# adjusting basal rate overnight and bolus ratio late evening



## Dory (Jan 27, 2013)

Hi all,

following on from people's advice on here, I did an overnight basal test last night, although not sure how useful the data is given my correctional before bed....

Hour -------Basal Rate ------- Reading                 
0-1am ------0.43 -------------11.7* ---->   correction bolus of 4.9u
1-2am ------0.59 
2-3am ------0.7 --------------9.3
3-4am ------1.1 --------------7.1
4-5am ------1.2 ------------- 10.9
5-6am ------1.2 ------------- 6.2 
6-7am ------0.94 ------------- 5.0 
7-8am ------0.79
8-9am ------0.6
9-10am -----0.8 -------------  9.5 (pre-breakfast)

* I had eaten 2x Alpen light cereal bars and a Mullerlight yoghurt at 21.00 (36g CHO).  my reading at that point was 5.6; I had a bolus of 4.4 in one standard dose (at that time of night I am on a 1:8 bolus ratio) and no correctional. Assumption: either 1)that cereals (as in oats, barley, bran etc) take longer to peak in my blood than other foods and I should therefore do a multiwave or 2)my bolus ratio is not right and I need to adjust to say 1:7.  Questions: what do people think - is it likely to be 1 or 2?  I'm leaning towards 2, however my concern is that a 1:6 ratio will be too much for 'simple' foods (like if I have a veg stiry fry, or just a yoghurt for dinner etc).  If the solution is to have different bolus ratios for different foods, can can I work that on my Roche pump as my machine is set to different ratios according to time of day, not type of food? 

the above aside, this overnight test (as well as othes I did last week) show my DP rise occurrring beore the basal rate increase.  So think I've got my head round this one: clearly i need to start the basal rate increase earleir than it currently is.  I was thinking:

Hour------Basal Rate
1-2am----    0.6
2-3am----    0.9
3-4am----    1.2
4-5am----    1.2
5-6am----    1.0
6-7am----    0.94 
7 onwards-- going back to rates above

Questions: what do people think of that?  sensible?


*Points to note:*
1. I take ramipril at night before bed
2. I take levothyroxine in the morning when I wake up, before breakfast
3. I am quite insulon resistant so take slow release glucophage at dinner (between 18.00-21.00) eaach day
4.  I am on slimming world as i am trying to lose weight (this is THE single most inflencing fator of my life, I have been struggling with this for the past 10 years).  Currently on 'original' where there is a limit of the amount of CHO I can eat.  Cereals eg are restricted to 35g a portion.  So please bear with me if I can't follow any of your suggestions and come back asking for a different way round things! 
5.  I am shattered (and distracted; Murray is on) so apologies for any typos!


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## Hanmillmum (Jan 27, 2013)

You've had a busy night 

I would caution over changing anything because you had to do a correction bolus at beginning of your testing. Sorry to say that after your efforts. My understanding is that is best to be free from IOB and carbs to get a true picture of the basal.

 I would split the night into sections for testing as well or you going be burnt out. There is a good sticky on basal testing that I would follow or you could be chasing your tail.  

See what others think.


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## Dory (Jan 27, 2013)

Thanks - yes I did this exact same format Sun/Mon/Tues night last week as well whilst juggling work during the day so it's not nice!  Want to get this sorted asap so can move onto the day time ones (and get a proper nights' sleep!  )

I thought as much re the correction affecting things - although the general pattern of going high before my DP basal kicks in happened in the other nights too (when i had no correctionals etc - although i was on a different basal rate then).  Have a late start tomorrow (off to the orthopeadic clinic) so will try another over nighter tonight and post results.

Would be interested in people's thoughts on the evening bolus ratio?  as if that's going to keep on screwing things up I'll never be able to get a decent sample of overnight readings :rolleyes


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## Pumper_Sue (Jan 27, 2013)

Dory said:


> Would be interested in people's thoughts on the evening bolus ratio?  as if that's going to keep on screwing things up I'll never be able to get a decent sample of overnight readings :rolleyes



The simple solution is to skip your evening meal and test from there then no screw ups!.
No1 rule is sort your basal first don't change anything else otherwise you wont know what the problem is.

