# What to do with my basal?



## Unicornz (Jun 7, 2011)

Hi, 
As you guys have seen from my previous thread, I've been having loads of trouble trying to sort the dawn phenomon out I get in the mornings. I have tried and tried with adjusting basals but just couldn't get it to work (changed the total from 0.8u/h to 1.2u/h and tried changing the times too), so I have resorted to taking a preventative bolus as soon as I get up. 0.7 units seems to keep the levels fairly stable until I get to work. 

My question was though, now I know that this will most likely work for me, should I be turning my basal back to 0.8u/h? Or should I leave it at 1.2 even though that doesn't sort out the DP? I realise I might have to increase the bolus if I turn back the basal, but at the moment I'm using two different basal patterns (my weekend pattern doesn't include the increased basal in the morning because I tend to sleep in, but is identical to the week one otherwise).

It would be a lot easier if I could just use the one weekend pattern with the preventative bolus in the morning. What do you guys think?


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## Phil65 (Jun 7, 2011)

Unicornz said:


> Hi,
> As you guys have seen from my previous thread, I've been having loads of trouble trying to sort the dawn phenomon out I get in the mornings. I have tried and tried with adjusting basals but just couldn't get it to work (changed the total from 0.8u/h to 1.2u/h and tried changing the times too), so I have resorted to taking a preventative bolus as soon as I get up. 0.7 units seems to keep the levels fairly stable until I get to work.
> 
> My question was though, now I know that this will most likely work for me, should I be turning my basal back to 0.8u/h? Or should I leave it at 1.2 even though that doesn't sort out the DP? I realise I might have to increase the bolus if I turn back the basal, but at the moment I'm using two different basal patterns (my weekend pattern doesn't include the increased basal in the morning because I tend to sleep in, but is identical to the week one otherwise).
> ...




I have the same problem with DP, I increased my basal from 1.5u/h to 2.0u/h from 6am-8am, usually works for me, although still have to correct sometimes in the morning.  I am a big guy though, so need a lot of insulin, i take 1.5u/h during the day and increase to 1.75u/h in the evening and decrease to 1.5u/h during the night.  Basal is such a pain!!!!!! Hope you get it right soon!


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## shiv (Jun 7, 2011)

Is there any reason you've stopped increasing at 1.2u? Maybe you still need more than that. It's not causing a hypo and rebound is it?

If the 1.2u is keeping you sort of steady, why would you want to put it back to 0.8u?

You've been really patient with this, but maybe you need to keep going with the experiments. Look for a pattern - ie make a change, wait 2 or 3 days, then make another change. It's a pain, but if you go off the readings of one day, it can't really be trusted.


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## Unicornz (Jun 7, 2011)

shiv said:


> Is there any reason you've stopped increasing at 1.2u? Maybe you still need more than that. It's not causing a hypo and rebound is it?
> 
> If the 1.2u is keeping you sort of steady, why would you want to put it back to 0.8u?
> 
> You've been really patient with this, but maybe you need to keep going with the experiments. Look for a pattern - ie make a change, wait 2 or 3 days, then make another change. It's a pain, but if you go off the readings of one day, it can't really be trusted.



Hi Shiv! Yeah, the reason I stopped at 1.2 is because I sort of gave up lol. I followed all the guidelines like you said (waited 3-4 days after the change before making any new changes) and the weird thing was that it seemed to have worked for 2 days after making the change, but then on the 3rd or 4th day my BG would go up again to exactly the same levels as they were before the change (or even higher than before when I upped it from 1.1 to 1.2 u/h). It just feels like my liver is protesting after the first two days by kicking out extra glucose to make up for the extra insulin lol  

I also tried starting the basal at 5am instead of 6am, like you suggested, but that hasn't made any difference either. I would have probably stuck to it if I had seen some improvement (i.e. if now when I got to work my BG had only gone up to 10 instead of 15) but that hasn't happened at all. It keeps going up to the same level  

It's been three months of trying now and I must admit my patience has run out a little bit so I resorted to a bolus instead. My rates at the moment are: 

12am - 5am    0.9 u/h
5am - 9am     1.2 u/h
9am - 6pm     0.6 u/h
6pm - 10pm    0.9 u/h
10pm - 12am  0.7 u/h

I could try 1.3 but it just seems like such a massive difference


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## shiv (Jun 7, 2011)

Do you know what time the DP rise starts?

I really feel for you, I know how hard you've been trying with this! Don't give up  you can do this!


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## novorapidboi26 (Jun 7, 2011)

I also struggle with this on MDI, but the basic rules are the same I believe, just continue to increase your basal delivery rate until you know its too much (hypo).........I ended up giving up too with the basal because my constant increase to dose was not having an effect, but it was because I needed more, a lot more, and for no explainable reason........

DP is different as you know but the moral  is to keep increasing till you know its been too much....be safe.............


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## Unicornz (Jun 7, 2011)

shiv said:


> Do you know what time the DP rise starts?
> 
> I really feel for you, I know how hard you've been trying with this! Don't give up  you can do this!



Thanks  it's just a tad demotivating at the moment as this was the main reason for me to get a pump in the first place (not complaining though my overal controll throughout the day has improved beyond anything I could have ever hoped for!)

