# Some basal results - can anyone look over for me please?



## lauraw1983 (Jan 22, 2016)

So, still trying to nail these basal rates, morning first! I would really appreciate it if some of you seasoned pumpers could take a look over these and give me your thoughts? After making some changes my basal profile is this:

I had eaten nothing since 6pm the night before. BG was 11 at 11pm, corrected down.

00:00 - 06.00u
01:00 - 0.600u
02:00 - 0.600u
03:00 - 0.600u - BG 6.3
04:00 - 0.600u
05:00 - 0.700u
06:00 - 0.700u
07:00 - 0.850u - BG 4.3
08:00 - 0.900u - BG 4.2
09:00 - 0.925u - BG 4.2
10:00 - 0.925u - BG 4.4
11:00 - 0.925u - BG 4.3
12:00 - 0.600u
13:00 - 0.600u

So obviously a little too much of a drop from 6.3 to 4.3 @ 7am. But staying very steady!

I was going to change my 05:00 and 06:00 rate to 0.650 - would you agree?

Still have the 12:00 and 13:00 to do obviously, will update with those when I can.

Does anyone else find it hard to have these perfect situations to do basal testing? I've forced myself this morning to stay fairly "resting" to try to nail these rates, I work a desk job but don't work a Friday so normally much busier (with temp reduced basals running!) but tomorrow and Sunday being the weekend my routine is pretty different again! How many of you have a different "pattern" set up for weekends?

Thanks in advance for reading & any help appreciated!


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## everydayupsanddowns (Jan 22, 2016)

I am NOT making these as suggestions for what you should do - but here's what I would be thinking if these were mine...

I had eaten nothing since 6pm the night before. BG was 11 at 11pm, corrected down.

00:00 - 06.00u _Correction still working_
01:00 - 0.600u_ Correction still working_
02:00 - 0.600u _Correction still working_
03:00 - 0.600u - BG 6.3 _Assuming 4h insulin duration correction is now finished, perfectly in range so correction factor looks good_
04:00 - 0.600u
05:00 - 0.700u
06:00 - 0.700u
07:00 - 0.850u - BG 4.3 _OK We have dropped 2mmol/L here. Not disastrous, but not ideal. Without extra info I would assume general dip from 3am onwards. Basal changes take an hour or two to kick in, so we need to lose some insulin from maybe 3-4am onwards until just before waking_
08:00 - 0.900u - BG 4.2 _All holding steady from here on in - really ridiculously good!_
09:00 - 0.925u - BG 4.2
10:00 - 0.925u - BG 4.4
11:00 - 0.925u - BG 4.3
12:00 - 0.600u
13:00 - 0.600u

Possible changes:
02:00 - 0.600u _becomes 0.575u - begin to back off basal v slightly before the dip began??_
03:00 - 0.600u _becomes 0.575u_
04:00 - 0.600u _becomes 0.575u_
05:00 - 0.700u _becomes 0.650u_
06:00 - 0.700u _keep this as-is to counter any possible DP from rising onwards_​Then retest on another night to see what happened - ideally filling in the blanks a bit by testing at midnight, 2am, 4am, 6am rather than just 3am. It may be that the blocks aren't right and you need a slightly different 'shape' with some rates lasting longer and others shorter. Hope that aids your thinking.


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## lauraw1983 (Jan 22, 2016)

Thank you so much - it really helps having others input into this! I had planned to test at 5am but would appear I slept through that alarm - lots of nights of testing to get my overnight correct have left me knackered! Oops. I will revisit that in a few days just to check it.

I can see what you mean about backing it off slightly earlier too in the early hours. 

Thinking of setting my alarm tomorrow and getting up as though it is a work day, to see what happens when I eat. And then may fast over lunch time tomorrow if I have a fairly quiet afternoon - would you say that's a good plan?

Hmmm just to confuse things, my 12 noon test is 8.3!! A rise of 4mmol.    That suggests my 10am basal rate needs tweaked too?


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## everydayupsanddowns (Jan 22, 2016)

Difficult to say for sure on just one basal test - especially a morning one. My liver can get a bit twitchy after all those hours of fasting when I skip breakfast and has been known to do it's own unpredictable thing, releasing some stored glucose. Sometimes you can keep it quite with a chunk of cheese or something so it realises you are not starving.

On the other hand it might be that you DO need more basal late morning, and this boost is partly showing in your post-breakfast spikes.

