adjusting basal rate overnight and bolus ratio late evening

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Sorry posted that before I'd read the latest responses...

What did you count for the meal? I'm not sure there are many carbs in butternut squash?

Hang in there. This is tough times, but worth it in the end. Once you have a basic pattern properly sorted for you it will usually only need a little tweak here and there.
 
everydayupsanddowns said:
Did you have any hypos yesterday - even just little low-level dips can be followed by a bit of BG randomness as the liver belatedly 'helps out' when it fancies it.
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Nope Mike. no hypos at all yesterday.

Northerner said:
That sounds like a plan to me Dory. These things can't be rushed and stress/exhaustion will upset your hormone balance anyway. Give yourself lots of credit for the hard work you've done so far, regroup and recover your strength and sanity before resuming 🙂
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that's assuming that I have any sanity to recover Alan 🙄

Sue - just checking re your sf jelly plan: do you mean do another overnight test but have sf jelly at 5-6pm as my dinner? Or do you mean do an evening test as per the sticky (eat no later than 2pm, do the tests and then ok to eat after 11pm)? I will attempt whatever anyone suggests but think i may need to give my poor brain a few days rest
 
everydayupsanddowns said:
Sorry posted that before I'd read the latest responses...

What did you count for the meal? I'm not sure there are many carbs in butternut squash?

Hang in there. This is tough times, but worth it in the end. Once you have a basic pattern properly sorted for you it will usually only need a little tweak here and there.
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Thanks Mike. This is hard.

I counted a follows:
7CHO - butternut squash
2CHO - green beans
27CHO - yoghurt
11CHO - Alpen bar
20CHO - banana

This is more than I would normally have in one sitting because I usually have a snack (ie the yoghurt or the banana) later on in the evening and I knew I couldn't do that tonight and was hungry last night - so had it all in one go. Ironically I ahd more carbs tonight that I had last night at dinnertime! :(
 
I think you are already putting in an amazing effort on this Dory. I don't think I've ever run more than 2 tests in a week!
 
'evening' basal test

Thanks Mike. When you're having a rough time of things all the reassuring comments helps 🙂

Right - new day, new outlook. Reading 11.8 at breakfast this morning (not surprising after last night but my ratios this time of day normally sort out any blips before lunch). So, I was thinking of doing an evening test today (ie eat no later than 2pm, then fast until 11pm). It seems that the majority of my problems at testing overnight come from evening activities interfering....so thought (seeing as I'm working from home today and have the capacity to do it) I'd give it a go.... will post results later tonight.....
 
Dory said:
Thanks Mike. When you're having a rough time of things all the reassuring comments helps 🙂

Right - new day, new outlook. Reading 11.8 at breakfast this morning (not surprising after last night but my ratios this time of day normally sort out any blips before lunch). So, I was thinking of doing an evening test today (ie eat no later than 2pm, then fast until 11pm). It seems that the majority of my problems at testing overnight come from evening activities interfering....so thought (seeing as I'm working from home today and have the capacity to do it) I'd give it a go.... will post results later tonight.....
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Good luck Dory, hope things go well 🙂
 
cheers Alan 🙂
 
ok, so either my basal, bolus or correctional ratio is too high at breakfast: my reading went from 11.8 when I had breakfast at 7am to 3.8 at 10am.

Had lunch at 1pm, reading was 7.9. Had 45g CHO, 6.7u bolus and 1.5u correctional.....thought all was set perfectly for this evening's tests....

checked reading at 2pm: 6.0. Perfect, i thought.
checked reading at 3pm: 4.4. Hmm, I thought. not good
checked reading at 3.30pm: 4.0.

Have abandoned test.

I know that obviously I am having too much insulin somewhere, but if I can't do these frigging basal tests how am I meant to know whether I need to adjust the basal, bolus or correctional ratios??!! I need to change something - and now - if I'm going to have any chance of performing a full
basal test. What to do?
 
right. have phoned and left a message for an urgent appt with the DSN tomorrow sometime. The more I try and understand the numbers the more and more I just get things foggy in my head.

