[fgummett]

Maybe already mentioned but in getting back to basics are you confident in your basal rates? Also it seems common that I:C ratios can be different at different times of the day... I read here quite often that breakfast carbs need more insulin than later in the day, for example.

[rak1978]

Here's my story yesterday....

fasting: 140, bolus 1.2, 0 carbs: eggs

2 hrs after breakfast: 61, took 2 glucose tabs

20 min later: 105, bolus 3, 46 carbs: z bar & something else?

before lunch: 77, bolus 2, 50 carbs: chicken curry & naan, only took bolus for half of carbs because of the low (whoops)

1 hr after lunch: 224, bolus 1.1 correction

2 hrs after lunch; 205, bolus .8 correction

before dinner: 158, bolus 2.4, 45 carbs: turkey & soup

1 hr after dinner: 156

2 hrs after dinner: 117, bolus 1.3, carbs 16: greek yogurt w/ berries & almond butter

2 hrs after snack: 78, took 1 glucose tab

This was a fairly good day for me because I was trying to be really mindful of things. On a more typical/bad day, I'll have extremes of 35-400. Never steady.

I think the basals are pretty good, but may need some adjusting in the afternoon. I do have many different basal/bolus settings depending on the time of day. Basals range from .20-1.05. Boluses range from 1:7-1:18.

[Grunch]

The biggest thing is pre-bolusing if you're going high early and low after that.

The key things are: counting carbs precisely, figuring your exact I:C and ideal timing for bolusing. If you can control these 3 things then there's a very high chance you can eat high carb meals without problems.

It's easy to over/underestimate the amount of carbs in some foods. Like the soup you had, depending on what kind of soup it can be pretty hard to know how many carbs you are actually eating and that can make it seem like your D is out of control when in reality you're just miscalculating. I avoid some foods just because I have no idea how much to bolus for them.

[xMenace]

Originally Posted by rak1978

as long as their bolus ratio's and basal settings were correct.

So do you know if your basal settings are correct? Have you basal tested? Basals should keep you flat-lined without food. You really need to invest time in basals before you can hope to figure out I:C's.

So assuming your basals are correct, can you please tell me your I:C ratios? I have made similar observations as you between breakfast and lunch. I would be fine pp but constantly hypo before lunch. My basals are pdg.

My theory here is that because my breakfast I:C is higher than my lunchtime I:C, 2.5:10 vs 1:10, my tailing morning bolus was too high for my need. A bolus lasts about 6.5 hours. Ignore your pump setting, because that is different. The final couple of hours tend to be small and insignificant, hence shorter times for pump OB calcs. However in the case where your I:C drops from one meal to the next, this tailing bolus can be significant. In my case my 10:30am to 1:30pm OB insulin is 2.5 times my need!

I fixed my problem by dropping my breakfast pp basals between 10am and noon. Works great!

This may confuse someone, but effectively I now treat my morning bolus like a superbolus.

superbolus - Google Search

[rak1978]

Originally Posted by Grunch

It's easy to over/underestimate the amount of carbs in some foods. Like the soup you had, depending on what kind of soup it can be pretty hard to know how many carbs you are actually eating and that can make it seem like your D is out of control when in reality you're just miscalculating. I avoid some foods just because I have no idea how much to bolus for them.

The soup was homemade and I was too lazy to figure out how many carbs were in it...so I guessed.
It was made from all the sugary/starchy vegetables (carrots, parsnips, onions, sweet potatoes, butternut squash) roasted and then pureed w/ chicken stock. It was very good, but I'm sure it was loaded with carbs. This is the kind of thing I would like to be able to eat though without a problem. I don't want to have to say no to produce.
I do have a major problem with miscalculating/guessing. Most of the stuff i make is from scratch, and has a lot of ingredients, so it takes a long time to figure out carb content.
From now on though, I this is precisely what I need to do. I've counted very accurately today as well as pre-bolused and have been in the low 100's all day. Go figure.

[rak1978]

Originally Posted by xMenace

So do you know if your basal settings are correct? Have you basal tested? Basals should keep you flat-lined without food. You really need to invest time in basals before you can hope to figure out I:C's.

So assuming your basals are correct, can you please tell me your I:C ratios? I have made similar observations as you between breakfast and lunch. I would be fine pp but constantly hypo before lunch. My basals are pdg.

My theory here is that because my breakfast I:C is higher than my lunchtime I:C, 2.5:10 vs 1:10, my tailing morning bolus was too high for my need. A bolus lasts about 6.5 hours. Ignore your pump setting, because that is different. The final couple of hours tend to be small and insignificant, hence shorter times for pump OB calcs. However in the case where your I:C drops from one meal to the next, this tailing bolus can be significant. In my case my 10:30am to 1:30pm OB insulin is 2.5 times my need!

