Basal adjustment- MDI with CGM

Hi guys.

This switching my basal after about 10 years has me thinking: how does one properly adjust basal dosage? I’m using MDI with CGM. It seems there was a wiki topic or two on that subject here?

I’m guessing I’d just watch the CGM slope during fasting periods, but curious if there’s more to it than that.

You’ve got it right.

I’m a pumper, so during a basal test (typically a skipped meal), if my BG is rising all by itself for no reason, I’d slightly increase the basal starting 2 hours before the rise. And keep increasing it every couple days until it stays flat instead of rising. Actually, I generally keep increasing until it starts to fall a bit, and then back off to get it level. And I consider other explanations for a rise or fall, such as stress, to temper my decision about whether to change the basal.

For MDI, it would be a matter of increasing basal to try to control the rise, without causing lows during some other time of day. When I was on MDI with Lantus, I actually tuned the basal to limit the rise overnight, but this led to a mild downward trend during the day that I’d control by “feeding the basal.”

After 8 years, when I was no longer able to get a flat enough line with MDI, I started pumping and eventually ended up with basal rates ranging from 0.15 in mid day to 0.85 during portions of the night.