If you think you will starve to death by missing your evening meal, it's now considered ok to have some sf jelly.


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## Dory (Jan 27, 2013)

ok I'll try eating dinner at lunch, then fast from evening on.  

I was told that, when testing basal levels, I should not correct for high bGs.  Does that sound right?  Obviously if I go low then I will have to have something.


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## Pumper_Sue (Jan 27, 2013)

Dory said:


> ok I'll try eating dinner at lunch, then fast from evening on.
> 
> I was told that, when testing basal levels, I should not correct for high bGs.  Does that sound right?  Obviously if I go low then I will have to have something.



Read the sticky at the the top of the page. It gives clear instructions as to how high to allow your blood sugars to go before abandoning the test.
Same if hypo then abandon the test treat hypo and try again on another day.
Obviously making basal adjustments where needed from the info gained before you abandoned the test.


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## Dory (Jan 27, 2013)

oh yes, I had read that and you've reminded me about the upper and lower limits.  thanks.


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## Dory (Jan 27, 2013)

god i'm starving!!!!!!!!!!!!!


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## everydayupsanddowns (Jan 27, 2013)

The early part of the night in the OP is stuffed cos of that correction/food tail - though I did find it interesting how much your BG rose from 5-6am till 9am

That needs rechecking, but could do with looking at IMO


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## trophywench (Jan 28, 2013)

LOL, you can't start a basal test until after 4 hours since last fast-acting, whatever it was for - food OR correction.

As it was your basal test didn't start til  5am at the earliest.

Why don't you kinda split the whole night testing?  Test every 2 hours or 3, then next night do the in betweens.

First night you could do - say - 10pm, 1am, 4am, 7am.  Then next night 11.30, 2.30, 5.30, 8.30 - ish?

Or do 10pm to 4 am and then 3am to 9am?

Trouble is you know, if you stay awake all night you get different results to when you sleep.  Been there done that.  So I'm not all that keen on missing too much kip to do these.  (Oh come off it Jen, you aren't keen on losing ANY sleep at all, are you?)  (No I'm not Jen TBH - cos I have such difficulty getting off in the first place)


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## pgcity (Jan 28, 2013)

Keep going, youre on the right track.
Is there any chance you could eat about 4 or 5pm? Fasting from lunchtime would be difficult and may not give accurate data. I tend to test about midnight, 3am and 6am then the next next time 1am, 4am and 7am. You may need a few nights readings to see a pattern.


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## Dory (Jan 28, 2013)

hmmm, ok guys, got a partial set of data - not very helpful as my bG went over the limit so had to cancel the test.  But I can work on the data I have, which is as follows:

Time ------- Basal Rate -------- Reading
17-18.00---- 0.92 --------------10.8 (had dinner)
22-23.00 --- 0.48 --------------10.5
23-00.00 --- 0.43 --------------11.3
00-01.00 --- 0.43 --------------13.8
01-02.00 --- 0.59 --------------13.8
02-03.00 --- 0.7 ---------------15.3 (cancelled test, correction bolus, fell asleep pi**ed off as hell)

*Things I've noticed*
A).the fact that my reading stayed the same from dinner to 22.00 suggests that my basal during that period is fine, but my bolus and/or correctional needs to be adjusted - I have noticed this for a few days now.  I am currently on 1:8 bolus ratio between 19-00.00; I have thought for a while this perhaps needs to change to 1:7.  I may change this this evening, so i start off my overnight restest with a better change of making it through the night!
B).the bGs start increasing again at 23.00 - suggesting my basal from 22.00 onwards needs increasing (which is interesting as previoulsy I thought it may only need increasing from about 02.00 when DP occurs)
C).the correctional I gave at 02.00 brought me down beautifully to 6.9 when i checked at 07.00 this morning, so i know the correctional ratio at 02.00 is fine! 

