Author Topic: Just goes to show how often basal needs checking.  (Read 1124 times)

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Offline Pattidevans

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Just goes to show how often basal needs checking.
« on: 29 November 2016, 05:50:36 PM »
Was going to put this in the pumping section, but then I thought and decided it was more about insulin than pumping really, as it applies equally to those on injections.

19 days ago I finished the trial of the Libre and at that time my overnight basal was spot on.  I could see it trundling along all night with a fairly straight line and I was waking with FBGs in the 5s or low 6s with the one exception where I under-calculated dinner and even then, although the line was in the 9s, it was still flat.  Since then the weather here has turned distinctly colder and for the past 14 days my FBG has rarely been under 7.9 and quite often in the 8.5 range. Plus I have been struggling to get it down all day. That seems quite an abrupt change for a few degrees colder weather... but there it is.  I cannot pinpoint any other reason for this.

So I am very pleased to have picked up another sensor today so I can do some basal checking.  Had to go all the way to Truro to pick it up from the clinic, but did some shopping in the big Tesco at Pool on the way home so that was OK.  I have received this from Abbott as there was some mix up about a further trial and it has come as something of a "consolation prize".  I note they must have been getting rid of stuff that's about to go out of date though, as the "use by" date is 31/12/16!  So they wouldn't have been able to sell it!  Lots of members of the FB group have received stocks with short sell-by dates recently (although longer than 1 month).  Not funny if you've ordered in bulk to save on postage.

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline everydayupsanddowns

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Re: Just goes to show how often basal needs checking.
« Reply #1 on: 30 November 2016, 10:45:14 AM »
Absolutely agree Patti. Not sure if you saw this (or more importantly the trial mentioned): http://www.everydayupsanddowns.co.uk/2016/10/night-time-nonsense-perfection-isnt.html

Essentially, in a reasonably large CGM trial they looked at variations in insuline requirement over entire 24 hour periods and also compared days and nights. It turns out that insulin requirements overnight are likely to be even more variable than those during the day. Just at the point where you would *think* nothing is happening and things should be at their most stable - your body decides to throw a curve-ball and vary insulin requirements more!

FWIW I am having a right old time of things at the moment. All sorts of bizarre changes and reactions to 'normal' tried and tested meals. Fun fun fun!

Typical eh!
Mike

Type 1 since: 1991 Last HBA1c: 45 (6.3%)  Total Chol 5.0 (1.9HDL / 2.8LDL / Trigs 0.7)
Pumping NovoRapid in a MiniMed 640G
Blogging at: www.everydayupsanddowns.co.uk

Offline Pattidevans

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Re: Just goes to show how often basal needs checking.
« Reply #2 on: 30 November 2016, 03:52:55 PM »
Yes Mike, I read that blog with a great deal of empathy!  I just wish I could get two nights the same so I could decide what to do about the basals, even if only temporarily! 

Quote
FWIW I am having a right old time of things at the moment. All sorts of bizarre changes and reactions to 'normal' tried and tested meals. Fun fun fun!

Arghh.. dontcha just hate that?  I know ratios aren't supposed to change like basals, but I am not having normal reactions to the evening meals either.  It is nagging at the back of my mind that possibly stopping taking metformin means that my ratios need adjusting, but I can't really tell until I buckle down and start weighing stuff instead of guesstimating it.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline himtoo

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Re: Just goes to show how often basal needs checking.
« Reply #3 on: 01 December 2016, 04:05:33 PM »
I had to increase my basal rates by approx. 5% a couple of weeks ago when we had our first real cold spell.

T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline sedge

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Re: Just goes to show how often basal needs checking.
« Reply #4 on: 01 December 2016, 05:29:43 PM »
I didn't - and now it's staying cold, afraid I'm getting morning hypos, which is pretty ridiculous.  However because they don't happen at around the same sort of time each day despite a bit of selective basal testing (just night/early hours and morning rather than all day regardless - it's certainly a puzzle.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Just goes to show how often basal needs checking.
« Reply #5 on: 02 December 2016, 08:56:15 AM »
How different are the times you are having the hypos Sedge?


I'm not entirely sure whether this sensor is going to help at all in sorting overnight out.  I did start it right away and some say that if you leave it in 24 hours before activation then it's more accurate right away, whereas if you activate it as soon as it's in it takes 24 hours to settle down.  Anyway, night before last I woke to go to the loo at around 2 am, swiped and it said 2.9.  Checked with the meter and I was 8.  Around 4.30 the sensor said 3.6 but my meter said 7.2.  It seemed to settle yesterday morning and was reading much the same as the meter.  Then last night according to the sensor I was well hypo all night, but at 4am when I did a finger prick I was 5.2 and not hypo at all.  I know they say it can read low if you lay on it, but I've never had one that far out before.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline everydayupsanddowns

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Re: Just goes to show how often basal needs checking.
« Reply #6 on: 02 December 2016, 10:48:45 AM »
I am realising that the 'shape' of my general basal curve has changed more in the last 12 months than in my entire previous 4 years of pump use. It used to be that the general shape would stay the same, but just gently drift up and down a bit a few times each month.

Over the last 12 months though, the whole shape of it has changed multiple times, with peaks and troughs in completely different places. Probably compounded by the fact that my heart hasn't really been in 'proper' basal testing, so I've been making more ad-hoc changes on the basis of post-meal levels. I have properly basal tested a couple of times, but to be honest things seem to be swapping and changing so rapidly that I'd struggle to get a full set of double results (to ensure pattern not daily variation) done before things changed again, so I've drifted into fire-fighting.

