Are basal lows more intense?

[marked]

Holy ****! I am getting slammed with hard hitting and fast dropping lows. I am so unfamiliar with the intensity of them. My gut tells me that they must be from too high of basal settings, so I have lowered them, but I am still getting lows. And then because there is so little insulin in me I am then 5 minutes later I am at 250. I am yoyoing big time.
Unless a bolus dose is more sensitive than mdi dose. I had my mdi doses nailed because I try to eat consistenly day to day. Am I more sensitive to bolus does than a mdi dose? Is anyone aware of this possibility? I am thinking my pump educator set the basal reading way too high and that is why I am getting I slammed hard. I have to wing it until Wed before I can see my endo. Any suggestion?
Mark

[cheryl]

I feel like you, this is the best possible thing I can come up with....

We are now using fast acting insulin, that dies out quickly so think about it....if the basal is too high the low is gonna feel hard hitting, and then whamo, you over do it, and boom your so **** high, but the fast acting is quick, peaks and all that good stuff...

I feel a lot more sensitive to insulin sometimes, it is sometimes a pain in the rear, I just always talked myself thru low's I bought those juicy juice juice boxes with 16 carbs for 4 oz....they bring you back up, sometimes, or alot of times the way I deal with it, When I bolus for a meal if I am in the 80's or low 90's I always eat a couple of peanut mm's or reese's cup the minature one, just one....then I am pretty level, if I am nervous about my two hour postmeal a pop a little more or If I had been extremely active a granola bar....I dunno it has been working for me,

I have felt hard hitting low's when I was on the pump for a while I just learned how to deal with it, cause I don't think my basal will ever be set perfect cause I am really active then I am not, so I choose snacking and guessing instead of temp basal rates....cause hey who is gonna refuse food LOL....

It works 95% of the time, for me, I know how you feel though, those lows are killer at first, in time, they get much easier to deal with and the impact is not so bad....

Cheryl

[daryop]

I am soo lucky to read this topic. I have been dealing with this problem for almost 2 months and because of the place we live (Skagway - Alaska )we have no doctors I learn almost everything from this web site. My issue was going too low after the meals and have to eat eat eat all the time and check bg levels. After I read one of Cheryl`s post i adjusted my Lantus from 15 to 13. The result is amazing, its been only 2 days but i feel like I`m on the clouds and felling like I can even skip a meal. The BG stays 120 all the time.

Thanks a million...I wouldn`t think 2 units of Lantus makes such a big difference..But it really does....

Daryo

[duck]

Mark, you didn't provide enough information for me to give any valid feedback, ie, when was the last time you bolused, and how much? What did you eat?

In my experience, the lows that muck me up the worst were the ones I had with NPH back in the day...the ones that muck me up nowadays are the ones where I lower slowly...like the parable about boiling a frog slowly. If I drop fast, I feel it and can react to it. But if I am slowly dropping, I kind of ease into it, and my "reaction mechanism" doesn't kick in sometimes until I am acting/feeling weird.

[xMenace]

Are you brand new to pumping? Basal testing is used to adjust basals. Your basal pattern with a pump may have hills and valleys which weren't apparent in MDI.

[marked]

Cheryl, your guess sounds plausible, the fast acting would pile on to each other if the basal amount was set too high, yeah, then the low would come hard and fast. At that makes even more sense when I think about it, some of the lows coming a calling right after I bolus for a meal, and that is with a square wave bolus, so the (possible correct) bolus triggers the basal low. I am not sure about the square wave yet, that is an experiment.

Duck, I eat very simple, usually a turkey or chicken sandwhich,veggies,not much carbs. Or veggie chili with brown rice, somthing like that. And that I would square wave the bolus 5 units for an hour. I am doing the square wave because I am thinking that maybe a square wave would mymic the symlin more accurately. I don't know about that though.
Interesting as to what you say about your killer lows. This is such an individual disease,isn't it? Slow onsetting lows nail you, for me if I can see them coming it gives me time to eat a few jelly beans, if it is hard and fast I don't get the chance.

Xmenace, yes I am brand new to pumping, you have a very good idea, Skip each meal one day at a time and see what the basal does. It would seem I need to isolate whether it is a basal problem or a bolus problem and that would do it.
Thanks for the feedback.
Mark

[duck]

Yeah Mark, get those basals figured out and dialed-in...pumping is almost fruitless, otherwise.

[Cyborg]

Sounds like the timing of the insulin is not matching the action of the Symlin you are taking... To help offset the delayed digestion effect of the Symlin, I always use a combo bolus, something like 50/50 over 2 hours, ymmv. :vroam:

[xMenace]

Some help.

http://www.centremedsurg.com/Forms/Basal%20Rate%20Worksheets.pdf
HOWTO profile your Basal Rates. (http://www.insulin-pumpers.org/howto/baslr.html)
Diabetes Self Management (http://www.diabetesselfmanagement.com/article.cfm?aid=2161)
Integrated Diabetes Services - Diabetes Management (http://www.integrateddiabetes.com/pump_bt.shtml)

[cheryl]

Cheryl, your guess sounds plausible, the fast acting would pile on to each other if the basal amount was set too high, yeah, then the low would come hard and fast. At that makes even more sense when I think about it, some of the lows coming a calling right after I bolus for a meal, and that is with a square wave bolus, so the (possible correct) bolus triggers the basal low. I am not sure about the square wave yet, that is an experiment.



Hey Mark, what are your blood sugars when you get a hard hitting low after you bolus, that is why I sometimes eat a tiny extra right before the bolus cause....I know i am on my way down...I don't feel comfortable bolusing in the 80's or 90's only at breakfast, lunch sometimes, dinner never.....

Dinner was my worst issue, I was on too high basal rate, when i first started pumping, I bolused once when I was 80 withing 45 minutes I plummited to 43 yea it sucked.....and another time I accidentally pushed the act button when I was 78 at dinner time and had a nice 50 within 45 minutes.....so I had adjusted my basal to lower about 3 hrs prior to my normal time eating...and then I didn't suffer as much or ever unless I had been running around like a chicken with my head cut off....

I was thinking something was up with me, but it's not, this was happening to me while I was loosing a ton of weight and it was before I realized that is what my body was doing....it was crazy, now since I am not really loosing weight usually 4 or 5 carbs work for me, I just know what my body is going to do 95% of the time....only a few times I have been wrong...

Cheryl

[marked]

Cheryl,
I think 95% of the time is a very comfortable place to be yeah? The key is to know what your body is doing and where it is going yeah?
I seem to be having lows differantly. I can have a fasting blood sugar with no bolus in me sitting at 75 and thinking everything is good and 10 minutes later I was at 40 and on the floor. Sometimes I am having a fasting blood sugar of 80 or 90 give a square bolus, eat and 10 minutes later and I am back on the floor with a 40. Symlin is complicating this thing greatly, Before on mdi I couild dose at 70 or 80 and hold the blood sugar to peak of 120 and level out at 90. Now I can't seem to do that at all. Perhaps your call is right on, raise my fasting blood sugars to 100 before I bolus. I don't know. But I realize I gotta get a correct constant basal fasting blood sugar first. But it is hard to figuere because I am yoyoing so badly. I am caught in the twilight zone of diabetes. Thanks for your input.
Mark

[deansreef]

does the pump adjust the bolus based on BG's- if low it subtracts insulin and the opposite if high?

Dean