Basal Discussion Deep Dive for Everyone

My Dexcom graph in the post above does fly in the face of prevailing basal guidance.

All of the prevailing T1D guidance says that the correct basal rate keeps you level. If you take more, you’ll supposedly trend downward and keep going. If you take less, you’ll supposedly trend upward and keep going. It’s this idea of a specific, finite basal rate (that you must decipher) that probably keeps all diabetics from changing their rates as often as they might need to. Furthermore, additional basal insulin (during hormone induced insulin resistance for me) LEVELS me at a lower LEVEL. It does trend downward at first after I dial up more basal, but then it finds a new leveling point.

I think this detail might help a lot of people, particularly women. Is this unique to me? Maybe. I imagine this applies to a lot of people experiencing insulin resistance due to a variety of causes, though.

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Basal and bolus interaction…when I’m accidentally running too much basal, my bolus kicks in and can tank me fast. But the extra basal doesn’t seem to do anything on its own too impressive. Conversely, when I’m not running enough basal, I’m not climbing or anything…but my bolus can’t do anything without more and more and more being taken. This is the gray area that I spend all of my time managing bc prebolus rules for one day can lead to drastically different results the very next day.

Input is welcome.

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So is it fair to say that taking too little basal is worse than taking too much basal?

If I know I am managing a situation of too much basal, it can work out okay sometimes. But it can turn ugly on me faster than too little basal…as far as acute ugliness…which I’m pretty adverse to. But these margins in straight units of insulin astound me.

Insulin resistance due to hormones (most likely) is at it again: near ovulation (day 14).

Top graph is last night’s overnight timeframe. Bottom graph is the last 24 hours (yesterday and overnight). I had to use +20% to get through breakfast yesterday, but got through the rest of the day with +0% and pretty decent balancing with peaks and dips care of boluses the rest of the day. I would have liked the average BG to be lower, but in dealing with hormone induced insulin resistance this is a pretty good balancing act. No tanking lows. No stuck highs. BG movement throughout the day is what I’m going for. I was able to eat 2100 calories which was no small feat.

Snack bolus at 7:15PM of 4 units. Ate a snack at 8PM. Mini correction of 0.5 units at 9:15PM. Going into bedtime, I used +15% basal because I had noticed increased resistance through the evening. I haven’t gone above +10% temp basal overnight in a long time because it almost always results in a persistent low.Then here are the overnight actions:

Using +15% basal overnight
11:20PM: 1.35 correction
3:20AM: 1.8 correction
6:40AM: 1.5 correction
6:40AM: Turned up temp basal from +15% to +20%
7:10AM: Turned up temp basal from +20% to +25% when I woke up for the day

Clearly I didn’t have enough basal overnight. The correction boluses would eventually chip away at the high bg, then the insufficient basal would win and I would drift back up to 200+. This is the information that is always changing on me. This is why it is hard for me to eat enough each day because I’m trying to pin down what the basal needs are while eating enough but not tanking and not spiking above 220 if at all possible. I am pleased with how well I kept the full day in balance without getting into a rebounding rollercoaster situation, which is super easy to do in this set of circumstances.

I went ahead and pulled the pod 8 hours early even though the cannula looked fine in the viewing window. Blood all the way up the cannula. So chicken and the egg problem for me…did the site wear out from the number of correction boluses the last two days from hormones? Or did the blood prone site just intensify the problem?

Don’t know. Hoping for better luck on the new pod today. My percentages for extra basal are close enough to what I would expect to see that I think both hormones and blood in the cannula contributed to what I was seeing last night. Always managing the gray area.

And after this post I saw a six inch long run of blood coming down my arm. Awesome.

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@Eric, I used +10% basal today and have ridden the wave. It’s been enough to drive me slowly down but not so much to get in my head and stress me out about surprise tankings. It has helped me eat like a bit of a jackass today. Not a total jackass, but enough of a jackass to make me happy and help my calorie count for the day while being pretty active. Thanks!

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Awesome!

I know it’s not the commonly held practice, but basal really supports the meals a lot. Just a little bit goes a long way.

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How frequently do you employ this tactic? Under what scenarios? Just curious.

I struggle w finding the balance of just enough extra without throwing myself into overtreating and bouncing.

