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

Ted & Richard,

I am on day 9 on the pump.  I really appreciate your discussion of the basal rates.
First five days went great for me.  Last four were very different because of the
dawn phenom.  I think the dawn phenomenon was due to a lot of stress at work this

Brent Mayes

Ted Quick wrote:

> "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
> occasionally,
> 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
> strength
> 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

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