I'm just going to let them look at the numbers and suggest changes. Anything to stop the 2, 3 hypos a day I'm currently having.

All I know is that it's too much insulin. But dont' know where to cut down.
 
Dory said:
All I know is that it's too much insulin. But dont' know where to cut down.
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Logic says the simple option is to reduce your basal.
Lower the basal and use that as a starting point.
 
I haven't looked this up, but I think John 'Pumping Insulin' Walsh suggests a complete reset if things are completely out of kilter.

Some of the results you posted a while back from partial basal tests made it look like more insulin was needed (climbing steadily overnight), but here you are crashing.

Not sure if this will appeal, but you could start from a blank page...

I'd make a note of your current pattern first so that you can refer back to it.

The take your average TDD for the last 14 or 30 days and if hypos are your problem of late consider reducing by 10%, 15% or something.

Then take 50% of that reduced figure (the idealistic basal:bolus split) and that will become your new daily basal. Then set the flat rate as 1/24th of that over 24 hours.

You could also consider resetting your meal ratios by the 500 rule (or similar) ie 500/TDD = grams of carb dealt with by 1u of insulin. Flat rate all day.

Then cautiously test over the next few days to see if you can spot repeating patterns of highs/lows. and look to sort basal first, then tweak meal ratios.

Only do this if you have completely lost faith in your current set-up as it's pretty much a 'hard reset'. Like starting pumping all over again. And before you do that it would be good to pass the suggestion by your DSN to get their steer.

Better still get hold of a copy of Pumping Insulin which explains it all in much more detail (and without the errors of memory I've probably introduced!)
 
Dory said:
ok, so either my basal, bolus or correctional ratio is too high at breakfast: my reading went from 11.8 when I had breakfast at 7am to 3.8 at 10am.

Had lunch at 1pm, reading was 7.9. Had 45g CHO, 6.7u bolus and 1.5u correctional.....thought all was set perfectly for this evening's tests....

checked reading at 2pm: 6.0. Perfect, i thought.
checked reading at 3pm: 4.4. Hmm, I thought. not good
checked reading at 3.30pm: 4.0.

Have abandoned test.

I know that obviously I am having too much insulin somewhere, but if I can't do these frigging basal tests how am I meant to know whether I need to adjust the basal, bolus or correctional ratios??!! I need to change something - and now - if I'm going to have any chance of performing a full
basal test. What to do?
Click to expand...

When you correct, what ratio do you use? I only ask because 1.5 seems quite a lot for a reading of 7.9. My own correction for that level would be 0.6 units. Of course that also depends on what your target level is. Personally if I was planning on doing a basal test and I wasn't sure of my correction ratio I probably wouldn't correct a 7.9, thus removing one source of variation.

Also, what is your lunchtime carb ratio? I can't work it out as 6.7 doesn't go into 45.

While I agree that you need to get your basals right before tweaking anything else, I also sympathise with your difficulty in getting a good starting point to do the basal testing, which means you have to start with the information you've got and change one thing at a time.

Another thought is that I don't think I would have necessarily abandoned the basal test. The difference of .4 between your 3pm and 3.30 readings was so small as to be insignificant and it's possible that at 2.5 hours the remaining action of the insulin might not have lowered your levels any further - depending on what you ate.

Maybe a strategy could be to choose a time when you are happy with your level and take it from there - any time when you have no active bolus insulin and it's at least 4 hours since eating.

It's very frustrating I know but you'll get there eventually I'm sure - hang in there!
 
Mike - yes, book is ordered with Amazon and due for delivery any day now. I'll see what the DSN says about adjustments. The numbers really aren't going in anymore, it's waaay over my head.

Mary - I have quite high insulin resistance hence the high correction factor. And that time of day I'm on a ratio of 1:7 - sorry I mistyped the carbs, I had 47g not 45g.

I think the problem is I've been so used to eating a lot throughout the day because I've got a lot of insulin. When my food portions go down, I've still got all that insulin flaoting round. So overall, I think it's probably about time i lowered everything. Complete overhaul.
 
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