*Plans for tonight*
1. change the bolus ratio at dinnertime to 1:7
2. change basal rates as follows (this is using the basal testing sticky on this forum):
Time----------Basal rate
22-23.00------0.58
23-00.00------0.53
00-01.00------0.53
01-02.00------0.69
obviously I won't be able to change any of the basal rates after 02.00 yet as I had to cancel the test after that (grrr) - but will re-test tonight with the 2 changes above and hopfully I should be able to do the 02.00-onwards basal checks then. 

PG - I had dinner at 5-6pm yesterday so will be doing the same tonight (although I am out at an exercise class from 6.15 so will have to have main meal at lunch then something small by no later than about 4pm in order that I don't upchuck in the class )  - guessing that's the right way of doing things!

Thanks for all your help guys.  Fingers crossed tonight will give better readings!!

I like your plan TW about testing in phases.  might try the 22-02.00 one night then 02-06.00 the next.  Thanks!


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## Pumper_Sue (Jan 28, 2013)

Dory,
      even though your bs stayed the same from 5 pm to 10.pm it is still to high.
So if you changed your basal to lower the bs it stands to reason that your ratio is correct as things stands.

You are thinking back to front, ie trying to use a bolus to correct a basal problem.

Just realised you have mentioned an exercise class............ skip the basal testing as you will have completely different results.
If the exercise class is a reggular thing then when you sort your every day basal out think about another basal pattern for that class.


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## Dory (Jan 28, 2013)

Sue,

I'm not thinking back to front.  My bG levels aren't routinely high that time of day and over the last 2 weeks of keeping detailed records I have determined that it's only when I eat that they go up.  Hence it is the bolus that needs correcting.

Funny, the guide you referred me to that you posted says to keep to the same exercise pattern as you would normally when you are doing the testing.  I do about 4-5 classes a week so tonight is a normal night for me.  If i didn't keep to as normal a routine as possible, I would be creating a basal profile that I would never use.


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## Pumper_Sue (Jan 28, 2013)

Dory said:


> Sue,
> 
> Funny, the guide you referred me to that you posted says to keep to the same exercise pattern as you would normally when you are doing the testing.  I do about 4-5 classes a week so tonight is a normal night for me.  If i didn't keep to as normal a routine as possible, I would be creating a basal profile that I would never use.



So last night did you go to your exercise class?
If you exercise on  4 or 5 nights then you need 2 seperate basal paterns. So exercise nights sort 1st if that's the main thing you do. Then nights off from exercise have another patern. 

Please please do not change any carb ratios until you have sorted out your full 24 hour basal.
You are going to end up in one big mess if you do.
Don't run before you learn to walk  It can take 6 weeks or more to sort the paterns out. So don't try craming everything into a few days. Tiny steps and you will move faster


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## Dory (Jan 28, 2013)

I did a class in the morning - not sure whether that would count though.

Ok I won't go tonight (it'll save me ?5 I guess) and see what happens.  But I'm worried that if I don't change to a 1:7 ratio I'll end up with the same problem as last night (ie not being able to get a full nights' testing). Well i'll keep the 1:8 for the time being - will post later this evening with any news.....

thanks


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## trophywench (Jan 28, 2013)

Hang on - 5pm you were 10.8?  Before you had your dinner?

Why were you that before dinner?

If you were 10.8, you ate dinner and bolused for it, then your BG stayed the same all evening, then surely that's a sign that your BOLUS was correct - ie has completely dealt with the meal without interfering with your basal needs?


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## Northerner (Jan 28, 2013)

trophywench said:


> Hang on - 5pm you were 10.8?  Before you had your dinner?
> 
> Why were you that before dinner?
> 
> If you were 10.8, you ate dinner and bolused for it, then your BG stayed the same all evening, then surely that's a sign that your BOLUS was correct - ie has completely dealt with the meal without interfering with your basal needs?



I don't think she ate in the evening TW


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## everydayupsanddowns (Jan 28, 2013)

Dory said:


> ...
> Time ------- Basal Rate -------- Reading
> 17-18.00---- 0.92 --------------10.8 (had dinner)
> 22-23.00 --- 0.48 --------------10.5
> ...



