Basal shenanigans - no clear pattern

[everydayupsanddowns]

So here's a thing... About two weeks ago I seemed to need to put basal up 1u. Then I had a few brilliant days with hardly a reading out of place.

Then I got a bit of a cold/sore throat. Levels stayed perfectly fine.

Then on Saturday I was low almost all day despite continuous fruit pastille gobbling (always expecting to see a high result).

On Sunday (when I had considered reducing basal in the light of Saturday) BGs started high and remained so all day despite corrections.

Through the rest of the week (cold still in place) I've raised basal 1u again and been adding +20% to boluses for 'Illness'.

Sometimes these have worked perfectly. Sometimes I have gone hypo. Sometimes I have gone high.

Bedtime to FBG results during this period have ranged from completely level to -2mmol/L to +4mmol/L

Something is clearly not right, and I can think of (at least) 3 reasons for every errant BG result...

What do you guys do when this sort of thing happens? Just ride it out till it settles a bit? TBH basal has been a bit of a movable feast for a few months now and the recent stability made a refreshing change, so it's annoying that it has all gone bo9nkers so soon.

Just ranting really 🙄

 

[shiv]

Hey, sorry things are so pear shaped at the moment. If I have this, I tend to ride it out for a few days. If after a few days it's still going on, I'd look at making some small changes and take it from there.

Hope things settle down for you 🙂

 

[Northerner]

I find it very difficult to predict BG when I have even a slight illness, so tend to just ride it out and try not to stress too much about it. Like you, I try and adjust and end up with highs and hypos - very frustrating and you start to feel very lost with what you are doing. I hope this is just down to the sore throat etc. and that things settle soon 🙂

 

[everydayupsanddowns]

Thanks Shiv

I think that's most of my frustration at the mo. Cold is clearly on its way out (and had no noticable BG effect for first week) but every time I start to think, "right ease back on the correction" I get lumped with an above-target reading.

Bedtime last night was 6.0, fbg 9.6. Given that HelenM posted research the other day about the lack of evidence for Somogyi (not identified in CGM tests or something) I have no idea what that might have been apart from the cold (but I'm taking more basal anyway).

If I had 2 days on the trot with the same thing happening I'd run a basal test overnight, but the day before the day before bedtime and fbg were within 0.2 (and I still had the cold!)

Pffffffffffft!
M

 

[shiv]

My fasting readings have been all over the place recently, I really need to basal test. Some days I wake up in the 5s, some days in the 13s! I'm a bit burntout at the moment so haven't been being terribly proactive, just reactive.

I hope things settle down for you soon, diabetes is such a pain. (understatement of the century)

 

[bigpurpleduck]

Oh Mike, I feel for you! There's nothing more frustrating than being unable to see the wood for the trees.

When I find chaos ensuing, I tend to ride it out but that's partly because at certain times of the month I know it will settle for a week or two. Obviously you don't have a monthly cycle to help predict changes. I'd say wait a few more days - it could well be the cold still causing trouble. If you're sure it's well and truly gone and things are still mental, I'd start with the hypos. I think it's in John Walsh's Pumping Insulin there's a quote says "Avoid highs by avoiding hypos", or something similar. Basically identify any hypo patterns first, and change things to stop them. If you run high for a few days, fine. I've found this advice of focusing on hypos is pretty good when things are going crazy. My liver seems to go through periods of overactivity, and reducing hypos helps to calm it down.

Anyhow, keep us posted. Fingers crossed for you things settle soon.

 

[Robster65]

split 😛

I shall no more. Or I might. 🙄

Rob

 

[FM001]

Colds and flu and any other illness always sends my bg skywards, I tend to ride the storm and not change my basal but increase my bolus to compensate, often juggling both insulin's isn't worth the hassle for the sake of a couple of days feeling under the weather.

 

[bigpurpleduck]

split 😛

I shall no more. Or I might. 🙄

Rob

Well, if Rob's doing it...

Pump 😛

 

[everydayupsanddowns]

Rob - tried it. Disaster.
Emma - Blah blah blah!

Colds and flu and any other illness always sends my bg skywards, I tend to ride the storm and not change my basal but increase my bolus to compensate, often juggling both insulin's isn't worth the hassle for the sake of a couple of days feeling under the weather.

I'm doing a bit of both because covering with only 4-5hour duration insulin splurges doesn't help overnight. Additionally from experience if my basal is just a tiny bit lower than I need (as surely would be the case if illness has raised liver output) then neither meal boluses nor corrections work as expected. Ranted about that what seems like an age ago when we hand not long started blogging.

The frustration, of course, is that one day I seem to be getting consistently higher numbers and think, 'Ah it'll be the cold' and then another day no apparent effect, then a few days later higher readings again.

