lately i have been having real problems keeping my BGs in my target range. two times during a 24 hour period; about 2.5 hours after dinner i have started to trend up, and then by bedtime i have been having to do a correction bolus before going to bed. then at around 2am, i find my BG even higher than before i did my last correction, and i have to correct again. i wake up in perfect target range, but am very confused as to why my insulin needs have changed, and why they have changed so dramatically during these particular hours.
how often do you tweak your basal rates? any suggestions?
I would say we often tweak something once every few weeks. But when we’re lazy we may go months without making a change. That means tolerating a lot of stuff with daily corrections.
This description sounds very much like a IC / meal bolus issue, instead of basal.
If you skip dinner or have a low carb dinner and you don’t rise, that would be another indication of a bolus / IC issue.
You can attack it with increased basal at the time leading up to it, but I think a bolus a few hours after the meal, or an extended bolus could also fix it. And maybe would be easier to manage.
How soon do you spot it? If you see the rise on your Dexcom or from a BG test an hour after your meal, you can stop it much easier than waiting for 2.5 hours.
Try the different fixes (basal, extended bolus, or extra bolus) and see which works best for you. If it is not 100% repeatable every single time after every single dinner, I think the extra bolus makes the most sense!
We don’t tweak until his BG’s dictate that we tweak. If we have a rate set and he’s still high while fasting, we tweak up and test it. If we have a rate set and he’s going low while fasting, we tweak down and test it.
The key for us is that we have to see patterns. His body is going to be wacky on some days and we can’t do anything about the hormone spikes and all that…what we can, and do, focus on, are trends/patterns. So, we watch with a keen eye for patterns and if/when we see them, we tweak as necessary and test. Then rinse and repeat until we get the “new formula” verified.
this is exactly why i started this thread. i have noticed a brand new pattern that i have never seen before. so what i began to do was to eat exactly the same dinner each night at the same time for 4 nights in a row, after spending my days swimming as usual. so no changes other than the regular D things.
i have been consulting with eric about this b/c it has truly blind sighted me. first i thought it was an ICR problem, then i thought it was a basal problem. so i have been experimenting with both, but have ended up with no solution (yet ) other than doing correction boluses to contain my spikes. my only area that needs correcting is around bedtime and the first wee hours of the overnight. i know that i will eventually figure it out, but i am frustrated beyond and then some.
I only change the basal rate when I get tired of doing corrections (either insulin or food). Usually only do it every couple of months and usually the times remain the same. Usually everything changes by a fixed percent. (like all the numbers get cut to 80% etc.)
This week I am seeing a persistent high after lunch. After units of corrections I can get it down. Here is today’s example. My lunch IC ratio is already stupid (1unit :5 carbs) so I really do not want to change it.
But… I am just too lazy to do a basal test. I am hungry at lunch time
ARGH!!! - So maybe tomorrow I will do a basal test and see if it is a basal problem or an ICR problem.
@daisymae, I experience this same exact thing!! Bg starts to go up 2 or more hours later. It is consistent for me because I eat similar food each night.
I’m pretty sure in my case, the issue is bolus related, as @Eric suggested, because during a multi day fast, I did not experience the high.
I’ve tried all three methods mentioned by @Eric. I trippled by basal 6-9 pm. That works BUT occasionally I do not get the upward trend, then the low is long and severe.
I’ve also tried multiple boluses during these hours. Usually one or two boluses prevent the high, but this requires constant monitoring of Decxcom and or fingersticks, and sometimes I miss the rise.
I’m now trying extended bolus. This is useful because I can always cancel the extended bolus if I start to go lower. So far, it is working pretty well but it takes a lot of tweaking. At least with extended, I can mostly prevent the lows caused by triple basals. And it requires less constant monitoring and timing than multiple bolused. I found that I still may need a separate bolus though.
As to why this upward trend occurs, I’m not really sure. Someone said it could be the protein in the meal. I do usually have a small amount of fish, and cheese, so maybe it is the protein.
A thing worth mentioning:. Meal digestion can extend beyond two or three hours, especially if a lot of protein and or fat is consumed. Can take longer still if gastroparesis is present, which results in delayed stomach emptying.
