What went wrong here, bolus or basal?

(Posting my latest snafu here as a starter, feel free to keep it going with your own on topic posts)


My usual breakfast bolus has transitioned to a combo of 7 units Lyumjev injection plus 4u affrezza, followed by the same breakfast I’ve had every day for about a decade. But 4 hours later I was flatlining at 160 BG ?The same bolus and my “standard” basal usually bring this BG in for a smooth BG100 + or - after 4 hours.

What went wrong here, bolus or basal?

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Two flatlines indicate a perfect basal.

For me the difference between 160 and 80 is, well, yeah, 80 but at my current ISF, for me, implies an extra 1.6IU

That’s pretty damned impossible on MDI but I’m guessing you use a pump so do what the good AIDs do; just do it. Take the chance, role the dice, with the full correction (AIDs do not do this) or go for the forbidden fruit and stack it; for me that would mean 1 IU now and then watch for the flatline and do whatever it takes.

I should add; I never flatline line like that. Here’s a screenshot:

So, if it’s a quiz; bolus. Yet that is bollocks. You may think you ate what you normally eat but how do you know? [Full conspiracy theory here.] How do you know that the ingredients on that bowl of porridge oats, while identical to the last one you ate (we check every time) has not, in fact, just changed not to include the fact that the GM oats now contain more sugar?

Like I said, FCT, whatever, yet a valid point, conspiracy theories aside.

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Sounds like this is a one time issue since your meal, basil and bolus regimine has always worked prior.

That would make me think it is something outside basil or bolus. Maybe stress, illness, less activity than normal, slightly more carbs in your meal or just diabetes being an ass.

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…or injecting into an area that just didn’t absorb properly, perhaps because of overuse. That can happen even if there’s no noticeable lump where you injected.

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My answer to everything when I don’t know the why? You wore the wrong color of socks!

I have the same breakfast, the same bolus but if I start out lower when I wake up because I didn’t have as much of a DP rise, I skyrocket later because then I usually have a delayed FOTF increase. Notice that word usually!!!

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If we do everything exactly the same and get a different result, that means there was something different that we did not consider or do not know about..

The responses on this thread so far have highlighted many of the different possibilities. Like bad infusion sites, or maybe a variation from the manufacturer of the breakfast “porridge”. Or stress, sleep, illness, or less activity.

It can be a difference in how much you ate on previous days.

And how about if it was cooked differently? That’s something I believe @TomH has mentioned before?

And if it isn’t one of those, there is something else that has not been thought of or considered yet. I don’t believe in diabetes randomness. I believe out bodies do things for a reason. It’s up to us to figure out the reason. But sometimes that’s impossible.

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@Eric is right, if we agree the effect of treatments used are consistent, there is no other rationale that could account for a different result than another factor(s) being responsible. That “(s)” is important as having 2 or more factors being a bit different might cause a larger difference. We often look for a “primary” cause and if not found call it an anomaly, but in reality the small differences can add up to significant change. It doesn’t mean we give up, though at times we probably all have or will; rather it’s those times we need to either dig deeper or have a friend that helps us overcome the (hopefully) short-term shake in our reasoning and spirit. (OK, philosopher mode turning off!)

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Surely it’s helpful if we can figure out the reason, but it’s also optional. Sometimes it’s too hard or we’re too confused to figure out why.

My touchstone is “if your BG is too high, you need more insulin.” There are lots of times I just sugar-surf my way out of high BG without determining the cause. I’ll usually have a decent guess about the reason, and perhaps that may help me avoid or mitigate a repeat of the issue, but determining the cause is not important to me. There’s no need to get frustrated or despondent about the why’s when I can just fix the high BG.

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Yes, I agree with all of this.

But the main reason I want to figure out the cause is so I can prevent it the next time. As a secondary reason, I just like to learn and discover things.

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Same here! As a follow up to my late morning 160 flat line, I pretty well figure it was my basal. That morning I got stuck on my computer and should have done either a correction an hour or so after eating or a temp basal increase to compensate. Completely forgot to even look at the CGM that morning.

I had the idea that others might want to post their “basal or bolus” quiz plots?

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I can’t drink a glass of water with massive management and achieve results like that these days, I’d be extremely happy with that line after any meal

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My new mantra in situations like that is “just roll with it”. :lotus:

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I had one today, but it was kinda obvious…

What went wrong here, bolus or basal?

Well, I forgot to bolus for my morning coffee. I usually do it when making the coffee, so I don’t normally forget it.

But I got kinda distracted today, and then realized it a little while later. :joy:

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Here is a funny one. Kinda obvious.

It was 7:26am, I had not even woken up yet. So no food or bolus. But what the heck?!?! Just my body being ridiculous.

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Perspectives are a funny thing. When I look at that chart, I’m thinking, BEAUTIFUL chart!!

:stuck_out_tongue:

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