adjusting basal rate overnight and bolus ratio late evening

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Dory

Dory

Well-Known Member
Relationship to Diabetes
Type 1
Hi all,

following on from people's advice on here, I did an overnight basal test last night, although not sure how useful the data is given my correctional before bed....

Hour -------Basal Rate ------- Reading
0-1am ------0.43 -------------11.7* ----> correction bolus of 4.9u
1-2am ------0.59
2-3am ------0.7 --------------9.3
3-4am ------1.1 --------------7.1
4-5am ------1.2 ------------- 10.9
5-6am ------1.2 ------------- 6.2
6-7am ------0.94 ------------- 5.0
7-8am ------0.79
8-9am ------0.6
9-10am -----0.8 ------------- 9.5 (pre-breakfast)

* I had eaten 2x Alpen light cereal bars and a Mullerlight yoghurt at 21.00 (36g CHO). my reading at that point was 5.6; I had a bolus of 4.4 in one standard dose (at that time of night I am on a 1:8 bolus ratio) and no correctional. Assumption: either 1)that cereals (as in oats, barley, bran etc) take longer to peak in my blood than other foods and I should therefore do a multiwave or 2)my bolus ratio is not right and I need to adjust to say 1:7. Questions: what do people think - is it likely to be 1 or 2? I'm leaning towards 2, however my concern is that a 1:6 ratio will be too much for 'simple' foods (like if I have a veg stiry fry, or just a yoghurt for dinner etc). If the solution is to have different bolus ratios for different foods, can can I work that on my Roche pump as my machine is set to different ratios according to time of day, not type of food?

the above aside, this overnight test (as well as othes I did last week) show my DP rise occurrring beore the basal rate increase. So think I've got my head round this one: clearly i need to start the basal rate increase earleir than it currently is. I was thinking:

Hour------Basal Rate
1-2am---- 0.6
2-3am---- 0.9
3-4am---- 1.2
4-5am---- 1.2
5-6am---- 1.0
6-7am---- 0.94
7 onwards-- going back to rates above

Questions: what do people think of that? sensible?


Points to note:
1. I take ramipril at night before bed
2. I take levothyroxine in the morning when I wake up, before breakfast
3. I am quite insulon resistant so take slow release glucophage at dinner (between 18.00-21.00) eaach day
4. I am on slimming world as i am trying to lose weight (this is THE single most inflencing fator of my life, I have been struggling with this for the past 10 years). Currently on 'original' where there is a limit of the amount of CHO I can eat. Cereals eg are restricted to 35g a portion. So please bear with me if I can't follow any of your suggestions and come back asking for a different way round things!
5. I am shattered (and distracted; Murray is on) so apologies for any typos!
 
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You've had a busy night 😱

I would caution over changing anything because you had to do a correction bolus at beginning of your testing. Sorry to say that after your efforts. My understanding is that is best to be free from IOB and carbs to get a true picture of the basal.

I would split the night into sections for testing as well or you going be burnt out. There is a good sticky on basal testing that I would follow or you could be chasing your tail. 🙂

See what others think.
 
Thanks - yes I did this exact same format Sun/Mon/Tues night last week as well whilst juggling work during the day so it's not nice! Want to get this sorted asap so can move onto the day time ones (and get a proper nights' sleep! 🙂 )

I thought as much re the correction affecting things - although the general pattern of going high before my DP basal kicks in happened in the other nights too (when i had no correctionals etc - although i was on a different basal rate then). Have a late start tomorrow (off to the orthopeadic clinic) so will try another over nighter tonight and post results.

Would be interested in people's thoughts on the evening bolus ratio? as if that's going to keep on screwing things up I'll never be able to get a decent sample of overnight readings :rolleyes
 
Dory said:
Would be interested in people's thoughts on the evening bolus ratio? as if that's going to keep on screwing things up I'll never be able to get a decent sample of overnight readings :rolleyes
Click to expand...

The simple solution is to skip your evening meal and test from there then no screw ups!.
No1 rule is sort your basal first don't change anything else otherwise you wont know what the problem is.

If you think you will starve to death by missing your evening meal, it's now considered ok to have some sf jelly.
 
ok I'll try eating dinner at lunch, then fast from evening on.

I was told that, when testing basal levels, I should not correct for high bGs. Does that sound right? Obviously if I go low then I will have to have something.
 
Dory said:
ok I'll try eating dinner at lunch, then fast from evening on.