Fun and games eh?!


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## lauraw1983 (Jan 22, 2016)

Hmm I see what you mean re; liver. Ok I will disregard that reading just now, not act on it. 

13:00 I was 7.4....

Scoffed some lunch now, was sooooo hungry! 

Curious what my 2 hour test will be, and 4 hour. I hope I am back in range.....fingers crossed!

Fun and games...grumble grumble......

My plan tomorrow or Sunday is to fast over lunch period. Although that relies on my carb ratio at breakfast being correct, and I have a sneaking suspicion it isn't, I think I possibly need 1u:8g rather than 10g? I suppose tomorrow morning is my test for that, see what my bloods do when I have food and from there can decide how to proceed - sensible??

Thank you again so much


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## everydayupsanddowns (Jan 22, 2016)

Sounds like a plan!

Did you leave any delay between lunch bolus and eating? And (if it does spike and you feel able to ride it out) check what the reading is 4-5 hours after lunch dose. Then compare that with fasting test over the same period to see if some of the BG movement might be basal, or ratio ,or a bit of both.


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## lauraw1983 (Jan 22, 2016)

I left about 10 mins, I know not quite the recommended 15-20 mins but was after school run, had to eat, then back out to my daughters dancing! I will do a 2 & 4 hour test, and possibly a 5 depending on the results! Would you correct at the 2 and 4 hour marks if recommended?

Just reminded myself, must phone the pharmacy to reorder test strips....gone through many more than usual!


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## everydayupsanddowns (Jan 22, 2016)

Not sure - would depend how I felt. Sometimes if numbers not too errant I take a couple of days with fewer corrections because all that overlapping insulin makes it much harder to see what's going on and the before/after of different doses.

Tricky call though, and def correct if numbers really running amok!


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## lauraw1983 (Jan 22, 2016)

So 2 hour test @ 3pm - 11.0

Hmmmm. Didn't advise a correction as 'correct' amount still on board. Will check again at 5pm....


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## lauraw1983 (Jan 22, 2016)

5pm - 6.8

So right back in target range at 4 hours - I want a nice 2 hour post meal reading!


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## everydayupsanddowns (Jan 22, 2016)

If back near range at 5-6pm then I would suspect timing rather than dose/basal is behind the 11.


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## everydayupsanddowns (Jan 22, 2016)

Oops! Posted as you were writing that.

Seems to me that shows that the dose is 'right' but the food is hitting too fast or the insulin is acting too slow.

Try waiting 20 mins to see if any difference, then 30 mins or 40 mins or whatever if not. Either that or look at the meal composition and mix it up a bit to see if you can find something that hits your BG slower.


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## lauraw1983 (Jan 22, 2016)

It's just annoying having to think about taking a bolus way before I have food - I don't always know and can't always wait to eat! Because I have stuff to do, not cos I am greedy.   Am I alone with that feeling!? I do know what you mean though. And I will trial it as I am curious what the difference will be once the basal part is correct....

6pm test - 3.8 - doh! 3 jelly babies then my dinner, only 18g carbs.....

8.30pm - 11.7  (!!)

Lunchtime meal was a pretty even split of carbs, fat and protein btw.


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## trophywench (Jan 23, 2016)

Firstly I agree entirely with Mike's suggested adjustments - I NEVER change any dose by more than 5% at a time if I can help it.  It's amazing how much difference altering 0.50u/hr to 0.51 or 0.49, can make !


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## lauraw1983 (Jan 23, 2016)

Thank you. Yeah my clinic have always said a 0.25 or 0.50 change at most each time and adjust gradually.

Went to bed on 6.8. Woke this morning to a 4.9 and 2 hours after breakfast - 8.8. 

Curious what it'll be at 4 hours, just praying for no hypo so I can do the basal testing as planned this afternoon - got the other half taking the kids out so I can focus on it today...hopefully! Afternoon a film or 2 for me! If it goes belly up, I will just go swimming with them! Lol.


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## lauraw1983 (Jan 23, 2016)

Sorry wrote that earlier but hadn't posted it - doh!


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## lauraw1983 (Jan 23, 2016)

Ok.....here we go with today's fasting results!


