Hi Everyone. its Daisy Mae here, and i wanted to open up a new thread because i have not been able to find one on this subject and i need some help and suggestions and any answers that anyone of you may have.
many of us already know that when we are sick we can become very insulin resistant and need to pump in more insulin than on other days. not just increasing our insulin basal at one time a day, but for 24 hours over time. so, for example, we might find that instead of our usual basal rate of 100%, we might need to elevate our basal to 110% or more. its a great help when we get the flu or have infections or even when we have unusual stress in our lives. sometimes, we might need to up our basal because we are traveling on a plane (this happens to me whenever i travel).
however, there are many other reasons to use a TB, and i am very curious to know how anyone goes about determining what that increase or decrease should be. do you start raising your TB at a modest percent (for example 110%) and then monitor your BGs carefully, and then increase you TB a little bit higher because that 110% is clearly not enough to keep you in target range?
or, do you know your D body so well, that if you should have the flu or go for a dental cleaning (etc.) that you always have to increase your TB a specific amount. (maybe 120%) ?
or, you are exercising and you need to shut off your basal entirely so that you have no IOB before you go for your workout. (this is something many of us are discussing on another thread.)
so many questions come up; i know that experimenting and experience and helpful guidance from other Ds is awesome. so i thought to myself: what do others do?
all experiences welcome and encouraged, no matter if you think what you have to say won’t matter, it will matter; so SHARE SHARE SHARE
thank you all in advance for your caring support !!! one D reaching out and helping another D
@daisymae Please do not increase your basal when you go to the dentist. One of the two worst things that can happen during a dental procedure is for the patient to go hypoglycemic.
The other is for the dentist to go hypoglycemic during a procedure
thx for your very appropriate advice !!! personally, i get very stressed when i go to the dentist and my BGs rise, but thats just me; i am certainly no doctor, and even if i were, i would follow YOUR suggestion/advice.
For me it usually is exercised based. And I will mostly look at the hours before doing a basal injection, and see how it looks, and use that for my decision.
Today I have been skimming along very low, so I already know tonight’s basal will be dropped. How much depends on how it looks right before and after dinner.
With MDI, adding basal is easy. But lowering it after you’ve already taken the basal shot is…impossible! So I will always tend on the lower side and add more later if needed.
I will let you in on my little secret. You may not think I am very smart after I tell you this, but my adjustments are not based on science or formulas or any fancy calculations. I have only one thing going for me - years of experience. So I make a change, and if it is bad, I know to do it differently next time.
@daisymae I know our goal is normalized Bg 100% of the time. But that is unrealistic.
In the dental setting, I know if you were going to have a procedure done by an oral surgeon, if your Bg is under 130 he won’t even start the procedure. The ideal Bg in that situation would be around 200, even though that high a Bg would throw you or me into apoplexy.
eric, i dont know how on earth you can comfortably function w/ bgs in the 70s. i feel much much better 80+ so long as i am around 120 or less. when i get into the 50s, i cant think straight. i become a complete ding-a-ling and am shakey and incapable of making any decisions. what is you secret? and btw, if you dont mind saying so, what is your A1c? it must be so low that perhaps you are not even a D (lol)
@daisymae What a coincidence! I just saw one of my T1 patients and am having him come back for a filling. He’s on a pump and I told him to lower his basal 20% for two hours before his appointment.
Ha Ha. i am about as far from being a doctor as my cat Oscar. but i know that i have had so many surgeries and procedures throughout my lifetime, that i am used to my endo instructing me to lower my basal to between 60% and 80% for a specific # of hours before and during my surgery.
the weird thing is that sometimes i dont even feel i am going low until around 50, then i test, and once i test, i begin to feel low. then i might have some chocolate, and my BGs climb back into range, but i still feel shakey, until i test again in another 1/2 hour or so, and once i see that i am now 98, i feel fine. but i know exactly what you mean by feeling the “drop” v. feeling steady. i just cant get over that you feel comfortable at such a low #. wow.
I was just wondering about how long people set their TB BEFORE they’re planning on setting out for any exhursion. for example, for myself, if i plan to go for a lomg walk, i need a lowered TB, but i dont know how long in advance i should start the TB setting. and, what difference is there between seeting a lowered TB v. a higher TB as far as the advanced time it will take for the TB to be in full action???
also, if i plan to travel outside, walk to the subway, get on the subway, get off the subway, walk to wherever i am going (maybe another 20 minutes), stay for 1 hour where i have arrived, and then plan on leaving 1 hour later, how long should i be setting my TB for?
yes, yes, i know YDMV and that we are all different, but what have been your experiences with setting a TB, both higher and lower…but particularly lower?
I aim for 2 hours. I find a basal change takes considerably longer to have an effect than a bolus. Sometimes it’ll take effect sooner or sometimes later, depending, but 2 hours is a safe choice for me.
I picked a couple of times when I was fairly flat, hadn’t recently eaten, had no IOB and wasn’t more than ordinarily active, then decreased (or increased) my basal by 25% or 50% and kept an eye on my Dexcom to see when my BG started going up (or down). That gave me my 2-hour ballpark for how far ahead I needed to change my basal.
do any of you find that your system returns to 100% basal faster when you turn OFF your lowered TB as opposed to when you are waiting the (appx) 2 hours for the lowered TB to kick in?
Depends on the level of activity I expect. Just local errands on foot, likely not. A hard-core bike ride, for sure. There’s no formula, just intuition. And hope.