I fixed my problem by dropping my breakfast pp basals between 10am and noon. Works great!

This may confuse someone, but effectively I now treat my morning bolus like a superbolus.

superbolus - Google Search

I have not done basal testing. I initially just went with the settings that my dr gave me and we've modified from there. Not very smart, huh? I have the book "Pumping Insulin", but haven't read it yet. Is the technique for basal testing in there?

I do very little basal between 9 and noon also! As far as my settings go, here they are....

basals:
12am-3am: .95
3am-7am: 1.05
7am-9am: .80
9am-12pm:.20
12pm-3pm: .75
3pm-12am: .80

bolus:
12am-11am: 1:15
11am-2pm: 1:12
2pm-5pm: 1:7
5pm-8pm: 1:18
8pm-12am: 1:12

sensitivity: 35
I take glucophage at breakfast and dinner

That's my life story. Gotta love the pump. It was a nightmare trying to manage this on injections.

[Subby]

I think it is smart to modify basal based on observation. Basal testing is just a way to ensure you're acting on the right feedback, and once it is established that someone may have a dynamic basal, and are willing and engaged, I think it's criminal that endos and DEs don't get them basal testing ASAP. Rachel, as you suspect Pumping Insulin has a section on basal testing. Basically, I couldn't get joy on the pump at all, until I basal tested. I think that's a place for you to start. Looking at your settings, I've got a feeling it's gotten too complex without a solid grounding, and at that point it's all somewhat out the window. I really admire how much you've obviously been involved and experimenting.

[justongarl]

Having headaches the same time every night a symptom of high sugar level? Also, I am extremely tired, more tired than ever before at night, too early for bed, fall asleep in my chair etc.. do you think this is when my sugar levels are too high?

[rak1978]

Okay, quick question....
I'm going to do the basal testing this morning until mid-afternoon. I take glucophage in the am w/ breakfast usually, do I still take that today? In "Pumping Insulin", it says to eat small amounts of protein throughout the day as desired, so I ate a couple of bites of eggs. Should I take the meds w/ the eggs while basal testing?

Thanks!

[foxl]

Originally Posted by rak1978

Okay, quick question....
I'm going to do the basal testing this morning until mid-afternoon. I take glucophage in the am w/ breakfast usually, do I still take that today? In "Pumping Insulin", it says to eat small amounts of protein throughout the day as desired, so I ate a couple of bites of eggs. Should I take the meds w/ the eggs while basal testing?

Thanks!

I would, I think ... though I am not an insulin user, don't you want to know your basal needs under "typical" conditions?

[Subby]

No eating of anything for 4 hours previous or during basal testing.

As for the glucophage, interesting question. I don't know of a definitive answer, and I haven't basal tested since going on met, so haven't thought about it. I would say, if you can take the glucophage without food with no adverse effect (feeling sick etc), do that.

Here's a great cheat sheet by John Walsh for basal testing, all the little rules involved:

Integrated Diabetes Services - Diabetes Management

[rak1978]

Thanks for the link, Subby.
In "Pumping Insulin" it says, "You may snack on small amounts of protein foods, such as nuts or cheese, during the test."
Hmmm...not sure which way to go. I am not very educated on this yet...just looked at the book at midnight last night.
I think you're right, Linda, about "typical" circumstances. I'm going to take it. Hopefully I'll get an accurate test.

Thanks for the quick help!

[Subby]

I hadn't noticed that in the book before Rachel, thanks for pointing it out. Well I guess it's up to you... I find some proteins can have an effect on my BG, albeit much slower and not as much as carbs. So I wouldn't personally snack except perhaps the very smallest amounts. Do you have a feel for if some do affect your BG? If not, I think you're best going without, or just really tiny snacks.

In the book I note that he "simplifies" basal testing by suggesting 6 or 8 hour stretches. Just a note that I find at times, I prefer to do it for shorter that that, and I can't see anything wrong with that. Once you are beyond the set up 4 hours, it's useful data...

[foxl]

No Changes in the Body's Normal Glucose Output

* No hypoglycemic episodes for at least 6 hours preceding the basal test.
* No illnesses during the testing (fever, infection, virus)
* No steroid medications being used
* Avoid testing during major stages of menstrual cycle if blood glucose changes are usually noted

Not taking your normal glucophage might fall under the category of a "Change in Body's Normal Glucose Output!" since it regulates gluconeogenesis ...

[Subby]

I definitely agree with that, provided if taken without food it doesn't backfire on you. Both not feeling sick, and for myself, I see metformin usually working only WITH food (still working out the best time to take it, but without much food it barely seems to work) to "do it's thing" in regulating my dynamic liver releases through the day. Rachel, if you share that suspicion at all for yourself, then I guess it is just going to be potentially a bit of a wildcard influence.