I donāt understand this statement. My basal rates donāt vary this much ābecause of hte pumpā they vary this much because of hormones. They varied this much when I was on Lantus, but I just couldnāt compensate for it so would spend weeks with my blood sugars running in the teens.
I do agree that basal and bolus adjustments can be clearer on MDI. I spent years on MDI, so Iām not unfamiliar with it, and I do sometimes miss the simplicity. On the other hand, things arenāt simple anymore once youāre up to taking 8+ shots a day and having to wake in the middle fo the night each night to dose insulin. The big question is, as some have stated, whether Tresiba will be able to take ācomplicatedā widely varying basal rates and insulin needs throughout the day/month and simplify control so that they arenāt issues anymore. Weāll see how that goes.
This is what I tend to see, but itās never entirely consistent from month to month:
Week #1, first half (start of period): massive reduction in basal rates and ratios needed, constant unrelenting lows that can last for hours on end even with dosing carbs.
Week #1-2: small increase in basals and ratios needed, but this is the āeasyā week when I can get nice flat linesā¦I think this is what diabetes is like for most people all the timeā¦
Week #2, latter half: moderate increase in basal rates and ratios needed, this week is inconsistent and tends to be a combination of highs and lows, as if hormones are fluctuating somewhat.
Week #3-4: massive increase in basal and ratios needed, and often these two weeks I struggle to stay in range even with these increases.
These are not divided strictly into weeks. Sometimes itās a week minus a day, sometimes a week plus two days. Sometimes my TDD changes by 100% throughout the month, sometimes my TDD only changes by 40%. And of course, this is all layered on top of other factors that impact my blood sugar, so my insulin needs could change more or less because of an illness or change in activity level or extra stress during that timeā¦
For me, hormones are by far the hardest part of diabetes management. Harder than carbohydrates, harder than exercise, harder than illness or stress or medications or weather or anything else.
Almost all of mine are exercise related, and can last for several days depending on what I am doing.
But outside of that, when I move from high to low carb for a few days I do a decrease in basal. That one might be worth noting - that changes in the amount of carbs might require a change in basal.
Thanks. This is something I hadnāt considered as a variable. My carb intake has been steady at the conference (I bought my own food, so have literally been eating the same thing each day), so Iām not sure thatās the reason in this case. Definitely will keep this in mind in future, though.
I just finished running a +100% basal for four hours plus correction with no change in my BG. This is after new site and insulin. I feel like Iām the only adult who deals with these insane swings sometimes!
Well I also have significant changes in basal, but they are generally not surprises. So maybe itās just a matter of connecting dots, and figuring out reasons?
Do any forms of birth control that change your cycles have an effect on your bg patterns ? Or have you looked into that? Might be a possibilityā¦ seems like OBs are prescribing the 3 week on/ one off types of regimens to be taken every day instead (forgoing the 1 week off) to eliminate the menstrual cycle for a variety of womenās issues these days, donāt know if it would apply in this case
Iām not sure. Iāve never tried. Ruth control because suppressing a natural process for years on end (which is what Iād need) weirdos me out, and my understanding is all birth control has risks of serious side effects if used long term.
I agree about factors. But there are a dozen or more factors I try to account for already. Then there are times like this, when Iāve literally been a robot for three days (same food, activity, weather, etc.) and still get totally unexpected chaos.
I donāt have one,so itād be my endo or GP. Iād be really squeamish taking something like birth control for the next 20 yearsā¦ Might help my BGs at times, but not sure thatās worth the increased risk of other conditions long-term use causes.
Plus, I donāt think all my problems are hormones, such as this latest issue. Iām pretty sure itās being caused by some other factor.
Obviously not my field of expertiseā¦ but I do know a ton of women are on them for that long and longer who donāt stand to reap and blood sugar control benefitsā¦ I donāt really like the idea of them eitherā¦ kept telling my wife they weird me out and she kept taking her concerns to obgyn docs about the concerns of long term side effects etc and theyāve just constantly assured her that any risks are minuscule and do not outweigh the benefits (even for someone who doesnāt have menses caused diabetes chaos)
If I were brand-new here and didnāt know anything about you, I would have to ask: Is it possible that one of your little basal chunks is wrong, and thereās a domino effect on all the others? (And it could be wrong but, with varying activity levels, carb intakes, hormones, you wouldnāt necessarily see a persistent pattern.) Letās say one basal segment is too high. So you go low, you correct or overcorrect, and now youāre high but the next basal is too low, etc. on down the line. Iāve run into this with my own adjustments a few times, and Iāve had to go back to square one and assess, remove or adjust each one all over again.
Iāve wondered about this, but whenever I do a fasting basal test I get a flatline. I donāt often change basal segments, only the total amount of basal up or down. But with my schedule being variable, itās possible that a basal segment becomes too high or too low for what Iām actually doing that day. Thatās where factors and adjusting for them comes inā¦ Bur Iāve read varying things about that, with some suggesting you should try to figure out and adjust for all factors and others suggesting the āwhyā doesnāt matter as long as youāre responding to changes as they happen
Good summary! Sometimes I do the former (such as consulting Eric on exercise) and other times the latter (such as waking up before the alarm and seeing that my BG is creeping up). Most of the time I feel like I am making it up as I go these days in contrast to believing (after diagnosis) that there were ārulesā to I was supposed to follow to make it all work.
I generally increase basal during the fall/winter and decrease during the spring/summer. Except for now, apparently, when Iāve had to drop it down. I donāt live Ina particularly cold climate, either.
Just an aside note - are you verifying your CGM numbers with BG tests often enough? Sometimes my CGM is super wonky. Maybe you should rule that out if you havenāt already.
Yeah, every six months or so Iāll spend a week fasting through all meals on different days. Most often Iāll flarline. If I donāt, Iāll fast through the same meal on another day. Sometimes the same pattern repeats, sometimes (more often) something different happens.
See above. Itās rare that I have a pattern of highs or lows at the same time on different days. My endocrinologists and I have rarely ever been able to find patterns like that in my BG. My suspicion is that there are patterns related to particular activities, but I have yet to find a good way of tracking that sort of thing. Also, my control is great compared to the average person with T1, so all this would seem to be nitpicking to my doctors.