I might try a lunchtime-evening test today if I remember as I've a Libre sensor on and it makes it very easy.
Mike

Type 1 since: 1991 Last HBA1c: 45 (6.3%)  Total Chol 5.0 (1.9HDL / 2.8LDL / Trigs 0.7)
Pumping NovoRapid in a MiniMed 640G
Blogging at: www.everydayupsanddowns.co.uk

Offline GrammaBear

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Re: Just goes to show how often basal needs checking.
« Reply #7 on: 03 December 2016, 02:58:56 PM »
FWIW I have also been having some strange looking curves in my basal reading too.  It was very mild weather where I live until the past week or so.  That also happens to be about the time when hypos appear at the oddest times and during the night I would go high.  Prior to all of these odd numbers, my basal was spot on.  Now I am in the process of resetting most of my entire basal profile given what the CGM is telling me.  Then again, when next Spring comes along, I will be doing it again.  Never a dull moment with diabetes.
Type 1
Tandem Tslim pump Oct 2015
Dexcom G4 CGM Sep 2007
A1C 6.5%~ Sep 2017

Offline Pattidevans

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Re: Just goes to show how often basal needs checking.
« Reply #8 on: 03 December 2016, 08:19:42 PM »
Kathy

I am not unsympathetic, but honestly if you don't have to reset it until next Spring you are exceedingly fortunate!  I seem to have to do it about every 6 weeks if not more often.

Mike,

Interesting that the whole shape of your basal has changed.  At the moment I cannot make head nor tail of my basals overnight as they are truly wierd, but that might be this sensor which doesn't seem very accurate and also the fun and games I am about to mention in another thread!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline GrammaBear

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Re: Just goes to show how often basal needs checking.
« Reply #9 on: 04 December 2016, 04:38:26 AM »
Patti ~

I understand your position about setting your basal rates all too often.  I did not mean to say that I only have to do it twice a year.  Actually it is a complete change from basal rates, correction factor and insulin to carb ratios at least twice a year.  I, too, have to fiddle with tweaking basal rates every 6-8 weeks.  The Endo does not think I need to have this approach, but he does not live in my house.  He figures that once you set your rates, they should be good for a long, long time.  We all know how that approach works.

Type 1
Tandem Tslim pump Oct 2015
Dexcom G4 CGM Sep 2007
A1C 6.5%~ Sep 2017

Offline sedge

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Re: Just goes to show how often basal needs checking.
« Reply #10 on: 05 December 2016, 02:20:32 PM »
Exactly as Mike said - random times.  Early hours, or just before I normally get up. or mid morning, or late afternoon, or after dinner, or late nights - but no pattern.  But anyway other than a hypo before lunch last Friday, since then I've been equally inconsistently higher and slapping temp basals on ever since.  It's just all over the place.

But anyway I'm still alive, and there seems little point in buckling down to do basal testing absolutely to the letter until it's decided if it's going to settle at all - I have an absolutely stinking cold at the mo - it'll be a 'thick' one for some hours and then start sneezing and be dripping wet for a time and then reverse.  I feel OK apart from using a whole kitchen roll as hankies in 3 days (tissues aren't either thick enough or don't have the tensile strength depending on where the cold is at alternately) so I can't see making any sense of it until I'm a bit recovered from that.  Then it will be Xmas - so all I can do is plod on!

And hope I CAN make sense of it again sometime in January ......
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Just goes to show how often basal needs checking.
« Reply #11 on: 05 December 2016, 02:53:15 PM »
Quote
I, too, have to fiddle with tweaking basal rates every 6-8 weeks.  The Endo does not think I need to have this approach, but he does not live in my house.  He figures that once you set your rates, they should be good for a long, long time.  We all know how that approach works.
That's interesting.  I know basals change frequently but I thought that bolus ratios were supposed to be more or less "set" particularly if you have basals right and they aren't interfering with food.  I'm pretty sure my own bolus ratios are wrong right now, but had put it down to the fact that I stopped taking Metformin.

Sedge

Sorry to hear about your cold.  I always find tissues too flimsy, but kitchen paper too rough.  Have you tried paper hankies (the ones that come in little packets of 10), they are thicker than tissues but a lot softer than kitchen roll.

Apart from that, like everyone else is saying, my BGs seem random and not a pattern to be seen!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Liam

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Re: Just goes to show how often basal needs checking.
« Reply #12 on: 05 December 2016, 03:00:22 PM »
My ratios rarely change but they have. It is almost always basal. Once you exclude basal then only ratios are left then it is them!
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Pattidevans

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Re: Just goes to show how often basal needs checking.
« Reply #13 on: 05 December 2016, 03:11:42 PM »
I found it very interesting that other people's ratios change!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline everydayupsanddowns

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Re: Just goes to show how often basal needs checking.
« Reply #14 on: 05 December 2016, 03:21:07 PM »
I found it very interesting that other people's ratios change!

I reach a point with basal changes maybe twice a year where the change has become significant enough to also seem to need to be matched with a ratio tweak.

This has always seemed fairly logical to me to be honest - If my basal dose has risen/dropped by 30% over a month or two, which can happen, then I might also cautiously notch my meal ratios up or down by 10%. I can then sometimes find (because mostly these days I have not been doing it 'properly' and actually fasting-testing my basal) that I might have been covering bolus shortfall with extra basal and may need to dial my basal back a notch or two.
Mike

Type 1 since: 1991 Last HBA1c: 45 (6.3%)  Total Chol 5.0 (1.9HDL / 2.8LDL / Trigs 0.7)
Pumping NovoRapid in a MiniMed 640G
Blogging at: www.everydayupsanddowns.co.uk