Ended up putting my basal rates up by 0.1 units an hour yesterday (about 5%). I had no lows yesterday and still had an overnight rise last night from 5.0 mmol/L to 8.4 mmol/L (90 to 151 mg/dl). So I’ll likely put my basal rates up by another 0.1 units an hour today.
Doesn’t seem like much when talking in pump terms, but a 0.1 unit an hour increase over the entire day is about a 2.5 unit increase in total basal. So, if the changes I make today are correct, this will be a 5 unit increase in basal (a 13.5% increase).
It’ll be interesting to confirm whether some of the things I’ve been speculating about are true, and if they are, I will document them here. So far, the past two cycles my basals have increased by 45-50%, so that is a good starting point. In addition to confirming the “typical” rise for me, I’m going to try to break down at approximately what point in my cycle I need to increase or decrease my basal rates.
Fitbit’s ability to track days and have this predictive inforamtion available on phone or watch at a glance has helped enormously in this endeavour.
I’m trying to right the ship after the perfect storm this morning.
Started on low hormone days. Was using -10% overnight. Then at some point my pump got blood in the site and I drifted up to 200. I switched the pod this morning, took a correction dose, ran a +25% basal like I usually do to get the site up and running. Then I tanked as I was going into my quarterly endo appointment. A couple of juice boxes and lots of confirming fingersticks later it got more manageable. The juice boxes really should have shot me through the roof but they didn’t. Only thing I can think of is that getting a good pod going and starting +25% when I’m in my -10% timeframe was just too much stress on the system.
Trying to dampen the swings and dial in again now during lunch…and trying not to over-anticipate and overreact to anything on my Dexcom in the meantime. Once I get bitten, it’s hard not to overdo my responses (mostly over-treating anticipated lows).
And here’s where the great inconsistency comes in and the reason I can’t just automatically make changes based on a certain date or change to a pre-set basal profile that increases a certain percentage…
This month, so far (one week left), I’ve had zero change in basals except for the 5% increase I did about two weeks ago. Otherwise, nothing. Blood sugar is flat overnight as long as I have a fresh infusion set and don’t let my pump run out of insulin.
Previous several months have seen a 40-50% increase in basals over the second half of the cycle.
So I am in peak hormone days. I have a couple of things going on right now that might show the elasticity of insulin needs.
I’m being more aggressive with highs in general now, and am slowly getting my average bg lowered overall (2 steps forward, 1.5 steps backward on that front).
I’m typically starting my day at a better bg these days due to changing some of my overnight Dexcom alarm settings to be tighter…and I wake up and test and dose as needed. Starting the day lower means better insulin action for my breakfast, so far as I can tell.
I’m tinkering with the basal/bolus relationship for meals and snacks. I use a higher temp extra basal during “eating hours”. The extra basal helps my bolus actually do its job.
I’m tinkering with temp basals for hormones and sedentariness at the same time. I.E. As reported previously, all of my insulin is received better by my body when I’m active (at home on nights and weekends, basically…just anytime I’m not at work at my desk, in other words). When I’m active, I need less extra basal (and bolus) to combat hormone-induced insulin resistance. When I’m sedentary, I need more insulin to combat just the sedentariness…but also even more for the effect from the hormones. So my temp extra basal settings on a work day look like:
12A-9A: +10%
9A-2P: +15% (after I finish the morning mad dash and get settled at my desk, my insulin effectiveness starts to fade so I ramp it up some to help with eating lunch and getting through the work day)
2P-12A: +10% (I try to reduce my basal a few hours before the work day ends so that I don’t tank with extra basal in my system once I get active again)
This is not a perfect system, but this is where my tinkering has lead me for the time being. I am getting better results than I used to…better meal management, more quantity of food eaten, fewer lows. It’s a process.
I’ll be interested to hear how lowering the average bg is going. I’m also curious to know if you’re targeting standard deviation at the same time as average bg. Last 2 weeks mine has been 40, but it was around 30 for a couple weeks awhile back. Inevitably it creeps up a bit. I aim for 30-35, but this is a challenge for me.
My goal SD is in 30’s but I’m always right around 40. I have hit the 30’s a few times lately. But yup, definitely trying to increase calories, decrease ave bg and decrease SD all at same time. It’s getting there. But seeing some of the T1D pediatric deaths from lows lately on other groups still keeps my ideal bg range (since I am often the sole adult around) higher than other FUDders. I’m fine w that for this period of life. I’m still working to get down to even that goal…but it’s getting there.
That’s really sad. I haven’t heard about these. I’m sure it’s really hard to target lower levels safely on a child. Especially if you don’t have a cgm.
