Lingering highs

[Pumper_Sue]

I can set the TBR to go through the whole night, but have no way of delaying its start.

As I stated above all I do is change the basal rate. You can do this on any pump as you do it when basal testing and adjusting basals so it's the same principle. You know that eating fatty foods raises your blood sugar at x hour after eating so increase the basal 2 hours before that and experiment with the length of time it's needed for as obviously everyone is different.

Just remember to change the basal back in the morning.

 

[Annette]

As I stated above all I do is change the basal rate. You can do this on any pump as you do it when basal testing and adjusting basals so it's the same principle. You know that eating fatty foods raises your blood sugar at x hour after eating so increase the basal 2 hours before that and experiment with the length of time it's needed for as obviously everyone is different.

Just remember to change the basal back in the morning.

The point is that, if you go high say 6 hours after a certain meal, you need to change your basal 4 hours after, but you go to bed 3 hours after, so you have to set an alarm to wake up and change your basal.
Fine if you dont go to bed before the 4 hours are up, but otherwise, delayed start tbrs would be useful! (All numbers taken at random btw)

 

[Pumper_Sue]

The point is that, if you go high say 6 hours after a certain meal, you need to change your basal 4 hours after, but you go to bed 3 hours after, so you have to set an alarm to wake up and change your basal.
Fine if you dont go to bed before the 4 hours are up, but otherwise, delayed start tbrs would be useful! (All numbers taken at random btw)

No you don't.
When you go to bed just change the basal setting on your pump so instead of say a basal of 0.70 @ 2am just change it over to 0.91 (example)
It's called using your pump and brain to the best advantage 😉
You don't wake up every hour to change or set your basals through the night do you, so why is eating fatty food an exception? Just change the setting before you go to bed. Problem solved.

 

[everydayupsanddowns]

TBH I just start a square wave bolus when I go to bed for those particularly difficult meals where I expect a reasonably predictable 'x' mmol/L rise overnight. I find that much easier to estimate than basal rate increases or having a specific basal pattern for an occasional takeaway (mostly because my basal seems to change up/down/shape about once a fortnight so I'd always be setting up the overnight pattern from scratch which is a bit too much faff). This is fine for me because the rises tend to happen more or less constantly through the night. If I continued to dip/was level for a few hours overnight and *then* began to rise I guess I'd just make the ad-hoc basal pattern tweak. But I am pretty sure I'd forget to set it back again some days and get myself in trouble the following night.

That's the main reason I prefer temporary apporaches to temporary situations. Changing my actual basal pattern for a one-off event just doesn't fit so well with a meal-specific event in my head 🙂

 

[Pumper_Sue]

That's the main reason I prefer temporary apporaches to temporary situations. Changing my actual basal pattern for a one-off event just doesn't fit so well with a meal-specific event in my head 🙂

I just leave a note on top of my clothes to remind me to change it back. So much simpler and more accurate the way I do it.

 

[Annette]

That's the main reason I prefer temporary apporaches to temporary situations. Changing my actual basal pattern for a one-off event just doesn't fit so well with a meal-specific event in my head 🙂

Exactly my feelings. I hadnt even considered making a 'permanent ' change to my basal then remembering to reverse that change next day (chance of remembering : slim) perhaps because it introduces a level of risk to the situation that Im not happy with (ie, forgetting and having a major hypo next night). But thats me.

 

[Annette]

I just leave a note on top of my clothes to remind me to change it back. So much simpler and more accurate the way I do it.

Notes go misteriously missing in my household I'm afraid. And I would actually say its not simpler your way (if using a combo)-far more button presses!
Each to their own.