I was told that, when testing basal levels, I should not correct for high bGs. Does that sound right? Obviously if I go low then I will have to have something.
Click to expand...

Read the sticky at the the top of the page. It gives clear instructions as to how high to allow your blood sugars to go before abandoning the test.
Same if hypo then abandon the test treat hypo and try again on another day.
Obviously making basal adjustments where needed from the info gained before you abandoned the test.
 
oh yes, I had read that and you've reminded me about the upper and lower limits. thanks.
 
god i'm starving!!!!!!!!!!!!! :(
 
The early part of the night in the OP is stuffed cos of that correction/food tail - though I did find it interesting how much your BG rose from 5-6am till 9am

That needs rechecking, but could do with looking at IMO
 
LOL, you can't start a basal test until after 4 hours since last fast-acting, whatever it was for - food OR correction.

As it was your basal test didn't start til 5am at the earliest.

Why don't you kinda split the whole night testing? Test every 2 hours or 3, then next night do the in betweens.

First night you could do - say - 10pm, 1am, 4am, 7am. Then next night 11.30, 2.30, 5.30, 8.30 - ish?

Or do 10pm to 4 am and then 3am to 9am?

Trouble is you know, if you stay awake all night you get different results to when you sleep. Been there done that. So I'm not all that keen on missing too much kip to do these. (Oh come off it Jen, you aren't keen on losing ANY sleep at all, are you?) (No I'm not Jen TBH - cos I have such difficulty getting off in the first place) :D
 
Keep going, youre on the right track.
Is there any chance you could eat about 4 or 5pm? Fasting from lunchtime would be difficult and may not give accurate data. I tend to test about midnight, 3am and 6am then the next next time 1am, 4am and 7am. You may need a few nights readings to see a pattern.
 
hmmm, ok guys, got a partial set of data - not very helpful as my bG went over the limit so had to cancel the test. But I can work on the data I have, which is as follows:

Time ------- Basal Rate -------- Reading
17-18.00---- 0.92 --------------10.8 (had dinner)
22-23.00 --- 0.48 --------------10.5
23-00.00 --- 0.43 --------------11.3
00-01.00 --- 0.43 --------------13.8
01-02.00 --- 0.59 --------------13.8
02-03.00 --- 0.7 ---------------15.3 (cancelled test, correction bolus, fell asleep pi**ed off as hell)

Things I've noticed
A).the fact that my reading stayed the same from dinner to 22.00 suggests that my basal during that period is fine, but my bolus and/or correctional needs to be adjusted - I have noticed this for a few days now. I am currently on 1:8 bolus ratio between 19-00.00; I have thought for a while this perhaps needs to change to 1:7. I may change this this evening, so i start off my overnight restest with a better change of making it through the night!
B).the bGs start increasing again at 23.00 - suggesting my basal from 22.00 onwards needs increasing (which is interesting as previoulsy I thought it may only need increasing from about 02.00 when DP occurs)
C).the correctional I gave at 02.00 brought me down beautifully to 6.9 when i checked at 07.00 this morning, so i know the correctional ratio at 02.00 is fine! 😉

Plans for tonight
1. change the bolus ratio at dinnertime to 1:7
2. change basal rates as follows (this is using the basal testing sticky on this forum):
Time----------Basal rate
22-23.00------0.58
23-00.00------0.53
00-01.00------0.53
01-02.00------0.69
obviously I won't be able to change any of the basal rates after 02.00 yet as I had to cancel the test after that (grrr) - but will re-test tonight with the 2 changes above and hopfully I should be able to do the 02.00-onwards basal checks then.

PG - I had dinner at 5-6pm yesterday so will be doing the same tonight (although I am out at an exercise class from 6.15 so will have to have main meal at lunch then something small by no later than about 4pm in order that I don't upchuck in the class 😱) - guessing that's the right way of doing things!

Thanks for all your help guys. Fingers crossed tonight will give better readings!!

I like your plan TW about testing in phases. might try the 22-02.00 one night then 02-06.00 the next. Thanks!
 
Dory,
even though your bs stayed the same from 5 pm to 10.pm it is still to high.
So if you changed your basal to lower the bs it stands to reason that your ratio is correct as things stands.

You are thinking back to front, ie trying to use a bolus to correct a basal problem.

Just realised you have mentioned an exercise class............ skip the basal testing as you will have completely different results.
If the exercise class is a reggular thing then when you sort your every day basal out think about another basal pattern for that class.
 