07:15 - Woke on 4.9 (yay!)
Ate breakfast about 07:45 - 52g carb - 5.2u given
09:45 - 2 hour post breakfast - 8.8
11:45 - 4 hour post breakfast - 7.7

07:00 - 0.850
08:00 - 0.900
09:00 - 0.925
10:00 - 0.925
11:00 - 0.925

Started fasting:

12:00 - 0.600 - 7.7
13:00 - 0.600 - 5.7
14:00 - 0.550 - 6.4
15:00 - 0.550 - 4.8
16:00 - 0.475 - 4.7
17:00 - 0.475 - 6.7
18:00 - 0.650 - 7.8

Ate dinner about 6.15pm. 69g carb - 6.9u plus 0.2u correction given. Will do 1, 2 & 4 hour tests post meal tonight.

_Changes? The 1pm to 0.575 and 2pm to 0.525? And the 4pm to 0.525?_

A quick question too - if doing 2 hour post meal tests, but it's a meal you want to pre-bolus by 15-30 mins for, do you test from the time you took your insulin or the time you started eating? Sorry if that's a really daft question!

If anyone has time to tell me what you would do/change if these were your results, I would again be forever grateful! I am slowly beginning to see the wood from the trees a little with it all...!


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## lauraw1983 (Jan 23, 2016)

Oh and what about the 4 hour post breakfast reading being from 4.9 to 7.7 ???    The day before the 4mmol jump I had was at the same time....so possibly more basal than bolus? Increase just the 10am one slightly?


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## trophywench (Jan 23, 2016)

52g is quite a big brekkie isn't it?  Do you regularly have that much?  - and Yes - it looks like a bolus issue to me mid/late morning rather than basal.

Moving to the afternoon of course, if you increased the 11am one to eg 0.95 - you might not have to do another thing, because your 1pm BG would not be that high neither would the 2pm.  Then, that means the 13.00 base rate would probably need to go DOWN - but try the 11am one first, and see what happens.

It can take ages, this - but just get it about right then live with it a bit and have a flippin rest I should !

Laura - it's never perfect every single day - never!  But if that's what you think you are gonna get - then you will be constantly disappointed I'm afraid.


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## lauraw1983 (Jan 23, 2016)

Not always that much no, but knew I would be fasting too - I am also doing slimming world so trying to stick to the 'rules' of that! It was a protein pot Arla yoghurt thing (13g carb), all bran crunch topping (35g of it, 19g carb) and an apple which was 20g carb. Nothing horrendous....I sometimes have similar and sometimes have much less, it depends how I split my day up really!

I am not looking for perfection, I am well past thinking that can be achieved , just looking to work as best I can on the results I have to smooth things over - my levels before were rather up and down! Alongside my anxiety as I knew it had to be tackled - just trying to do my best.


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## trophywench (Jan 24, 2016)

Well Laura - let your best not be in such a hurry, Mate!

It's like the tortoise and the hare you know - taking all this slower - will actually get you there quicker!  Honest it will.


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## lauraw1983 (Jan 24, 2016)

I know it's not some instantaneous solution, I know there's always changing goalposts with diabetes, but you are coming across quite patronising? I am asking for help, from people who have done this longer then me, on a forum designed for pumping. I have a very busy life and so time and the "correct" conditions to do all this testing aren't always easy for me - I have set aside time this past week or so to try to get results I can begin to work from.

What are your suggestions that I should do then to take it slower?


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## Pumper_Sue (Jan 24, 2016)

lauraw1983 said:


> I know it's not some instantaneous solution, I know there's always changing goalposts with diabetes, but you are coming across quite patronising? I am asking for help, from people who have done this longer then me, on a forum designed for pumping. I have a very busy life and so time and the "correct" conditions to do all this testing aren't always easy for me - I have set aside time this past week or so to try to get results I can begin to work from.
> 
> What are your suggestions that I should do then to take it slower?


With respect Laura,
Jenny is quite correct slow things down as Rome wasn't built in a day, the more changes you make in one go the muddier the water.
Jenny speaks from experience, I remember it well lol and @trophywench 
You are not the only one with a busy life style and like you we all have to find time to do the leg work with pumping that is part of pump life. Bottom line is you only get out of pumping what you put in. We are only tying to help you so don't throw it back in peoples face.


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## lauraw1983 (Jan 24, 2016)

With respect Sue,
I didn't suggest I was the only person with a busy life. I am sure Jenny does speak from experience, which is why I am here asking people to try to help me look over my results. I am certainly not throwing anything in anyone's face, that's a little rude. What would you change if those were your results?