 

[Simbul]

Hi all.
I have a bit of a mystery on my hands and seeing as it has to do with the original subject of this discussion, I thought I'd post it to ask for your opinion 🙂

Here's the timeline:

1. At 16:45 my BG was 4.2 and I was feeling the low particularly strongly. I corrected with the usual glucose tablets, but unfortunately I went a bit overboard and also had a 45g nut bar (13.5g of carbs, about half of those sugars). I was ready for some weird BG later on, but I couldn't imagine what would actually happen
2. At 17:30 I realised I overcorrected (and I was feeling fine), so I set up a 0.6u square wave for 1h
3. At 18:45 I changed my infusion set
4. At 19:30 I tested my BG again. Guess what, it was now 13.8. I had a correction bolus of 1.5u: since my insulin sensitivity is 3.5, it should have brought me down to 8.5 or thereabouts
   
5. At 20:45 I had dinner: usual stuff, tried and true carb counting, with a bolus of 4.8u
6. At 23:00, to my dismay, my BG was still 12.8. This is the main mystery: almost 4 hours after the correction bolus, why had it not gone down? I had a minimal bolus correction of 0.2u at this point, as most of the dinner insulin was still around
7. I woke up suddenly at 6:30 the next morning with a BG of 4.3

So my BG went down, then shot up, then down again. I can see how it would have followed that pattern given my sugary overload in the afternoon, but I can't quite explain why the swing was so pronounced. And the nighttime low is also a bit unclear.
It's almost as if my bolus correction at 19:30 had decided to take effect 8 to 12 hours later.

Any ideas? 🙂

 

[SB2015]

Although you knew the carbs for your meal, I wonder whether the content was slow release, or if there was a higher fat content to the meal which would again slow the release of the glucose from the food that you ate.

3. Did you remember to prime the cannula when you changed your infusion set? I have forgotten to do that before now (too often)

4. You may need more insulin when You are high than the normal correction. If I am above 12 then I add in an extra correction over and above the suggested amount. The higher I am the more I add in. I have these set up on my combo as Stress (+20%) and illness (+50%). I have worked these out for me by trial and improvement. You would need to work out if this applies to you and how much you would need.

6. Your correction would not have completed its job when you ate your meal. You mention that your carbs were correct, but it wonder what the glycaemic index was . If it was low GI it would release the carbs slowly, as it would if there was a high fat content. So that could account for the high later in the evening.

I hope that that lot makes some sense. Do you have easy access to a DSN? It would be worth getting them to look at your readings with you. They sometimes spot patterns that we don't see ourselves. apart from that just keep asking.

 

[Annette]

Your correction would not have completed its job when you ate your meal.

Just to add to this point - it may be (it is for me), if you add carbs to an already high bg, as in this case, your insulin resistance could be temporarily higher (which is why you need more correction dose for higher bgs than slightly high bgs, as in point 4), so your carb ratio may have been correct for a normal situation, but not for an abnormal one (as this was).

 

[Simbul]

Those are some interesting points.
I'm pretty sure the cannula was primed correctly and my dinner was not especially high-fat or low-GI.

I've definitely not accounted for the extra insulin needed in my correction. I remember we talked about it in another thread but it'll take me a while to get used to doing it: my bolus wizard has definitely spoiled me from that point of view
I also think you may be onto something with insulin resistance: I've noticed before that eating when my BG is high tends to perpetuate the high even though carb counting would suggest otherwise.

One doubt I have is to do with the low in the night / morning: if I had had a bigger correction or a bigger bolus for dinner, wouldn't that have made my BG even lower in the morning?

 

[SB2015]

One doubt I have is to do with the low in the night / morning: if I had had a bigger correction or a bigger bolus for dinner, wouldn't that have made my BG even lower in the morning?

If your resistance is higher with the higher BG the insulin will get 'used up' doing its job at those higher BGs. (Not exactly a medical description but I hope that it makes sense).

Could you delay your meal when you are high. Go for a bit of a premeal walk to get things down before you start eating. If you test about half an hour before your meal you could then delay the readiness of the food. And start to look at delivering your insulin before your meal. The higher I am the earlier I deliver my I insulin

With regard to the overnight lows, could you eat earlier, say at least four hours before you go to bed, so that the insulin has done its job before you go to bed. If you are particularly worried you could set an alarm to test during the night.

 

[Simbul]

Yeah, waiting before eating is a good point: I'll have to start doing that more. Thanks 🙂