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Long, was: Re: [IP] Help with Basal rate please!!!!I can't get it right!


< I have been a diabetic for 15 years and have been pumping since February
4, 1999.  I test my blood sugar at least 10 times a day and I still can't
seem to keep my blood sugars stable.>


These questions are always difficult to answer, since everyone is so
different (YMMV). That said:

It sounds like your BGs are fairly level during most of the day, with the
morning giving you the most problems. This is pretty common among pumpers -
sometimes referred to as the "dawn effect" (I can't spell phenomenon).
Typically dealt with by raising the basal rate in advance of the rise in BG
levels, to offset the increase. Drop the basal rate in advance of the
falling BG later on - this should result in fairly "flat" BGs. This "lead
time" may vary throughout the day. In theory ...

I've seen patterns similar to yours. It seems my dawn effect "shifts" -
it's never exactly at the same point at the same time. So, even though I've
got one of the best tools to work with (my pump), the raw materials (me)
keep changing in quality and quantity. This can drive the quality control
"inspector" (my endo) somewhat batty, leaves the "customer" (me) scratching
his head <g>

The best thing for me is averaging things out. I'll never get things
perfectly level - after all, I've got diabetes - BGs happen <g> I aim for a
safe waking BG level - a level which leaves me some room to drop
unexpectedly, due to things I never planned or forecast. If I'm a little
higher than target when I wake, I bolus to adjust.

Since you see a steady rise over the course of 5 hours in the morning, try
looking at the 4:00 a.m - 12:30 p.m time period, and fine tuning this zone.
You're currently only increasing a very small amount over a long period of
time. You might benefit from a number of basal changes for shorter periods
of time during these hours. Depending on how quickly you respond to basal
changes with Humalog, you might need to make the basal change anywhere from
1/2 hour to 1 hour in advance of when you want your BG to move (perhaps
longer, if you are more insulin resistant in the early morning hours).

Your other BGs sound good. Personally, I wouldn't worry too much about
going from 125 at bed to 150 at waking, especially if you bolused for a
snack. I'd much rather see a slow rise like this, compared to a drop in my
BGs. Early morning hypos were a problem for me through 42 years of this
disease. I've learned to play things on the safe side. Now, the paramedics
send me Christmas cards, instead of invoices <g>

"Over testing" as you describe it, is tempting. Rather than checking 1/2
hour after a bolus, you might want to wait one hour. Unless your insulin
works very quickly, you may not see a change in your BG this soon. If
you're high to start with, it may take even longer to see the BG change.
"Patience is a virtue, but sometimes I just don't have time for it" <vbg>

Sounds to me like you're doing well. You've got most of your basals set,
you recognize your tendencies and patterns. You're now officially part of
the "pumpers club" - those of us who get somewhat frustrated with not being
able to achieve perfect numbers. The fine tuning part can be challenging.
Try the Basal Rate Estimator at:
http://www.insulin-pumpers.org/howto/baslr.html for some guidelines.

I've been at this for three years ("pumpiversary" was April 1) - one of
these days I'll get it all figured out <vbg>

Bob Burnett

mailto:email @ redacted

Insulin Pumpers website http://www.insulin-pumpers.org/
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