I’ve decided to go off the NuvaRing. I posted a few days ago about how I’d gained some weight. I don’t think the weight is a direct result of birth control, but I’ve noticed that I do experience more insulin resistance while I’m using it. Not sure on the exact correlation between weight gain and insulin resistance, but I think there is one?
If only we could switch places! You can take my few extra pounds
There’s a lot of misinformation on the issue of birth control and weight gain, so it’s hard to say if it’ll help. Birth control/pregnancy are not a concern/possibility in my current relationship, so it’s the perfect time to explore how my bg levels are different without it.
I had a much easier time keeping weight on either (1) when I was on Lantus bc I had lows to feed throughout the day and (2) when I used to drink low carb wine bc it has a decent calorie count and it helped my bg the next morning so I could eat more while stable.
But I’m not doing either of those things now so I have to figure out this whole balance thing another way. And I didn’t plan either of those things…just observed the side effect.
I’d be curious about Nuvaring and weight. I hadn’t ever explored that…at least it’s not coming to mind so I’ll be curious on that front too. Good luck with everything!!
I see this very frequently. I also saw it throughout a supremely relaxing month-long holiday in the Tuscan hills, so for me it is definitely not stress related. @Katers87’s theory about “digestion overdrive” sounds like it’s headed in the right direction, but I haven’t looked into the science behind it. Isn’t digestion meant to slow down while we’re sleeping?
Sorry to intrude on a females’ thread, but this rise is obviously not gender related. Unless there’s something about me I don’t know.
Everyone is always welcome on this thread. I love that there is a wide audience and participation. Some of these things probably apply to everyone in some capacity.
My first pilot’s license (student certificate) said I was Male. So maybe I have some things to figure out, too!
My fall asleep spikes are still happening a significant percentage of nights. I am sort of happy to hear others see this, too. Maybe we can figure it out.
Insulin resistance definitely fuels weight gain, since insulin is a growth hormone and if you require more of it to achieve blood sugar control, you will likely start to store more fat, especially around your middle. It’s why you’ll sometimes see T2s complain that X insulin caused weight gain, but then discover that they were switched from metformin to Lantus or something, so that they stopped treating their insulin resistance at all and are now just feeding it with insulin instead. Of course that causes weight gain! Not the insulin’s fault…
Anyway, I lost about 12 lbs pretty easily when I stopped hormonal bc after taking it for about 15 yrs. It definitely seemed like my appetite was lower during my week when I wasn’t on the hormone pill, so seeing it if it was messing with my appetite and metabolism was a big part of my motivation to go off of it. It’s one of a few reasons I’m hesitant now to try hormonal bc again.
Now that I’m naturally cycling, I do see a dramatic effect of hormones on my appetite, that I think also co-occurs with insulin resistance changes, all premenstrually (there’s about a day and a half when I’m a black hole of hunger). My cycle researcher friend tells me that appetite effect is common.
mine Is definitely food related. If I eat high fat foods, I’ll truck along at 100 or so with the insulin covering the slow digestion fine, and then I get this big spike when I fall asleep.
I’ll look up the info I came across when I reached this conclusion, and I’ll probably post it tomorrow. On my way to a wine and oyster festival now
Also, I’d love to get tips on Tuscany! I’m hoping to plan a trip to Italy next year.
That was my initial thinking, because it makes total sense for a high-fat or high-protein meal, and it’s absolutely what I’d expect after a big pork roast dinner or pasta with a cream sauce or a couple of grilled cheese sandwiches. But there were times when I was on holiday I’d have a small, simple dinner of some grilled veg, a glass of wine, a piece of fruit. I would have expected a gently-rolling-hill CGM trace, but I got the fall-asleep Alps instead. Didn’t/doesn’t make any sense.
I had a typo before—I had been taking it for 15 years when I went off it and lost that weight. So I think it depends on how long you’ve been on it re: what kind of effect you might see. I suspect I gained at least the weight I lost, maybe more, when I first went on it, but it was a time when I was doing tons of things that may have influenced that (also I was a teenager), so impossible to say.
I see this every.single.night with Samson. It was chalked up to growth-hormones by the endo BUT I don’t think that’s it. I think it’s delayed digestion for the remainder of his meal, because if he doesn’t eat dinner (ie. he goes on “strike” and rejects what’s for dinner) he doesn’t have hardly any spike at all.
I see an overnight spike with pasta or rice (which i usually eat with some sort of protein), but not with other meals. So I attribute it to delayed digestion of a higher-carb meal…