Anyway, the CGM I had before I went on the pump showed that the rise starts occurring at about 6am, which is an hour before I usually wake up (I think that's what it said anyway). I still have the charts at home so I will double check tonight!


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## novorapidboi26 (Jun 7, 2011)

Nothing beats real time testing, the CGM is good, but pin pointing the ever changing hormone response is best down with hourly tests through the night.......................I hope you can sort it out soon...........


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## shiv (Jun 7, 2011)

If I were you, I'd keep taking the increase backwards - so start it from 3am or 4am. You might find that it's just taking a while longer to impact


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## Unicornz (Jun 7, 2011)

Actually, looking at the charts from the CGM it looks like my BG starts rising steeply exactly at the point that I wake up, so 7am on weekdays (which also explains why it doesn't happen when I sleep in long in weekends). 

Maybe I should try increasing the basal to 1.3 and see what happens. My DSN said to change basals about 2 hours before any highs or lows happen, so according to that theory 5am should be okay I think?


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## Unicornz (Jun 8, 2011)

Turned up the basal to 1.3 u/h at 5am yesterday and woke up to a nasty 2.7 at 6.20am this morning  Will keep it going for another day or two to see if it was just a blip. 

If not, I think I will go back to 1.2 u/h but start it at 4am instead to see if that helps!


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## Mel (Jun 8, 2011)

Why not take the basal back to 04.30am 
WE find that we have also had to increase the i:C at breakfast to help


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## Phil65 (Jun 8, 2011)

Mel said:


> Why not take the basal back to 04.30am
> WE find that we have also had to increase the i:C at breakfast to help



Hi Mel.

My I:C ratio at breakfast is 2.7 for 10g carb compared to 2:10 for lunch and dinner! My basal is also higher from 5am-9am.


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## Mel (Jun 9, 2011)

hi Looking at your basals again have you considered having more . For example we (daughter and I) have put a 12am - 2am , 2-3am , 3-5 am 5-6.30am rates on we arrrived at this by hourly testing overnight to see exactly when she rose and then talioring each one .this takes a few days and you need to let things settle for a couple of days inbetween to sleep and let the body settle


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## Unicornz (Jun 9, 2011)

Mel said:


> hi Looking at your basals again have you considered having more . For example we (daughter and I) have put a 12am - 2am , 2-3am , 3-5 am 5-6.30am rates on we arrrived at this by hourly testing overnight to see exactly when she rose and then talioring each one .this takes a few days and you need to let things settle for a couple of days inbetween to sleep and let the body settle



Hi Mel, yes I have considered hourly overnight testing but haven't been able to successfully do so yet. I've only been on the pump 3 months and the basals were too unstable in the beginning to be able to do this effectively. 

Thanks for reminding me though, I do feel that I should be able to do it now that things have started to settle down a bit, will do some basal testing this weekend


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## shiv (Jun 9, 2011)

Jelly jelly jelly!


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## Unicornz (Jun 10, 2011)

shiv said:


> Jelly jelly jelly!



Hahaha no I can't eat jelly I hate it lol the texture freaks me out!


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## Unicornz (Jun 13, 2011)

Update: after a few days of sitting out for the changes to kick in (I increased the 5am to 9am basal from 1.2 u/h to 1.3 u/h) I am happy to announce that this morning's levels were: 

7am: 5.1 when I woke up
8.30am: 5.3 before breakfast when I got to work!! 

I'm feeling at the moment as if this is too good to be true, so I will be keeping a very critical eye on it for the next few days. Will report back with the results 

Thanks for all the help so far! I'm feeling glad that I gave the basal tweaking another try even though I had given up lol.


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## Phil65 (Jun 13, 2011)

Unicornz said:


> Update: after a few days of sitting out for the changes to kick in (I increased the 5am to 9am basal from 1.2 u/h to 1.3 u/h) I am happy to announce that this morning's levels were:
> 
> 7am: 5.1 when I woke up
> 8.30am: 5.3 before breakfast when I got to work!!
> ...



Nice....sounds like you have cracked your morning basal!  To confirm, fasting is the only way to make sure you have it right....I've only been on my pump since April, but fasting at night with hourly tests is worth it ....tiring and a pain in the derriere though! Especially if you go hypo at 3am!


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## Unicornz (Jun 20, 2011)

Well, as promised, reporting back after a week of having monitored my mornings very closely. Last week seemed absolutely fine: 

Tuesday 
7am - 4.4 
8.30am - 7.0 

Wednesday: 
7am - 4.5 
8.30am - 5.5 

Thursday 
7am - 4.8 
8.30am - 6.1 

And now this morning things have gone wrong all over again. 

7am - 5.4 
8.30am - 9.4!!! 

I'm so close to desperation. Can't believe this has happened AGAIN! I haven't done anything differently this morning, not eaten anything. Spoken to my DSN and she said to monitor it for *a few more days to make sure it's not a blip and then to maybe up it some more. I will also get a CGM for a week at our next appointment so hopefully they might he able to make more sense of it when the results of that come in. Ah well, let's see what tomorrow will bring!


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## Pumper_Sue (Jun 20, 2011)

You might be just one of those people that has a basal that changes every week or so. Welcome to the club 
If you had this problem on MDI having a pump wont change it, just gives you the opportunity to change it at the right point. Which obviously makes pumping very hard work but none the less well worth it for the better quality of life.


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