EDIT: Re-read the previous post from bkh and realized I was talking about the second drop so had to re-word my response. Other my response didn’t make sense. Sorry.
Looking at the second drop starting around 4:30 AM and playing detective and going by the slope of the line around 11PM vs the slope of the line from about 4:30 AM to 9:00 AM, it looks to me like possibly a basal setting programmed around 3AM.
Or an extended bolus that was manually given around 3AM.
(I would have guess the pump given automated basal but Nicky already said she does not run this in auto mode. So assuming that is still the case.)
So Nicky. If you are still in the mood to be interrogated.
What are your various basal settings? Time and amount.
I AM in the mood to be interrogated, but I’m going to have to come back after I do a little exercise. @bkh I will return to answer questions. My blood sugar is in the rise now so I need to put this…down…
I had eaten a banana and something else to give myself a little bump for some exercise. Then I never got to do my exercise. I gave a bolus and got up and moved a little bit to give the insulin a push. I can create a pretty fast drop like that.
So yesterday I decided to clear away my alert for dropping. It was a big help. Because there was less chiming than usual, I noticed it when it did chime. I’m afraid a low alert at 80 will put me back at all chime all the time… I also have to be very careful treating preemptively as high as 80. I can turn and go really quickly. I actually have been doing a much better job holding a more steady line, but exercise always mixes that up for me. @Eric had me working on my numbers for a run, and I was having some pretty good success, but I have no idea how to handle a spontaneous workout… or the consequences if I didn’t get to do it.
@Thomas, this answer is for you, too. That slow drop is what most of my nights look like. They often land at 40. There was no correction during any point over night. No extended boluses. Trust me.
I see Thomas has made the same suggestion. My endo just had me pull back on my 4-8 am rate, but I could try starting it earlier. I have yet to see whether or not that lower rate has messed up my mornings. Too many things to keep an eye on.
That orange-ish colored block on the graph is the suspend. I let it go for the full 2 hours. I didn’t eat anything last night, so I figured I would let it run me a little high if it wanted… since the recommendation was to focus on the hypos. I did start to rise around 3:30 (suspended between 12:30 and 2:30–so makes sense), and although it only showed a 150, I was likely closer to 200. I would like to not hit that in the middle of the night, but I also understand that starting at that 200 is how that 4:30 am gentle slope DIDN’T end at 40.
I wanted to answer the questions you guys put before me, but I do not mean this to be pressure to solve my problems. I appreciate what you guys have done already— it really has gotten me thinking about it from a different angle.
Unclear. Were these the values when the graph was taken or were the values changed after the graph and these are modified values since?
For starters, I would change the 4-8 AM to 0.8.
In general, I am very suspicious of the basal settings. The hours are too “exact”.
When we make basal changes, they are specifically due to patterns we see in the cgm. These have an artificial look to them. They look like what might come from a Doctor. Hopefully you don’t take that the wrong way.
Which point [on the graph] do you feel you are running high?
EDIT: Got it.
I did start to rise around 3:30 (suspended between 12:30 and 2:30–so makes sense), and although it only showed a 150, I was likely closer to 200.
The accuracy and trust you have on the cgm is potentially a subject in and of itself. I have heard good things about the cgm that comes with the 670g. And horrible things about the earlier generations of Medtronic sensors.
I am hurt. And now that I know how you feel, I’m not going to tell you that ALL of my settings come from a Doctor.
They do. That part wasn’t a joke. Occasionally I mess with something here or there, but in general I just deal with the resulting numbers. I was diagnosed with diabetes right before being diagnosed with melanoma and having my son diagnosed with autism. And, believe it or not, things really didn’t let up for many, many years. It’s why I have to laugh at how little I know… I’m 15 years into the disease and have spent only the last one learning what to do about it.
Who’s defensive? You didn’t ask for any of that, but I can’t answer a question like that without some explanation.
But I’m here now. And I’m going to give the 4-8 recommendation a shot at .8.
That was unclear. Those were my values before the graph was taken. I changed them last week. Unnecessary comment on my part.
I’ve got a wicked case of “lag” with my sensor. It’s faster on the drops, but it still catches stuff late. It’s the sweeper. I have usually treated, tested, corrected, cleaned up and carried on by the time I get suspended, which means I spend my days clearing inappropriate suspends. It’s why auto mode was tough… you can’t clear anything. With my lag, EVERYTHiNg was inappropriate.
That’s two separate issues. Too many alerts has been a real problem, so I understand your concern there. Maybe only at night for now? But if you don’t have an alert at 80, I don’t see how can you prevent going below 65. That was my reason.
As far as treating a fast drop at 80, you need to find a small enough treatment to arrest the fall without causing a big bounce. The amount of glucose depends on your body, but there has to be an amount small enough that it stops the fall without driving you way high again. Half a glucose tab? One tab? Two? Since you’re concerned with too much bounce, start at the small dose and if it wasn’t enough try a slightly larger dose the next time. The key is a small exact dose of glucose, so it doesn’t turn into an eat-the-pantry treatment. Because that’s guaranteed to give you that dreaded rebound.
Ok, so you’re gradually reducing the ovenight basal, and eventually it’ll get it dialed in.
