Bolus or basal? Porridge problem again

[SB2015]

I am still trying to sort out my morning bolus for porridge.
I have made some changes and trying to keep a watch on the different variables, but it am not sure which to change. Any ideas welcome.

7:58. 4.3 (-0.3) 28g. (2.2) (Eaten 15 min later). Total bolus 1.9 Multiwave 1.2/ 0.7 (30 min)
8:13. Ate breakfast
9:33. 4.4
10:30. 5.0
12:00. 6.6
13:00. 7.5

So is it that I
- need to change the split of the multiwave
- increase the extension of the bolus
- increase the basal rate in the morning
- change my carb ratio at breakfast
And why? Then I can work out others for myself

I am going to try a fasting test tomorrow to check that out and eliminate one variable.

 

[Annette]

Id say your bolus looks ok, and would want to look at basal running up to lunch. Your basal test will tell you if thats ok, if so, then repeat the porridge experiment and see if a similar pattern occurs.

 

[SB2015]

Thanks Annette. Only another hour to go before end of fast.
Readings a bit up and down so can make small adjustments. The bit that I had hoped would explain the rise toward midday is not helping, as I am dropping, suggesting the basal is actually a little too high rather than too low. Ho hum.
Things are never quite straight forward.

 

[trophywench]

You were a tad low before brekkie SB, hence when the upfront part of the bolus started doing it's stuff, you were still a bit low.

Before breakfast and up to lunch, that's when your basal needs looking at - a bit less about 6am and a bit more about 10am or 11am (I'd like you to do it at 1030am but dunno whether you can do that on your pump, can on the Insight but can't on a Combo)

I think, sort the basal and the bolus will be fine.

However - I'm not sure I'd want all the bolus on any multi-wave to be delivered over the space of just half an hour? Is it even worth multiwaving to then deliver it all that quick? - that question isn't specifically to you, it's general. I mean - I wouldn't bother m/w- ing anything for less than an hour? - usually 1.5 hrs with mine.

 

[SB2015]

Thanks TW.

Are you wired into my handset!! I completed a fasting test and guess what, I tweaked at 6:00 and the tweak I wanted to do between 10 and 11 I spit between those two as I am still on a combo.

I tried a Multi extended for 1 hour for my porridge but went too low before, but I now know that it was my basal. I will look at that again and can now work on my bolus, confident that basal is sorted (for now).

Looking at breakfasts over last week I also think that my carb ratio is a bit low for breakfast. I checked it on an accurate CHO and faster release breakfast (well I just wanted my chiabatta and yummy jam that we always used to have on Sundays) and that confirms it. (I think you mentioned that on last enquiry as well but the basal was mucking things up). I was very surprised how low the spike was on that breakfast, just due to delivering 40 minutes before breakfast. It is when I start low that I end up with bigger spikes after a meal.

Where would you aim to be before breakfast? I know that 4.3 was low. I am usually happy with anything between 4.5 and 6.5.

It is so helpful having knowing eyes able to advise, and the general advice is also valuable. It is the kind of details that I have not been able to get from our DSNs so far so this is very valuable.

Many thanks.

 

[Annette]

Is it even worth multiwaving to then deliver it all that quick? - that question isn't specifically to you, it's general.

Yes, it is. We're all different, after all! I find a half hour extended bolus removes my 'shortly after meals hypo', whereas an hour or longer makes me spike more than I'd like. But that's the sort of thing only a libre or CGM can really show you.

 

[Annette]

Where would you aim to be before breakfast? I know that 4.3 was low. I am usually happy with anything between 4.5 and 6.5.

I dont actually eat breakfast (bad diabetic!) but I aim to be 5-6 in the mornings, more so that I dont have to faff around with eating and waiting etc before I drive to work.
Once your basal is sorted, try checking your carb ratio with something even plainer than your chibata/jam combo - because the higher sugar from the jam (and fat from the butter?) might muddle things slightly. My old DSN used to suggest just trying a couple of digestive biscuits, for example (I actually always went for weighed bread with a scrape of marg, as I know that's a straightforward thing for me to digest). Then you'll have a real steady baseline to work from for your porridge.

 

[SB2015]

I dont actually eat breakfast (bad diabetic!) but I aim to be 5-6 in the mornings, more so that I dont have to faff around with eating and waiting etc before I drive to work.
Once your basal is sorted, try checking your carb ratio with something even plainer than your chibata/jam combo - because the higher sugar from the jam (and fat from the butter?) might muddle things slightly. My old DSN used to suggest just trying a couple of digestive biscuits, for example (I actually always went for weighed bread with a scrape of marg, as I know that's a straightforward thing for me to digest). Then you'll have a real steady baseline to work from for your porridge.

Thanks Annette. I have adapted the Carb ratio for this morning, and will do a plain breakfast (digestives are a big treat to me, not because individually they are a problem but once the packet is open!!). Is you DSN available for hire. I have never had such detailed advice available.

 

[trophywench]

Yes, it is. We're all different, after all! I find a half hour extended bolus removes my 'shortly after meals hypo', whereas an hour or longer makes me spike more than I'd like. But that's the sort of thing only a libre or CGM can really show you.

Fair enough, that's why I asked, we are indeed different - and of course I haven't got a Libre so I don't know if I get spikes, though obv I know I don't get the hypos, since where I would - I already do a delayed bolus anyway LOL

 

[everydayupsanddowns]

Where would you aim to be before breakfast? I know that 4.3 was low. I am usually happy with anything between 4.5 and 6.5.

I always prefer to be at least 5 for FBG. These is some research that shows a significant association with FBG below 5 and overnight hypoglycaemia. If your basal is bang on on a pump it *shouldn't* be a problem on a pump, of course, but mine never stays put for long!

 

[HOBIE]

I love my Porridge. I would say multiwave is the answer ,& of course what you are doing work/ activity

 

[SB2015]

Thanks all. I shall continue to work on it.

I know basal is now correct (for now) and have had lovely straight lines overnight and mornings are fine.
Now I just need to sort out sensitivity, carb ratio, timing of delivery, extension.

So many puzzles each day and all for free!! I am glad that I like Mathematics.

 

[trophywench]

LOL - amazing how good you get at it, but at least you had all the facts presented to you when asked to calculate how long it took A & B to fill the swimming pool or dig that 'ole, whereas for the diabetes conundrums - there are always going to be bits you don't know and have to guesstimate!

Talk about a degree in 'Applied' mathematics - reckon most have us have achieved Firsts by now, and also the Masters, or is it a PhD, for Maths? that follows it ......

 

[SB2015]

I always prefer to be at least 5 for FBG. These is some research that shows a significant association with FBG below 5 and overnight hypoglycaemia. If your basal is bang on on a pump it *shouldn't* be a problem on a pump, of course, but mine never stays put for long!

Exactly. Two nights of lovely straight lines and waking on very similar to bedtime, and then...
Wobbles last night, but then I spent the afternoon and evening dealing with consequences of a rebellious pub lunch, so perhaps it was just settling down again.

It is hard to estimate the carbs in a homemade fish cake, especially when you left your phone at home so no access to Carbs and Cals app.