Ho hum. I must be nearly out the other end of it by now.

 

[novorapidboi26]

Lol, it really is a pain, I too have results which I cant explain and which I cant act on because they are never consistent enough........

 

[heasandford]

yes - wouldn't we be the ones to benefit from CGMs (ooh, have I said that before??)

 

[Ellie Jones]

There's one thing that hasn't been mentioned!

What type of food have you been eating?

Don't forget if you've had high fat or pasta meals it takes longer to adsorb, and a cold my make this a little bit longer..

If I've got a cold/infection I always ride it out with corrections rather than start changing basal rates.. Not worth the hassle of having to do another lot of basal testing when everything calms down again

 

[everydayupsanddowns]

Oh Ellie! Bless you but my diet is what it always is, with (roughly) the same carb counted meals of known low-ish GI, or at least known absorption profile, variants. There has been no big dietary change that would account for the inconsistency, and some meals which allegedly should have absorbed slowly (eg pasta) have rocketed into the bloodstream. Sadly, that isn't (or at least doesn't appear to be) 'it'.

I'm pretty convinced that it is/was the cold, though it continually frustrates me that the BG effect of a low-level illness seems to be so varied for me. There is a kind-of curve to it no effect, some effect, more effect, some effect, no effect but various days/meals in between just don't follow the pattern.

I'd have thought for pumpers TBR would be perfect for illness, only covering it with boluses means you're only getting 12hours-ish of extra (4hr per meal dose). Dont; you see a big rise overnight? You're not the first pumper to say they only counteract with boluses, so clearly it works for you. Odd that as an MDI luddite I seem to have to do a bit of both!

 

[Robster65]

Just before I go outside to do something, thought I'd pitch in again.

Is it worth recalculating everything as if newly diagnosed ?

ie. basal worked on the formula for body weight. Bolus injected 10-15 minutes before the meal and stick with that timing but tweak the dose.

I know you've done some experiments with premeal timings and I would have thought that once you get beyond the 15-20 minutes, the bolus is either working or there's an injection site issue. Small doses can sometimes be a problem.

I'm just trying to fire some ideas at you, but always hard to come up with solutions when you've tried everything.

Hope you get there. 🙂

Rob

 

[everydayupsanddowns]

Oddly enough today seems to be much better behaved. I seem to be emerging from beneath the cloud 🙂

Thanks to everyone for all the suggestions and support. Much appreciated.

 

[shiv]

I'd have thought for pumpers TBR would be perfect for illness, only covering it with boluses means you're only getting 12hours-ish of extra (4hr per meal dose). Dont; you see a big rise overnight? You're not the first pumper to say they only counteract with boluses, so clearly it works for you. Odd that as an MDI luddite I seem to have to do a bit of both!

I use a TBR if I am sure it's illness causing funny levels. Otherwise I'd just see permanently elevated levels, which drop with corrections and then come back up. I'm worried I'm getting ill at the moment as I'm seeing higher numbers and my piercing is beginning to hurt (which might sound daft, but when it hurts it's like my body is working overdrive to reject anything that could be a foreign body ie the bar, like it's working to reject the illness). Bleugh, I really don't need to get ill!

 

[Phil65]

I've discovered that if I have consistently high readings they are nearly always due to an absorbtion problem, I am much more careful where I site my cannula now ....rather than just sticking it in my stomach 'anywhere!' often I was inserting into a lypo/lumpy area. Was the same when I was on MDI!

 

[Northerner]

I've discovered that if I have consistently high readings they are nearly always due to an absorbtion problem, I am much more careful where I site my cannula now ....rather than just sticking it in my stomach 'anywhere!' often I was inserting into a lypo/lumpy area. Was the same when I was on MDI!

When I saw my consultant last month he recommended I began using other injection sites - I had been using my tummy mostly and although I thought it looked fine her obviously thought the site needed time off. He also said that I might need less insulin, which I was sceptical about. However, since changing sites, mostly just sticking the needle in my backside now, I have to say it seems he was correct. Today I had 6 units for my lunch that previously I would have injected 11 or 12 for - yesterday I had the same lunch and hypoed on 7 units, hence today's reduction.

So, absorbtion was clearly an issue for me, and I guess tat the longer you've been doing it, the more difficult it becomes to find a reliably 'fresh' site for the injections.

 

[everydayupsanddowns]

I think there's a lot in what you say Phil. Could easily explain the unpredictable hit/miss nature since I'm using different sites each time.

Of course it doesn't make it any easier to work out where might be a good spot, and where is a dodgy one (no lumps or anything obvious to avoid, but some areas which suggest a very slight build up of lipohypertrophy)

M