It would actually be easier to say when I don’t do it. Because I always do it except under a few circumstances like these:

  • Away from home - lack of access to my own refrigerator and pantry totally screws up the tactic.
  • Any travel situation, driving or flying.
  • Working in an office, which I don’t usually need to do.
  • Something like a dentist appointment where I can’t stop and eat.
  • Any time I am needing full concentration and can’t take a break for eating or can’t afford the mental lapse a low might bring,
  • Any time when I am trying to cut weight and the extra eating will screw me up.

Other than that, I will do it.

It is generally not any kind of crashing low, or anything that needs a lot. Just a handful of peanuts, or a few potato chips or bite of cookie, or something small like that.

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Does it change your prebolus timing for meals?

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Yes. Like down to zero.
:grinning:

I mean really, if I am dropping before a meal, I don’t need any pre-b time. So an hour or two before the meal, if I can hold off on any correction snacks, I can hit that bolus button and start eating right away.

The only exception is for super sweet things. I still pre-b for that.

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Thank you. That’s super helpful. I’ve been struggling with figuring out that part. Will give it a whirl!

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Here it is again… Sorry to pick out something not core to the thread, but I’ve been looking for this explanation.

Which would probably be you, Eric… But maybe tomorrow. So you can go rest your weary brain. :smiley:

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By the way, @T1Allison, excellent thread. Printing and reading. :smiley:

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There are a lot of things in this thread that can anwser your question.

What is the difference between taking 0.5 units when you are flat at 100, and flat at 300? If you are at 100, maybe 1/2 a unit drops you. But if you are at 300, it might not even make a dent.

Look at the part about GSK3 phosphorylating glycogen synthase. That is your medical answer.

Think about how a small amount of water puts out a single match (before the fire has grown) versus how much it takes to put out the big forest fire. That is your analogy.

But it is so easy to see from personal experience.

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@T1Allison

Trying to put together some thoughts on this topic. Why does insulin work so much better when you have a background of basal insulin?

I have touched on this before, but here are some continued general thoughts on the subject. I have not worked this out into a coherent post, but wanted to put them down so I don’t forget the thoughts I had.

Walk through the thoughts and see if they make sense. It helps me to go slowly though the concepts and get my mind wrapped around it.

When insulin is absent, your body interprets that as not eating. Since for the non-D, eating means insulin will appear, this makes sense. No insulin means there must not be any food. And if there is no food, the body does not want to store glucose. Instead it wants to use glucose that is available in the blood. Not storing it, but instead using it!

When there is insulin present in your body, your body senses that it is in a “fed state”. Because insulin is release when you eat, your body determines that insulin being present means food is also present, so you must be in a “fed state”.

When in a “fed state” your body will try to store some of that for later - “I have food now, so I need to bank some of that food for later”. The process that happens when you are in a “fed state” is called glycogenesis - the conversion of glucose into stored glycogen.

So when insulin is present, your body is adept at storing glucose. Storing glucose means that glucose goes from your blood into the storage form in your skeletal muscle and liver.

A strong basal - to your body - means “I have insulin, so that means I must have food. Since I have food now, I can store it…”

The difference then - when you have a strong basal running - is that your body is going to take available glucose in your blood and tuck it away into storage. That makes the glucose in your blood more likely to be removed faster and more efficiently. So the stuff you eat will be more likely to be stored than remain available for use.

Sorry, this is just a rambling post. Let’s explore this at some time and see if we can make it coherent.

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If this is your version of an incoherent post, @Eric, then what do the rest of us sound like?

That all makes perfect sense. I appreciate your explanation. I had not thought about it like that before.

I’m assuming that my body needing more insulin when I’m sedentary at work is not necessarily a function of fed vs non-fed state as much as it is an efficiency problem? Although in saying that now…I know my basal rates are accurate in a non-fed state…so I’ll need to keep rolling that one around. The delta between how much extra basal I need in a “fed” state on sedentary work days compared to active weekends is noticeable…so maybe it’s both (fed state vs non-fed state, plus efficiency of my body). Will keep thinking on this…

Thanks for posting.

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Don’t think of a fed-state in terms of eating.

In the non-D:
eating = insulin = “fed state”

For us, it is different. Having sufficient insulin makes the body think it is in a fed state, and the resulting storage that takes place.

We can make our body think we are in a fed state, regardless of whether we are eating or not eating. Simply by taking insulin.

In the non-D, food always means insulin! And insulin always means food. The two are always together.

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I am late to the party and just reading through this thread. The discussion has given me a lot to think about in terms of some recent episodes of dawn phenomenon. :+1:t3:

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