I understand your frustration at having to cancel the test, but for my money this was a GREAT set of results. Along with the partial data from the previous evening (from 5am onward) this seems to show pretty clearly that overnight you are rising steadily by about 1mmol/hr.

In your shoes I would increase basal for the complete overnight period to attempt to counteract that.

Regarding exercise classes/gym visits - do you use TBR before/during/after exercise at all? If you usually do, then setting your basic pattern will be fine with or without attending the classes. Because your TBR adjustments will be dealing with the class.

Your meal bolus looks pretty darrned close to me - though it would be interesting to see what basal was doing during that period. It may well be that your basal is a little low at that point in the evening too, which would give the impression that your bolus/correction was out - because some of the bolus/correction would be covering basal shortfall.

I'd be tempted to focus on basal for now - and cautiously firefight occasional higher than ideal numbers. Some very wise forum old-hands once advised my to 'only change one thing at a time' which has proved to be very valuable advice.

Thanks for posting your results so far - very interesting.


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## Dory (Jan 28, 2013)

thanks Mike,

I don't use a TBR - I could never get the dosage right, it would work some days but not others (and that was when the classes were the same) so I just gave up.

Thinking about it, I think you and TW may be right about the bolus for dinner.  It must be the correctional dose that's not right in th eperiod beforehand, which I suspect needs to be a bit higher (it is currently 1 : 1.4 which is low for me).

Anyhoo, you're right - baby steps; I'm taking Sue's advice and just focussing on basal at mo.  once i get overnight sorted I wil be moving on to the other periods in the day as the sticky suggests.

I will post my results tomorrow and see how I get on - glad they're not boring you all to death


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## everydayupsanddowns (Jan 28, 2013)

No no... not boring at all!

You may need to bear that in mind if your basal does end up rising as you will (naturally) have more IOB when exercising. 

For 45 mins-ish of cardio I currently set a 70% TBR for an hour before and discinnect entirely for the exercise. Effectively 35% basal for 2 hours. That means I need to 'top up' with relatively few fruit pastilles.


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## pgcity (Jan 28, 2013)

It's not boring. It's really useful to see how everyone else tackles basal changes because its something I have struggled with. I would have a night off if I were you though because when I am tired my levels go wacky anyway.


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## Dory (Jan 28, 2013)

oh i very very much like the idea of disconnecting for classes!  At the moment I am putting the pump in my trouser pocket but given its weight, it does tend to leave me having to hoist up my trousers at several points during the class!  not great when you're trying to do a side kick-step out-side kick-karate block 

I tihnk I'll get the 'basic' basal rate sorted first, then do the bolus/correctional ratios and then focus on the sport basals.....this really is all a lot for me to take on (as I've said, never had this level of support or explanation) but I'm so relieved that I've found al of you as it reassures me that my thoughts on things (like protein causing my sugars to rise, needing a different ratio depending on the size of your portions etc) are actually not stupid!

I can't thank you all enough....


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## everydayupsanddowns (Jan 28, 2013)

Tweaks required for exercise will be entirely individual to you, of course.

I think many pumps have options of neoprene belts/holsters for sporty types. 

I'm experimenting with lower TBR still attached for longer runs at the mo, cos the half marathon is likely to be 2 hours and I get the feeling it's not so good to detach for that long.


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## Dory (Jan 28, 2013)

I tried most of the belts that roche gave with the starter kit and looked at what else was on offer on their website and didn't really see anything suitable; the problem with the belts is that when i jump up and down (a lot in both the combat and dance classes) the belt (and pump) does too!  really puts me off my technique which is dangerous as you can land wrong, mis-step, kick people mistakenly (which I have done before! but because they were standig too close, not because of my pump).....

i was told that you should really be off the pump for no longe than an hour so your idea of reduced TBR with retained attachment is probably right.  only thing i noticed with the reduced TBR when I did it for my classes is that i'd come home and my reading would be high although would then return to normal after a few hours.  never hung round long enough to do proper assessment of that but guessing that theoretically I could do an increased TBR for during the class then do a reduced one to kick in say, an hour after i get home, for a couple of hours.  But hey, that's much further down the line,  basics first.  and of course, high impact short course doesn't have the same effect as a 2 hour marathon!

