Hey Chris,
I’m not following what you mean. Are you saying get a script for like Lantus or something similar? I have a meeting with my trainer in about 30 minutes. I’m also noticing a trend of dropping really low around 2-3am when I’m sleeping. Probably going to have to set up a different basal rate during the midnight to 4am slot.
Yes, that’s an excellent observation. Midnight or 12:30 is a good time to reduce the basal. I don’t know whether 4am is the right time for the next basal change, you’ll have to see what happens when you are no longer going too low at 2am. Whatever time your BG routinely drifts out of range in a similar way each day, make a compensating basal change 2 hours or 1.5 hours before then. I generally wouldn’t try to change an entire basal schedule at once, I usually fix one trouble spot at a time, then move on to the next.
PS, it’s rude of me to speak for Chris, but yes, he was suggesting to inject some long-acting basal insulin to cover a portion of your basal requirement, so the insulin supply in the pump lasts longer. Lantus is a traditional choice. Levimir is useful if you have vastly different day and night basal rates, because the Levimir only lasts about a half day, so you can take a different amount for the morning and night. Tresiba is a really long-acting basal (like 42 hours) that some people really like because for them it tends to smooth out their basal requirement. Consult your physician on this? And check your insurance formulary.
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Yes, I am saying if you get Lantus or whatever your preferred basal insulin is, you can inject enough to cover 75% of your basal needs each day, and then set the pump up to provide the remaining 25%. We do this for my son so he can disconnect for long periods of time for baseball games, it works really well as long as he remember to inject it. In your case you would be doing it to make the pods last longer, but the exercise benefit would be there as well.
@bkh Not rude to speak for me at all. I enjoy when people add to the discussion because I don’t always articulate myself well enough in posts.
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Others can speak to this better than me, but have you discussed adding metformin to your regimen. Why more commonly a T2 med, I believe some T1’s with a lot of insulin resistance find it help in reducing the amount of required insulin. Something to consider chatting with your doc about.
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I’m a little different in that I use my OmniPod for basal only and inject meal time and correction doses.
I have several different basal settings and I’m noticing that @egreen76 is finding their basal isn’t a flat profile but is changing around 2:00 am. There are possibly other times when you could adjust your dose from 4.4 units to something else to help flatten out your profile.
A CGM, your doctor, and/or basal testing can help with this:
Here’s hoping you get it all worked out with your trainer and if not, with your endo when you get there. It does take time to make all of the necessary adjustments, so don’t be too hard on yourself. You’ll get there!
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@Jim26 I take 1000mg of Metformin with my night meds around 8pm. I’ve been taking it all along even before going back on the pump when I was doing MDI. Great idea though! 
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@Tapestry Thank you! So my changes today consisted of decreasing basal insulin to 3.75 from midnight to 4am. We’re going to see how that does. And I’m not going to eat a midnight snack so I won’t have to bolus and see if that changes anything during my sleeping hours. We also increased my basal from 4am - Midnight to 4.8. While it was a little lower today on that 4.8 I still was not in range. So I’ll be bumping up to 5.2 for in the morning through the day tomorrow. It still comes out to 120u/day just on basal. My Dr. called in an adjustment to my Fiasp to up to 250/daily just to be on the safe side with me still having to adjust my basal. I’m going to give it a week of adjusting to see what happens and what other trends I see happening. I know I start going low around dinner time - I did today and had to drink a full fledged Mtn Dew to get me back up above 100 so I could drive home and have dinner.
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Yes, that’s important to reveal what the basal rate itself is doing all by itself. It’s best if there was no food or bolus/correction insulin during the 6 hours (or at least 5) prior to the basal test.
So either this is excess bolus left over from lunch, or it is too much basal at this time of day. The test is to skip lunch (or eat lunch a couple hours earlier) and see if the drop still happens around the same time as before. In that case, I’d make a new basal rate, slightly lower, that starts about 2 hours before the drop. And adjust from there.
The ability to have different basal rates at different times of day is a principal benefit of pumping instead of MDI, so I wouldn’t be concerned about going from 2 basal periods (one from midnight to 4am and one for the rest of the day) to a few more. Your body decides how much insulin you need, you get to observe how much that is and set the pump to do it.
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@egreen76 It really does take time to get your basal dosing right. And, no sooner do you think you have it right, something is bound to come up to change that.
Changes in seasons can have an effect on blood sugar, as can stress, sleep, hormones, hydration, medication, exercise/activity, … and so on … it can be so much more than just how many carbs you consume.
I say can be because we’re all different and what works for me or effects me and how, may be the total opposite for another person.
You’re doing great! Keep up the stellar effort! It will pay off!
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@bkh So I tried the no midnight snack and still ended up going low on 3.75u. Tonight I’m going to try not taking my Metformin, a decreased carb (P2 snack), and small amount of insulin to cover it.
My numbers looked pretty good today on 5.2u/hr. I’m going to keep running that for a bit and see how it does. I slept a lot today so there wasn’t a lot of eating going on. When I did get up and start moving around I spiked - don’t know if that was FOTF or not. I’ll keep a watch on it.
You all have been great at helping me with this. Your input and encouragement is SO helpful to me as I work through this! I just want you to know how much I appreciate it!
Emily
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@Tapestry - Thank you for the encouragement. I’m trying to find my way. I put my book down that I really should be reading…called Sugar Surfing, but I’ll pick it up again soon. It would be a lot easier of my husband could get into it too, because then we could read together. But he’s a type 2 controlled on pills, so he doesn’t totally get it for insulin and pumps. Truly I hope he never has to! I wish I could be controlled on pills too, but that is not in my future. It’s already been tried before I was diagnosed 1.5. I’m finally looking forward to seeing my new Endo in about a month. Maybe she’ll have more insight into preserving the Pod for more than a day. Until then, I’d rather change out a pod a day than to be tied to tubes.
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If that happened to me, I’d try lowering the basal again, bit by bit, until I found the dose that neither drives me low nor makes me go up. Dropping metformin, adding a snack, and adding insulin to me introduces 3 additional factors that make it harder to find the right amount of insulin. If you normally take metformin, I’d stick with it unless your medical staff suggests that you stop. Just keep reducing the insulin dose until you find the amount that doesn’t make you go low.
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I think this is very sound advice, i.e. only change one variable at a time. Too many variables usually means we get frustrated before finding a solution.
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While Sugar Surfing has great suggestions in it, one of the tenants of the technique is that your basal rate(s) must be set so that they keep your blood sugar flat when not eating. So, I wouldn’t worry too much about trying sugar surfing techniques until you have the basics (basal rates and carbohydrate and correction ratios) well set.
I believe they do make U-200 Humalog (twice as strong as regular Humalog). That might be an option to ask about.
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