So my son had been having some pretty wild variations lately, which we had attributed to hormone swings, and undoubtedly some of them were. However we also had a “happy” accident. It is baseball season and we had switched to giving 50% of his basal from a Lantus shot because he needs to be disconnected from his pump for 3+ hours a day, and doesn’t have much time to manage his D during games. Well my son forgot to turn his program to the one that delivers half of his basal, so we essentially added 10 units a day (0.41 units per hour) to his basal settings and surprisingly everything calmed down. Yes it is a little too much basal, i.e. he keeps waking up at 70 because his pump now shuts off his basal when he is going low at night and we need to tweak that, but it is now clear he needed more basal than we were giving.
With the additional basal his weekly Coefficient of variation dropped from 42 to 31 and his standard deviation dropped by almost 25 points.
I was just talking to a friend about this today after she saw a pretty crazy (fast) response to breakfast. She’s still figuring out her basal dose and timing, and I suggested she may have had insufficient basal on board, which then caused an “ah-ha” moment for her.
Prior to starting basal insulin myself, I was seeing gradually quicker and steeper spikes (and some random rises with no food eaten). It was pretty unpredictable.
Many people don’t realize the impact that basals have on your BG. If my basal is 1.0 for 4 hours and it should have been 1.5, my BG will rise 140 points. Same as forgetting to take a 2.0 bolus. Although basals may be correct they should be checked occasionally as the requirement may change.