How are you finding it with training?


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## Northerner (Jan 28, 2013)

I got a SPIbelt for carrying my meter in when running - you don't know you're wearing it!


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## everydayupsanddowns (Jan 28, 2013)

Training is going well thanks... Fortunately I was in touch with some clever Northern bloke who sorted me out with a brilliant schedule - eh Alan!

Your increased insulin need with high impact is quite common I think - and your 'during/after' mix sounds like a great place to start. Runsweet.com might be a good place to look, but high impact can be a bit more anaerobic (glucose released from muscle store) than cardio plodding


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## Dory (Jan 28, 2013)

i have one of these:

http://www.stepnpump.com/rockwear-instructors-microphone-belt.ir?cName=accessories-rockwear

but am a little too large to wear it without it riding up at the moment 

but the problem with belts etc is that you are very conscious of it - doing combat classes where you're doing high kicks and jump kicks and when you're doing dance classes doing spins, plies etc is a lot different to the motion you make whilst running.  i used to run too and i was fine with the belt when running but can certify that it's completely different when doing lots of complex movements!


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## Pumper_Sue (Jan 28, 2013)

Dory, can you not attach your pump to your bra or nestle it in the middle? It should be safe in there as contact in that area was a complete no no when I practiced Karate many years ago. There are plenty of clips available to attache pump to said garment.


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## Dory (Jan 28, 2013)

*What Is Going On????*

Hi Sue yes I attach it using a phone sock style holder with clip to my bra - it gets very hot and sweaty tho - not good for insulin!!

Guys, I am a bit worried - reading before dinner tonight at 5.30pm was 5.8....had my dinner using same bolus ratio as yesterday, checked it at 7pm and it was 8.0...fine i thought, post meal rise, excellent.....

checked it half an hour ago and I'm down to 4.4.  I've done nothing different since yesterday in terms of bolus/correctional ratios, the basal rate changes i made won't kick in until 10pm so it can't be them that's changed things tonight... exerise has been about the same..... so why on earth have i had such a different reaction tonight to last night?!  

See, this is what I mean when I say that there is NO predictability to what the flip my sugar levels do!!!!!!!!!!!    i'm pretty sure it's going lower too - haven't checked yet want to leave it another 15 minutes just to check 

I am physically exhausted with this now!  I can't do this on my own anymore


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## Pumper_Sue (Jan 28, 2013)

Dory said:


> Hi Sue yes I attach it using a phone sock style holder with clip to my bra - it gets very hot and sweaty tho - not good for insulin!!
> It wont come to any harm for an hour or two stop worrying.
> Guys, I am a bit worried - reading before dinner tonight at 5.30pm was 5.8....had my dinner using same bolus ratio as yesterday, checked it at 7pm and it was 8.0...fine i thought, post meal rise, excellent.....
> 
> ...



Yes you can sort it and you are not alone you have the forum members to help you.
Did I miss where you were going to miss your evening meal so no bolus or corrections to confuse things?
Exhustion........... have a good nights sleep and basal test another night


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## Dory (Jan 28, 2013)

good news re pump in bra - that solves all my worries - thanks.
i ate at 5.30pm, bolused at the same time as i was eating - exactly routine as yesterday.  Dinner yesterday was chicken korma (slimming world recipe) with cauliflower rice and some tangerines/sharon fruit.  dinner tonight was homemade pork burgers (again, slimming world friendly), roasted butternut squash, green beans and a mullerlight yoghurt and alpen cereal bar for dessert.  reading before dinner today was a lot lower (5mmol) than yesterday.  but yesterday's readings post eating dinner showed the readings to stay at the same level from 5.30pm onwards - whereas tonight they've dropped.  That's what i don't understand 



Pumper_Sue said:


> Did I miss where you were going to miss your evening meal so no bolus or corrections to confuse things?