Maybe I was/am suggesting too many changes at once, this is where I seem to be getting myself confused though - but I was taught to look where a change occured and change the setting approx 2 hours before? 

So changing the 10am one up to 0.950 should bring that 12noon in a little lower, but then I see quite a dip at 3/4pm (which is often when I dip in the day) so should I not apply a reduction to the 1 and 2pm too? Then fast and re-test over that time frame in a couple of days?


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## everydayupsanddowns (Jan 24, 2016)

I think your results are much closer to perfect than you realise Laura  if I show similar results at my clinic they say, 'we won't see another of these today like this!'

Again, not suggestions, just my thoughts looking at these as if they were mine:

12:00 - 0.600 - 7.7
13:00 - 0.600 - 5.7 .550?
14:00 - 0.550 - 6.4  .500?
15:00 - 0.550 - 4.8  .500?
16:00 - 0.475 - 4.7  .550?
17:00 - 0.475 - 6.7  .650?
18:00 - 0.650 - 7.8

I'd probably ignore the 'dip' at 1pm as quite frankly meters just aren't that accurate, and unless you see that several days running t could well have just been 'one of those things'.

I can see a dip in your BGs 3pm-4pm and a dip in your pattern 2pm to 5pm, but these don't seem to 'line up' so that the basal dip precedes the BG dip. The shape/timing has prob shifted since you set it up before. I would be inclined to back off basal earlier, and ramp it back up earlier too.

Tricky really as if you are not careful you can end up with dozens of rates!


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## trophywench (Jan 24, 2016)

Sorry Laura!  Were I trying deliberately to be patronizing - believe me, not only would everyone else be jumping down my neck - but it would be much more heavily loaded towards it.  There would be no possibility of anyone not noticing unless they can't read yet.  I also do 'sarky' pretty well too.

I have been there myself more than once as Sue mentioned LOL - but the kind of good, kind of frustrating thing I've found with pumping is that I can alter something by an absolute gnat's whisker at - I dunno - 1am or something - and it's still affecting my BG by eg 9pm.  So I just have to wait till I can see if it does or not, before I tweak anything else.  Drives me potty sometimes.  I am not terribly patient.

I have therefore discovered and had to accept, which I didn't want to believe you me cos when I want something done, I want it DONE - precisely because I'm busy and only want to visit each problem ONCE - and sort it so I can forget it and get on with whatever - you cannot DO this with a ruddy pump!  It is only for that one reason, because it does give me better results for more hours out of every single day of my life, and I therefore feel I'm doing better for ME as a whole - that I don't say 'Bollards to the stupid thing!' and throw it in the bin!

So I have to accept it, if I want to keep the benefits.

My driving instructor (Married man, two grown-up daughters) was wont to say to me week on, week out - 'Patience is a virtue, find it if you can.  Seldom in a woman - often in a man!'  He didn't annoy me saying it - cos I knew very well he was ruddy well right!  (Bet his daughters and wife used to want to hit him though .....)


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## everydayupsanddowns (Jan 25, 2016)

How did you get on for the rest of Sunday @lauraw1983 ? Are you considering any more tweaks?


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## lauraw1983 (Jan 26, 2016)

Hi Mike - thanks for asking, came on last night to update but my laptop took a massive wobbly at home! In work but will update later on. Going in the right direction mostly though!


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## SB2015 (Feb 1, 2016)

Hi Laura

I eventually gave up looking for perfection in my readings, acne I realised that this was not going to happen.  Like you I took the time to check on the Basal rates and adjust as necessary.  Well done for your persistence with it all.  It is well worth it.

Delivering the bolus before the meal is worth doing but it is difficult sometimes.  I try to test once I start cooking (actually usually once my husband starts cooking - a bit of a gem), calculate the carbs and then decide on timing of the bolus dependent on BG and nature of food.  The lower the BG ( ie if it is low 4s), and the lower the GI of the food the nearer the meal I bolus, and vice versa.  Having said that I often forget, or I am too engrossed in what I am doing and don't want to stop.  I've only recently started this so I am still sorting how early to do the Bolus so Mike's ideas have been useful.  

Thanks for starting this post and for all the advice from everyone.


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## HOBIE (Feb 3, 2016)

Keep at it Lauraw. Pumps are so adaptable


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