Basal conundrum

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Northerner

Northerner

Admin (Retired)
Relationship to Diabetes
Type 1
As you may know, my basal is pretty much sorted - certainly I don't have hypos at night any more and always wake to 5.x these days.

However, one thing I have noticed is that it seems to be insufficient in the mornings leading up to lunch. Usually my breakfast will be about 4-5 hours before my lunch, but occasionally I have had it earlier - 6 hours pre-lunch - and have noticed that my levels before lunch are then above range. Today, I was 4.7 before breakfast, later 6.9 before a 4.5 mile run and 7.6 after (about 2 hours after breakfast). I would have expected the run to at least keep me in range, or maybe send me a bit low even, but I was 8.2 before lunch, 6 hours after breakfast.

I know it's not drastically high or anything, but you know me and my quest for perfection! Just wondering what I could do. I don't really want to mess about splitting the lantus dose as I don't think that will be particularly helpful. Perhaps I should just have a snack at four hours and in the immortal words ' bolus for a biscuit'!?

Any thoughts?:confused:
 
maybe your bolus ratio has altered? You could chuck in a bit more dose with your breaky maybe? to keep you a bit lower? Or to check it is your basal do a test thing starve for 6 hrs?? see what it does.
 
Hi Northerner,

If you really wanted very tight control you could consider splitting your basal. However, it'd be very hard work. I've recently stopped splitting my basal as I've found out it created more problems than it resolved. 8.2 is a good figure to see before lunch and I would have no problems in seeing that. If you did split your basal I suggest that you see your DSN as soon as possible and start with something like two units. You'll need to keep the morning levemir (if you're on it) at around the same time.

Tom
 
Hmmm everyone is being very technical .... I say go for a snack and see how that effects things for a few days , if no joy then start the complicated stuff the boys have suggested :D
 
I'd probably be inclined to do a little testing initially to try and work out exactly what's going on, testing 2hrs, 3hrs 4hrs etc after breakfast to work out exactly what's going on. I would be tempted to say skip the run while testing so you get a unaffected reading but I suppose that's more tricky in your case as if you do run at that point everyday then however you 'set' your basal needs to take that into account.

I'm also wondering if it could be some sort of dawn phen-esque situation, so maybe you could tweak around a bit with your breakfast ratio, or add a unit or so on with breakfast to cover the slight rise. Of course you'd want to be really cautious with that to make sure it doesn't take you low inbetween.

You did mention the other day that you think you're probably honeymooning still. Not wanting to disappoint or anything but also wondering that if this is a recent thing maybe it's the start of your honeymoon ending and whatever your pancreas is still producing at the moment is dimished at that time of day, maybe your honeymooning pancreas is compensating for a more significant dawn phen so is 'tired' later on and not doing so much.

None of that may be much use, all just thinking out loud really I'm afraid....
 
Thanks guys. I have considered adding a little extra to my breakfast dose, but I think that would just have the effect of dropping my too low within four hours. I have done tests at 3 and four hours as sometimes I am returning from my run at 3 hours post brekkie, and sometimes having my pre-lunch test at around 4 hours post brekkie.

So, the rise is happening between 4-6 hours when the brekkie bolus has expired. I think it must be a pre-lunch insulin resistance, since I do need quite a lot more bolus for breakfast than later in the day, and once that's run out then the basal level is too low. All other times the basal seems fine, just the mornings that it's a little on the low side.

Tom - I'm not overly concerned with an 8.2 before lunch, but it's annoying - especially after a run!😱😉

I'm going to try tha snack thing after 4 hours and add in a bit more bolus. I suppose I could just have a unit of bolus and no snack, but that might drop me too low. Am I being too obsessive? I'm sure it'll all fall apart one day when my honeymoon is finally over!
 
Northerner said:
I'm going to try tha snack thing after 4 hours and add in a bit more bolus. I suppose I could just have a unit of bolus and no snack, but that might drop me too low. Am I being too obsessive? I'm sure it'll all fall apart one day when my honeymoon is finally over!
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I wouldnt say you were obsessive , just cautious of your long term health , not a bad thing surely. I would try the snack first before anything more complicated :D😉
 
Personally, I'd leave well alone.
You have very good control already and if you start tweaking things a little here and a little there, very soon things can get out of hand and you will be all over the place.

Be happy with what you have 🙂 Others (myself included) would (*almost*) kill for your sort of control.

If it ain't broke, don't fix it.
 
AlanJardine said:
Personally, I'd leave well alone.
You have very good control already and if you start tweaking things a little here and a little there, very soon things can get out of hand and you will be all over the place.

Be happy with what you have 🙂 Others (myself included) would (*almost*) kill for your sort of control.

If it ain't broke, don't fix it.
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Alan, I know you're right, it's just the way my mind works!🙂
 
Hi Northerner..

Can I just agree with what Alan has said .. personally I would leave well alone .. you have excellent control and work hard at maintaining those levels ...🙂.. I would be over the moon if Nathan had the readings you were getting..🙂

If you are bothered .. you could as others have suggested ..check your BG hourly, leading up to lunch .. just to see what is going on, if there is a pattern etc.

About 10 mths ago... the consultant and dietician decided to push Nathan into carb counting .. starting with breakfast .. they give me the ratio's etc ..reluctantly I agreed ..although I did tell them the level of insulin he was too take would make him hypo.. they on the other hand were adamant it would'nt .. they were wrong .. after a week to 10 days of this .. and changing the ratio's myself .. I flatly refused to do anymore, and so did Nathan.. it took me a good month to regain the same levels as before.

Heidi
xx🙂
 
Thanks Heidi, I think a lot of it is down to me being healthy for nigh on 50 years then getting told all these awful things about complications that could happen to me - I'm still relatively new to this and those warnings are still ringing loud in my ears (not that I think I will ever become complacent, just feeling the fear sometimes).
 
Northerner said:
Thanks Heidi, I think a lot of it is down to me being healthy for nigh on 50 years then getting told all these awful things about complications that could happen to me - I'm still relatively new to this and those warnings are still ringing loud in my ears (not that I think I will ever become complacent, just feeling the fear sometimes).
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I understand totally how you feel .... Just try not to be to hard on yourself...🙂 .. On the complication side of things .. yes.. true many are horrendous .. and I have them implanted in my brain as does Nathan .. One thing I have learnt over the past 2 and a half years is though diabetes from time to time just throws something at you ..that you cannot explain as the reason why.. for instance Nathan went to bed at 17.1 the other night ...😱.. nothing done differently at all .. food, insulin, activity, exercise etc... then woke at 4.2....The following day he had a night hypo and two during the day???

Heidi
xx🙂
 
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