Today, for the first time, we were able to largely suppress a hormone peak with a very high temp basal.
Over the past few weeks, we have seen many high evening hormone peaks, sometimes above 300, take several hours and more than 15 units to bring down. Some of them require triple or quadruple stacking.
Lately we have tried a new technique, which consists in combining very high basal from the moment we suspect a peak with high early boluses.
Today, for the first time, we were able to control the peak below or around 150 (after a brief incursion over 200) for several hours with a high +50% temp basal. The moment we suspected it (right as it crossed 120), we upped the basal and gave a large bolus (5U).
I am not sure if this is going to become SOP. Nonetheless, it is an interesting experiment for us.
The control was not clean or flat, btw, it was ugly, and sometimes low. But this time we were not stuck at 250+.
For another peak yesterday, we used the same technique, but with a +30% temp basal, that we turned off as soon as BG started coming down. We synchronized the landing with a meal (about 50 carbs). We had a very moderate low two hours after the landing, whereas the previous peak with a +50% temp basal had a nasty post-landing low.
It seems that, when you go down from a very large step in temp basal, the effect of the previous temp basal lasts more than 3 hours after shutdown.
We find that temp basals work amazingly well for controlling both (what I presume are) peaks associataed with hormonal changes AND high fat meals that would require an extended bolus. But it’s true that if you go too high on the basal you have to watch things for about 4 to 6 hours, at least for us. Turning off the basal at the right time is critical and it often has to happen before the blood sugar has even turned down. For us, once it’s flat but maybe even high, we turn off and that usually provides a smoother landing.
Thanks for the great idea: we were turning it off when turning the corner, so turning earlier might work better with us.
We have used temp basals with very good results, but it is the first time we are trying major steps up in temp basal. Clearly, the step up depends upon your conditions—in our case, it looks like +30% definitely helps with our harsh hormone peaks and is easier to recover from.
I would rather use +50% based on the peak’s climbing rate, but recovering from the following low was hard and painful. We’ll have to see if we can find some ad hoc rules.
I don’t have a good mental model on how well temp basals work when combined with boluses. Like you (I remember a previous post you made on the subject) I have a feeling that it is the instant insulin concentration in the blood that counts, in which case a temp basal would not help much if you constantly (say, every hour) inject boluses. But I am not 100% sure that our intuition is right, although logically it would seem to be.