I wasn't going to miss my evening meal as was doing the overnight fasting rather than the evening meal fasting - I've always been told to do the over night first as that affects the entire next day (although my thought on that is that you could say that about any fasting/testing period because the whole system is circular).

It's so hard for me to do the over night testing during the week as most days i don't even get home until 7-8pm so don't eat dinner until 8-9pm (which rules out an overnight test) 

I've just checked reading now and an hour has passed and it's dropped to 4.1.  I may see how i get on.  If it's ok when i go to bed I'll continue with the overnight, if not I'll cancel.  I might do an evening fast/test tomorrow (I'll need to read up on the periods to eat/fast/test etc for that period though)


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## Pumper_Sue (Jan 28, 2013)

Looking at what you ate, I would suspect your insulin has worked before the carbs have hit your system. Hence your hypo  Slow release carbs and fat would require an extended bolus or a split bolus.
This is why I so wanted you to get some sf jelly and have that as a snack instead of your evening meal. It takes out all the hassel of whats gone wrong and why when you bolus for your meal


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## Dory (Jan 28, 2013)

ok.  i'm completey lost now.  

if i ate pork burgers (using the low fat pork remember ,everythng i eat is low fat so even the 'oil' i use to cook with is fry light) with butternut squash and a yoghurt, i should do an extended bolus? and is that because the protein slows down the release of the carbs in the squash and yoghurt?
in that case, why the same thing not happen ast night?  surely the chicken in the korma woud have slowed down the release of carbs in the tangerine/sharon fruit?

your suggestion of only having some jelly instead of a meal before the fast period would mean i don't eat anything from lunchtime (1/2pm) until the next morning at 6-7am....that's a lot to ask - that's like rolling the evening fast-test and overnight fast-test into one? is that a healthy thing to do?

if it's ok to go without a whole meal from lunch till breakfast the next day, then i can do that tomorrow as I have sf jelly??


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## Dory (Jan 28, 2013)

****contemplating just admitting myself to hospital so they can do all this as I seemingly can't do it on my own as it never goes right****


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## LeeLee (Jan 28, 2013)

Could exhaution be part of the problem?  Can you live with giving yourself a couple of days rest before having another go?  

Sorry if this sounds simplistic.  I have no experience of insulin, but can still remember what sleepless nights did to me when I was a new Mum many years ago... and I was not diabetic at the time.

{{{hugs}}}


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## Dory (Jan 28, 2013)

test abandoned - readng now 3.6


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## Dory (Jan 28, 2013)

Thanks LeeLee.

You're completely right; I am stressed and exhausted.  Ideally I need to be able to work from home (at most) throughout all this but I'm so worried that my boss thinks I'm trying to pull the wool over his eyes and am taking teh mick that I'm trying to sort this as quick as possible.  

I might see if I can get an agreement to work from home for the next 2 weeks.  Things like fasting tests will be a lot easier to manage from home and will mean less stress.


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## everydayupsanddowns (Jan 28, 2013)

Did you have any hypos yesterday - even just little low-level dips can be followed by a bit of BG randomness as the liver belatedly 'helps out' when it fancies it.


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## Northerner (Jan 28, 2013)

Dory said:


> Thanks LeeLee.
> 
> You're completely right; I am stressed and exhausted.  Ideally I need to be able to work from home (at most) throughout all this but I'm so worried that my boss thinks I'm trying to pull the wool over his eyes and am taking teh mick that I'm trying to sort this as quick as possible.
> 
> I might see if I can get an agreement to work from home for the next 2 weeks.  Things like fasting tests will be a lot easier to manage from home and will mean less stress.



That sounds like a plan to me Dory. These things can't be rushed and stress/exhaustion will upset your hormone balance anyway. Give yourself lots of credit for the hard work you've done so far, regroup and recover your strength and sanity before resuming


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## everydayupsanddowns (Jan 28, 2013)

Sorry posted that before I'd read the latest responses...

What did you count for the meal? I'm not sure there are many carbs in butternut squash?

