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Re: [IP] low all day

Hi Laurie,

> Do you raise your basal rate for the whole day or just the period
> when you went high

I raise my basal until my body tells me it's dropped again. That may
be anywhere from 12-48 (or more) hours later.

> Do you do a correction bolus as well?

Yes -- I should have mentioned that. I do *not* correct the high bg
with a higher basal. I correct the high bg with a bolus and adjust the
basal to maintain euglycemia (normal bg).

> When you do this do you find that you have to adjust your basal the
> other direction the next day or soon after?

Yes, the basal adjustment may need to be reversed the next day, but
that's easy to do and, meanwhile, I've controlled my bg and felt

One thing I've found is that the basal shift is a jump -- it's not
gradual. I'll cruise at a certain basal and then I'll suddenly need
another one. There can be periods of a week at the same basal and
periods where a given basal lasts a day. Many basal changes occur as
soon as I hit the sack. That may be because the basal change is a
reaction to something I ate. Or, it may be that certain hormonal
changes only occur once I fall asleep. Without something to measure, I
have no sure way to tell. Interestingly, I use the same HCF
(hyperglycemic correction factory) regardless of the basal rate. That
is, when the basal is adjusted correctly, I always need the same bolus
for a given meal. ** My basal changes are independent of my bolus
requirements. **

> I prefer to do a correction bolus if high or eat or decrease a bolus
> if low and then see what happens the next day before making changes.

There's no right answer for everybody, but I do NOT want to wait a day
when I can regain euglycemia with the push of a few buttons.

Many people differentiate between adjustment of bolus and basal. I do
not. To eat or to correct a high bg from a known cause (i.e., I ate
too much of a good thing), I'll take a bolus. If my bg shoots up for
an _unknown_ reason, I need a basal change and I need it NOW. If my
body doesn't need a basal change, I'll know within 4 hours due to a
mild hypo or hyper. Most of the time (>90%), the basal change is
needed for at least 12 hours; I do not want to chase high bg with
boluses for that long.

> But I sometimes have one or two days that are just different for no
> reason and if I change the basal then I would have to deal with the
> opposite problem the next day.

Yes, that's my experience. I raise and lower basals indifferently.
What's important is that I maintain euglycemia and feel good.

> Ironically my daughter told me today that she was having trouble
> going low all weekend and ate all day without taking humalog.

That was certainly my experience on MDI. There were "furnace" days
when I'd eat incessantly and not really seem to need much background
insulin. There'd be other "sluggish" days when I couldn't seem to
lower bg with normal boluses. The pump has allowed me to demonstrate
that these changes occur with some frequency and they can be quite
dramatic. I've discovered some causes, but, alas, not all of them.

The biggest advantage, by far, of the pump for me is the ability to
adjust basals. Adjusting boluses is easy once the basal is at the
right level. In fact, when I'm fortunate enough to have a basal rate
that lasts several weeks, I consider it to be a "vacation."

Of course, as in all things diabetic, YMMV.

regards, Andy
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