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Sue,

I'm not thinking back to front. My bG levels aren't routinely high that time of day and over the last 2 weeks of keeping detailed records I have determined that it's only when I eat that they go up. Hence it is the bolus that needs correcting.

Funny, the guide you referred me to that you posted says to keep to the same exercise pattern as you would normally when you are doing the testing. I do about 4-5 classes a week so tonight is a normal night for me. If i didn't keep to as normal a routine as possible, I would be creating a basal profile that I would never use.
 
Dory said:
Sue,

Funny, the guide you referred me to that you posted says to keep to the same exercise pattern as you would normally when you are doing the testing. I do about 4-5 classes a week so tonight is a normal night for me. If i didn't keep to as normal a routine as possible, I would be creating a basal profile that I would never use.
Click to expand...

So last night did you go to your exercise class?
If you exercise on 4 or 5 nights then you need 2 seperate basal paterns. So exercise nights sort 1st if that's the main thing you do. Then nights off from exercise have another patern.

Please please do not change any carb ratios until you have sorted out your full 24 hour basal.
You are going to end up in one big mess if you do.
Don't run before you learn to walk 🙂 It can take 6 weeks or more to sort the paterns out. So don't try craming everything into a few days. Tiny steps and you will move faster 🙂
 
I did a class in the morning - not sure whether that would count though.

Ok I won't go tonight (it'll save me ?5 I guess) and see what happens. But I'm worried that if I don't change to a 1:7 ratio I'll end up with the same problem as last night (ie not being able to get a full nights' testing). Well i'll keep the 1:8 for the time being - will post later this evening with any news.....

thanks
 
Hang on - 5pm you were 10.8? Before you had your dinner?

Why were you that before dinner?

If you were 10.8, you ate dinner and bolused for it, then your BG stayed the same all evening, then surely that's a sign that your BOLUS was correct - ie has completely dealt with the meal without interfering with your basal needs?
 
trophywench said:
Hang on - 5pm you were 10.8? Before you had your dinner?

Why were you that before dinner?

If you were 10.8, you ate dinner and bolused for it, then your BG stayed the same all evening, then surely that's a sign that your BOLUS was correct - ie has completely dealt with the meal without interfering with your basal needs?
Click to expand...

I don't think she ate in the evening TW 🙂
 
Dory said:
...
Time ------- Basal Rate -------- Reading
17-18.00---- 0.92 --------------10.8 (had dinner)
22-23.00 --- 0.48 --------------10.5
23-00.00 --- 0.43 --------------11.3
00-01.00 --- 0.43 --------------13.8
01-02.00 --- 0.59 --------------13.8
02-03.00 --- 0.7 ---------------15.3 (cancelled test, correction bolus, fell asleep pi**ed off as hell)
Click to expand...

I understand your frustration at having to cancel the test, but for my money this was a GREAT set of results. Along with the partial data from the previous evening (from 5am onward) this seems to show pretty clearly that overnight you are rising steadily by about 1mmol/hr.

In your shoes I would increase basal for the complete overnight period to attempt to counteract that.

Regarding exercise classes/gym visits - do you use TBR before/during/after exercise at all? If you usually do, then setting your basic pattern will be fine with or without attending the classes. Because your TBR adjustments will be dealing with the class.

Your meal bolus looks pretty darrned close to me - though it would be interesting to see what basal was doing during that period. It may well be that your basal is a little low at that point in the evening too, which would give the impression that your bolus/correction was out - because some of the bolus/correction would be covering basal shortfall.

I'd be tempted to focus on basal for now - and cautiously firefight occasional higher than ideal numbers. Some very wise forum old-hands once advised my to 'only change one thing at a time' which has proved to be very valuable advice.

Thanks for posting your results so far - very interesting. 🙂
 
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thanks Mike,

I don't use a TBR - I could never get the dosage right, it would work some days but not others (and that was when the classes were the same) so I just gave up.

Thinking about it, I think you and TW may be right about the bolus for dinner. It must be the correctional dose that's not right in th eperiod beforehand, which I suspect needs to be a bit higher (it is currently 1 : 1.4 which is low for me).

Anyhoo, you're right - baby steps; I'm taking Sue's advice and just focussing on basal at mo. once i get overnight sorted I wil be moving on to the other periods in the day as the sticky suggests.

I will post my results tomorrow and see how I get on - glad they're not boring you all to death 🙂
 
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