Hang in there. This is tough times, but worth it in the end. Once you have a basic pattern properly sorted for you it will usually only need a little tweak here and there.


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## Dory (Jan 28, 2013)

everydayupsanddowns said:


> Did you have any hypos yesterday - even just little low-level dips can be followed by a bit of BG randomness as the liver belatedly 'helps out' when it fancies it.



Nope Mike. no hypos at all yesterday.  



Northerner said:


> That sounds like a plan to me Dory. These things can't be rushed and stress/exhaustion will upset your hormone balance anyway. Give yourself lots of credit for the hard work you've done so far, regroup and recover your strength and sanity before resuming



that's assuming that I have any sanity to recover Alan 

Sue - just checking re your sf jelly plan: do you mean do another overnight test but have sf jelly at 5-6pm as my dinner?  Or do you mean do an evening test as per the sticky (eat no later than 2pm, do the tests and then ok to eat after 11pm)?  I will attempt whatever anyone suggests but think i may need to give my poor brain a few days rest


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## Dory (Jan 28, 2013)

everydayupsanddowns said:


> Sorry posted that before I'd read the latest responses...
> 
> What did you count for the meal? I'm not sure there are many carbs in butternut squash?
> 
> Hang in there. This is tough times, but worth it in the end. Once you have a basic pattern properly sorted for you it will usually only need a little tweak here and there.



Thanks Mike.  This is hard.

I counted a follows:
7CHO - butternut squash
2CHO - green beans
27CHO - yoghurt
11CHO - Alpen bar
20CHO - banana

This is more than I would normally have in one sitting because I usually have a snack (ie the yoghurt or the banana) later on in the evening and I knew I couldn't do that tonight and was hungry last night - so had it all in one go.  Ironically I ahd more carbs tonight that I had last night at dinnertime!


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## everydayupsanddowns (Jan 28, 2013)

I think you are already putting in an amazing effort on this Dory. I don't think I've ever run more than 2 tests in a week!


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## Dory (Jan 29, 2013)

*'evening' basal test*

Thanks Mike.  When you're having a rough time of things all the reassuring comments helps 

Right - new day, new outlook.  Reading 11.8 at breakfast this morning (not surprising after last night but my ratios this time of day normally sort out any blips before lunch).  So, I was thinking of doing an evening test today (ie eat no later than 2pm, then fast until 11pm).  It seems that the majority of my problems at testing overnight come from evening activities interfering....so thought (seeing as I'm working from home today and have the capacity to do it) I'd give it a go.... will post results later tonight.....


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## Northerner (Jan 29, 2013)

Dory said:


> Thanks Mike.  When you're having a rough time of things all the reassuring comments helps
> 
> Right - new day, new outlook.  Reading 11.8 at breakfast this morning (not surprising after last night but my ratios this time of day normally sort out any blips before lunch).  So, I was thinking of doing an evening test today (ie eat no later than 2pm, then fast until 11pm).  It seems that the majority of my problems at testing overnight come from evening activities interfering....so thought (seeing as I'm working from home today and have the capacity to do it) I'd give it a go.... will post results later tonight.....



Good luck Dory, hope things go well


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## Dory (Jan 29, 2013)

cheers Alan


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## Dory (Jan 29, 2013)

ok, so either my basal, bolus or correctional ratio is too high at breakfast: my reading went from 11.8 when I had breakfast at 7am to 3.8 at 10am.  

Had lunch at 1pm, reading was 7.9.  Had 45g CHO, 6.7u bolus and 1.5u correctional.....thought all was set perfectly for this evening's tests....

checked reading at 2pm: 6.0.  Perfect,  i thought.
checked reading at 3pm: 4.4.  Hmm, I thought.  not good
checked reading at 3.30pm: 4.0.

Have abandoned test.

I know that obviously I am having too much insulin somewhere, but if I can't do these frigging basal tests how am I meant to know whether I need to adjust the basal, bolus or correctional ratios??!!  I need to change something - and now - if I'm going to have any chance of performing a full 
basal test.  What to do?


