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

"Richard D. Spector" wrote:
> Hello all my name is Richard Spector,

Hello, Richard.
> My basal profile is as follow:
> 12:00 am - 4:00am  .9
> 4:00 am - 9:00am 1.0
> 9:00 am - 12:30pm 1.1
> 12:30pm - 4:00pm .08
> 4:00p - 12:00am .09
> I am on a 1unit to 10grams of carbo count
> and a 1 unit to 30point for lowering my blood sugar.
> I am using Humalog insulin and I have no signs of Gastro stomach nerve
> problems.
> My problem is in the early morning I tend to have a steady increae in
> blood sugar without eating a thing.  

Sounds like Dawn Phenomenon to me. It's why I got my first pump 5+ years ago.

I can wakeup at say around 6:30am
> and my sugar will be 95 and then it will steadly increase and by 11:30am
> it could be 180.  So I almost always have to give myself a high sugar
> bolus to combat the raise in blood sugar.  It can range from a .5 to 1.0
> bolus. It never comes back down on its own.  This isn't always the
> case.  Sometimes this happens and sometimes it doesn't.  I have
> evaluated the level of stress during this time and in is the same during
> each day but again sometimes my sugar will only raise 25-40 points and
> sometimes it will raise 80-100 points.  I usuall will not eat a single
> thing until after 12:00pm.  I don't feel hungry until early lunch.

OK, one well known effect of Dawn Phenomenon is that it will usually raise
the bg level through the morning BECAUSE you haven't eaten enough (or possibly
early enough) breakfast. Your body has a built in system to give enough energy
to start the day, which is the reason for Dawn Phenomenon. Most people, diabetic
or not, have this happen daily.

So, what happens is that your body knows it's getting to be time to wake up and
the liver releases some stored glycogen (which becomes glucose) to get you
started for the day. If you eat breakfast it will stop putting out the glycogen
fairly soon and you can be stable through the morning.
> I try to increase the basal rate from 9-12:30 and sometimes it works and
> sometime it drops me to low or I have a low blood sugar in the mid
> afternoon for no reason even if I haven't ate all day.

OK, thing is that Dawn is best counteracted BEFORE it gets going, not after 
you wake up. For instance, I have my lowest rate, 0.4 u/hr, from midnight to 
3:30 AM, then raise it to 0.9 till 4:00 AM and 1.5 from 4:00 to 7:00. This 
keeps me from going low during the night before Dawn kicks in, then makes the
energy availble for getting up, as nature intended. I used to go directly from
the lowest dose to the highest at 4:00 AM, but it had some rough edges
so I put in the intermediate step to keep it smoother.

> Am I taking to much insulin for my height and weight. 

Hard to be sure from here, but I think it's just not distributed right around
the day. Once you find the basic pattern it may be reduced in total, but
that remains to be seen.

 I am very
> frustrated with this process.  I am very good about taking my blood
> sugar.  In fact maybe to good.  I will feel my sugar starting to
> increase and I will try to bolus to correct the increase and then I wil
> take my sugar once every half hour to see if it has come down.  I am
> sure this ads to my stress level.  But I want to make sure that the
> insulin is working.

I'd suggest that you get up at 3:00 AM or so and test to see if the dose
needs to be reduced between midnight and then. If you go low then you MIGHT
be suffering from both Dawn and Somogyi Effect (rebound from early AM hypo)
which can confuse ANY plan. Anyway, this will give you a basis for starting
out right, then work through the rest of the day one phase at a time. There 
is a good "how to" section on the IP webpage (though I haven't looked at it
myself) that explains this in detail, as I understand it.
> My afternoon sugars and evening sugars seem to be okay.  Sometimes I
> will eat something before bed and I will check my sugar and it will be
> 125 and in the morning it will have increased to around 150.  Not always
> a problem I assume I miss counted on the carbos.
> Please help and if any more information would help I will be happy to
> provide it for you.

One other thing that may affect you. Humalog has been seen to decrease in
for SOME of us after about 2.5 days in the pump. This can be counterbalanced by
mixing Humalog with Velosulin or Regular insulin in a 5 to 1 ratio. This
stabilizes the
Humalog without changing the activity curves noticeably.

Ted Quick
email @ redacted
Type 1 for 43 years, MM506 for 5 years, MM507c now.
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org