For the last several months now, Samson’s blood sugar has been much more erratic. He’s been having lots of highs and lots of lows – often the highs are at very consistent times of day, so that makes me think they’re fixable. The trouble is I’ve been trying to fix his settings because I know for sure they’re wrong. But the problem is I get contradictory results base on basal testing versus other patterns.
The standard advice, in everything from John Walsh’s Pumping Insulin to the Looped group, is to check basal settings with a fasting BG when all the bolus insulin is out of your system. Luckily, since Samson is a picky eater who gets very involved with his toys, he often isn’t ready to eat “on time”, and we have a few hours here or there where we’ve been able to do basal testing without him even realizing we’re doing this test. Plus, one day last week he was so tired he just came home at 4:30, fell asleep and slept all the way till 6am the next day. So we got a good long stretch from about 9pm to 5am where he had no bolus insulin in his system, his settings were just left alone, and I had to give him low treatments throughout the night. I eventually even gave him a 0 temp basal for a few hours to get him up.
So when I do the fasting basal testing, I am seeing several drops in blood sugar, as if the basal is too high. BUT, on a day to day basis he usually runs high for several hours (11am to about 4pm, then again from about 7pm or 8pm to midnight), and often crashes low several hours later, which suggests an overly strong mealtime bolus to compensate for insufficient basal. When I run autotune, it suggests my ISF is too strong and my basal is too weak – essentially recommending the opposite of what the basal test is recommending.
My ISF is probably too strong because I see a lot of those hills and valleys where Loop is mandating a high temp basal very quickly, and then it shuts off abruptly as the blood sugar begins to nosedive. Given that we’re also spending a lot of time high, that would suggest the basal is too low. This is the direction my endo is also leaning.
But, i guess I’m wondering if all this confusion is because food somehow takes a lot longer to be digested for Samson, or at least that it affects his blood sugar a lot longer than all the absorption models assume.
I’m feeling a little paralyzed and not sure which way to go next. Samson is starting a new school next year and I want to have his settings dialed in and reasonably close to ideal by September. I’m just not sure what to change first. We have about 10 weeks to get things dialed in.