If 1.2 is too much, try 1.175, then 1.15, then 1.125, until you get to the point where it’s starting to rise rather than being a slow fall or level. Then increase one step so it doesn’t rise. I see that Thomas has suggested a huge adjustment, from 1.2 down to 0.8, but I’m not that bold and in my body that adjustment would be way way too big. I tend to make small adjustments day by day so I can understand the cause and effect as I see how it goes from “pummeting” to “falling” to “drifting downward” to “more or less level” without getting myself knocked around by any big drama.
Thomas said “In general, I am very suspicious of the basal settings. The hours are too “exact”.” I agree with him on that. And I’m also questioning that brief reduction from 8pm to 10pm. That doesn’t make sense to me unless you routinely exercise from 10pm to midnight and this is the reduced-basal preparation.
That’s a separate issue. You’re working to stop it from falling at night. Then if you see a subsequent rise in the wee hours, you can make a separate basal setting for that. For instance, if you find the mornings start rising on the graph at 7am, you’d want to start adding a slight bit more basal a couple hours earlier, around 5 or 5:30am.
No pressure at all, because we can’t solve the problem. The most we can do is give encouragement and ideas, and say what we see in the graph. It’s up to you to do the experiments that reveal how your body works with the treatments you apply. Then you get to pick one issue to work on next and hone in on that. One step at a time.
The present issue is that too many alerts at night made for ignoring all the alerts, and you ended up seriously too low. You’re fixing that step by step, with adjustments to basal and adjustments to the technique for treating lows with limited amounts of fast carbs. Maybe the next thing to work on will be a rise in the wee hours of the morning; we’ll see. But let’s take those overnight lows out of the picture first. And get you some safe and sound sleep.
I can’t sleep bc I’m too stressed about my son starting a new school mid-year in a few hours. So here I am.
Not sure how others feel about the “Think Like a Pancreas” basal rules of thumb…but I have found them to be reliable for me even when factoring in un-discussed hormonal swings…but the biggest rule of thumb is that the basal profile should have one peak and one valley in the day. Your settings give you two peaks and two valleys. Barring unusual work schedules/sleep schedules/etc, basal rates are typically highest for dawn phenomenon and lowest for your window of second circadian low (mid to late afternoon). I’d guess that you are carrying too much basal for a significant part of the day and that’s contributing to your nighttime lows. For me, too much basal acts like a train that takes a long while to get stopped.
I totally get being loaded up. You are loaded up, without a doubt. I love Sugar Surfing and mini corrections when it’s used on top of a tried and true basal profile. Sugar Surfing on top of an untested basal profile is prone to a lot of issues, especially if your CGM isn’t performing optimally. Testing out your basal with fasting here or there may be the biggest help (eventually, when life allows).
Dear @bkh and @Thomas, I have last night’s graph for your viewing (and analyzing) pleasure…
Thomas, I forgot to switch my suspend last night to suspend BEFORE. I think that change might be a positive one as last night I ended up having to treat. I also went with a conservative adjustment to my 4am rate and decreased by just .1 rather than dropping it to .8… I saw Bkh’s note late and tried to do something in the middle. However, I can still see the slope, so maybe I’ll drop it again tonight. Anyway, I’ll be back around to respond to your thoughtful comment, Bkh. Thank you both again!
Yes, that’s exactly the way to do it. There’s still a drop, but it’s slower than before, so take a little less basal to sneak a little closer to a flatline. In these graphs we can see an overall downward trend from 2am or maybe earlier, so a slight decrease in basal starting at midnight and going through 8am could help. Progress is good.
I thought that @bkh had a good suggestion for selecting a measured small correction. We really struggle with treating at 80 too. Sometimes it turns around and the treatment causes a spike. Then it’s like ping pong from low to high to low. A long time ago I read a post from @Thomas that was something like treat with 15g and wait 15 minutes. Now this was for a low. But the same principle probably applies. EH doesn’t tend to eat the whole pantry (unless he’s at a meal, and then he’s likely to! ) I’ll be curious to see how much you treat with (3 skittles? 1 gummy worm?), at what point/when, and how that works out.
Ugh. Neither do we. And since I’ve picked up running and have decided that mornings are better because they’re cooler, it’s been difficult. We aren’t @daisymae good at waking up, suspending, and doing a good breakfast, then running hours later. She’s amazing!! For us, it’s really tough!!! Let me know when you figure this out.
I can hear @Eric cringing from across the country on this one. He’s ready to fire your pump. Totally made that up, but I know from reading another long running sporting thread that it’s possible to not have 200 be the way to prevent 40. There’s gotta be a better way.
First, about doctor suggestions. The delivery was funny.
Second, I think we start with the doctor dole out, but then I get pissed after enough nights of alarms and not sleeping and tweak the stuff myself. It seems like @Nickyghaleb you’ve already gotten to the point this week of looking at the night time numbers and making small corrections based on the advice from @bkh and @Thomas. Go you!
I thought that too. It’s like the pump is showing up with the fire engine after the building has burned to the ground.
I’m guessing I’m not going to talk you out of the 670g. But I’m going to throw in my 2¢ on your pump.