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## Dory (Jan 29, 2013)

right.  have phoned and left a message for an urgent appt with the DSN tomorrow sometime.  The more I try and understand the numbers the more and more I just get things foggy in my head.

I'm just going to let them look at the numbers and suggest changes.  Anything to stop the 2, 3 hypos a day I'm currently having.

All I know is that it's too much insulin.  But dont' know where to cut down.


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## Pumper_Sue (Jan 29, 2013)

Dory said:


> All I know is that it's too much insulin.  But dont' know where to cut down.



Logic says the simple option is to reduce your basal.
Lower the basal and use that as a starting point.


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## everydayupsanddowns (Jan 29, 2013)

I haven't looked this up, but I think John 'Pumping Insulin' Walsh suggests a complete reset if things are completely out of kilter.

Some of the results you posted a while back from partial basal tests made it look like more insulin was needed (climbing steadily overnight), but here you are crashing.

Not sure if this will appeal, but you could start from a blank page...

I'd make a note of your current pattern first so that you can refer back to it.

The take your average TDD for the last 14 or 30 days and if hypos are your problem of late consider reducing by 10%, 15% or something.

Then take 50% of that reduced figure (the idealistic basal:bolus split) and that will become your new daily basal. Then set the flat rate as 1/24th of that over 24 hours.

You could also consider resetting your meal ratios by the 500 rule (or similar) ie 500/TDD = grams of carb dealt with by 1u of insulin. Flat rate all day.

Then cautiously test over the next few days to see if you can spot repeating patterns of highs/lows. and look to sort basal first, then tweak meal ratios.

Only do this if you have completely lost faith in your current set-up as it's pretty much a 'hard reset'. Like starting pumping all over again. And *before* you do that it would be good to pass the suggestion by your DSN to get their steer.

Better still get hold of a copy of Pumping Insulin which explains it all in much more detail (and without the errors of memory I've probably introduced!)


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## MaryPlain (Jan 29, 2013)

Dory said:


> ok, so either my basal, bolus or correctional ratio is too high at breakfast: my reading went from 11.8 when I had breakfast at 7am to 3.8 at 10am.
> 
> Had lunch at 1pm, reading was 7.9.  Had 45g CHO, 6.7u bolus and 1.5u correctional.....thought all was set perfectly for this evening's tests....
> 
> ...



When you correct, what ratio do you use? I only ask because 1.5 seems quite a lot for a reading of 7.9.  My own correction for that level would be 0.6 units.  Of course that also depends on what your target level is. Personally if I was planning on doing a basal test and I wasn't sure of my correction ratio I probably wouldn't correct a 7.9, thus removing one source of variation.

Also, what is your lunchtime carb ratio? I can't work it out as 6.7 doesn't go into 45.

While I agree that you need to get your basals right before tweaking anything else, I also sympathise with your difficulty in getting a good starting point to do the basal testing, which means you have to start with the information you've got and change one  thing at a time.

Another thought is that I don't think I would have necessarily abandoned the basal test. The difference of .4 between your 3pm and 3.30 readings was so small as to be insignificant and it's possible that at 2.5 hours the remaining action of the insulin might not have lowered your levels any further - depending on what you ate.

Maybe a strategy could be to choose a time when you are happy with your level and take it from there - any time when you have no active bolus insulin and it's at least 4 hours since eating.

It's very frustrating I know but you'll get there eventually I'm sure - hang in there!


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## Dory (Jan 29, 2013)

Mike - yes, book is ordered with Amazon and due for delivery any day now.  I'll see what the DSN says about adjustments.  The numbers really aren't going in anymore, it's waaay over my head.

Mary - I have quite high insulin resistance hence the high correction factor.  And that time of day I'm on a ratio of 1:7 - sorry I mistyped the carbs, I had 47g not 45g.

I think the problem is I've been so used to eating a lot throughout the day because I've got a lot of insulin.  When my food portions go down, I've still got all that insulin flaoting round.  So overall, I think it's probably about time i lowered everything.  Complete overhaul.


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