weeks or so just to keep aware of basal.