When you started with this pump, it very well might’ve been the best possible thing at the time. You fully admit that your plate was full at the time of your diabetes diagnosis, and the 670g probably made a big difference in your overall control, and BG management probably became easier. It’s like a big steering wheel. It turned your T1 around - it let YOU turn your T1 around. Or at least it got you out of the ditch and onto the road. But now you’re getting on the race track, speeding along towards bigger goals, more refinement. And the big steering wheel isn’t enough to allow you to fine tune your driving style. And you’re interested in that fine tuning! I read it on here every time I look! There’s @Nickyghaleb coming up with smart questions! Wanting better control. Working hard at it. Being thumped by her pump.
I question if the 670g is the right tool to be using for the job you now want to do. A year’s worth of learning is a lot! And you’re probably not going to give up on working this stuff out at this point. So maybe sometime soon it might be time for a 670 pump vacation and a trial of a different kind of pump? I know some people on here would probably be able to facilitate a loan.
Anyhow, I get the feeling that the 670 is probably part of your identity and leaving that behind might be hard (hundreds of YouTube videos and your own group elsewhere inspired my guess…).
And sorry for the really long random string of replies to stuff that’s been covered! I had thoughts I wanted to share. But I’m doing this all from my phone and once I’d pulled all those quotes, I sure as heck wasn’t going to delete them all!!
Love the way you put this. It makes me think ALL of those LOOOOONG posts really weren’t being ONLY skimmed over (or looked past completely). No one has made me feel that way here, BUT thanks for really hearing me.
Those things came from the pump. I was me before any of it, and I will only continue any of it as long as I wear it. Once this is done, I’m going back to being the Happy Hermit. Seriously, this is just the first pump that I’ve had on my body WHILE I have been learning about my disease. So if I identify with it, it’s because it’s been the first device that I’ve cared to manage. The others… you know when people buy treadmills and end up just draping clothes all over them? If the others had been big enough, they would’ve held a lot of clothes.
I can’t believe these words are about to spill from my fingertips… but I’m a problem solver, and I enjoy a good challenge… can really dive into a puzzle… It’s just taken me this long to realize diabetes has got all my favorite stuff. Diabetes is AWESOME.
I have more to say, but i really, really have to shower before the opportunity is gone and my family is quietly not happy. I like it when you guys make me think… And I’m doing a lot of thinking about how I’m running things. And whether or not things wouldn’t be better on a different route. That’s a big one. And I can smell myself. So i’ll think it over with soap.
Hey @Nickyghaleb, I dropped from 160 to 106 during my shower tonight. I felt nauseous and was like, “Hmmmm, maybe I’m dropping”. I’m on a new sensor that’s not dialed in yet, so it didn’t know. Sure enough, the nausea was right. So thanks for that tip!
Well, you’re welcome, and I’m sorry! Oooh, that nausea/hot shower combo sounds tough. I’m glad you got out safely.
And a 160 to 106, huh? So not even low… just the fast drop. I woke up two nights ago… maybe three now… at a 35 or so and felt fine. I made myself look at my graph and even check my calibration factor. All signs pointed to a nice, steady and slow decline (like most of my nights). Stark difference from that night just recently, at the exact same BG, when I was on my knees fighting that nausea. I feel sharp rises in my skin. Maybe my new super power is feeling sharp drops in my belly.
Progress is good. I’m getting organized. And am back with another question…
If I pull back on my midnight basal, should I leave my 4am alone?? I’m worried on the accumulation affect… that if I start pulling back earlier as well as the changes at 4, that now I’m looking at 8 hours of less insulin. I’m trying to avoid setting up what auto mode would do… it would make for the prettiest line at night and then send me to 300 in the morning.
It’s falling all the way from 2am til 8am, so you need less basal all the way from midnight til 6am. If the 4am basal were right, your BG would level off around 5:30 or 6am. But it didn’t, it was continuing to fall until 8. What happened at 8am to cause the rise?
So to answer your question directly, I’d suggest to modestly reduce the basal both at midnight and at 4am.
But you’re not accumulating a deficit of basal insulin, you’ve got a surplus and are changing the settings to make the surplus go away. If we see a routine rise like the one at 8am in the previous graph, we’d fix that by gradually increasing the basal starting at 6am or 6:30am. Not by giving you too much basal at 4am and 5am.
A cup of coffee to the head. It’s my favorite thing to be able to get up and have a coffee without waiting… and that only happens when it’s to correct a low.
Changing stuff now… and leaving the 6-8am as is. For tonight.
And now that I know how you feel, I’m not going to tell you that ALL of my settings come from a Doctor. 
You didn’t ask for any of that, but I can’t answer a question like that without some explanation.
) I’ll be curious to see how much you treat with (3 skittles? 1 gummy worm?), at what point/when, and how that works out.
after the building has burned to the ground.
Seriously, this is just the first pump that I’ve had on my body WHILE I have been learning about my disease. So if I identify with it, it’s because it’s been the first device that I’ve cared to manage. The others… you know when people buy treadmills and end up just draping clothes all over them? If the others had been big enough, they would’ve held a lot of clothes.