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Re: [IP] Is this when I need the square wave bolus?
> Bolused after eating, since I started out low and thinking I could cope
> with some of the delayed digestion.
> At 11:00 p.m. (ready for bed) test blood sugar: 98 -- perfect. Go to
> sleep, wake up c. 4:00 a.m. feeling like crap. Test blood sugar: 306.
> My basals are now pretty well set and if I eat normal healthy food and
> go to bed with an acceptable blood sugar, I will wake up with an
> acceptable blood sugar (or even a tiny bit low).
You'll probably get 15 different answers - sigh... all of them will
work at one time or another. Anyway...
Sounds like you might have gone low and
rebounded. What kind of insulin are you using?
This is a pretty standard reaction if your insulin gets in late.
Insulin and digestion match pretty well for about 3 1/2 to 4 hours,
then you run off a cliff and all the insulin after that point just
takes you down. Lily had this problem for a while until we figured
out that A) on regular she had to bolus 30 to 45 minutes early or she
would go low in 4 hours and B) on H/V 5/1 mix at least 1/2 of insulin
must go in at onset of meal and the rest immediately at the end of
meal. This turned out to be true even if she was LOW.
It is better to correct the low with glucose or some crackers and
bolus correctly for the meal.
This can all be figured out low/high predicted direction, etc... by
applying the unused insulin rule.
> I think in a case like this I need to usse my square waave bolus, but
> I'm not sure. Do you program it to give more insulin than normal? I
> was thrilled to get a 98 after dinner out, but now I know it will
> probably rise significantly overnight. Can't bolus extra at 11:00 or
If the above explanation turns out to be bogus for you, consider
running an elevated temporary basal rate for an hour or two when you
go to bed that will give you the extra insulin as/after you go to
sleep. That delays the effect of the insulin up to several hours so
you will not go low/high.
Lily's basal requirements go from 0.1u/hr waking to 1.5u/hr an hour
or so after she goes to sleep. With a variable bedtime, she has use a
temp basal at bedtime for several years now to eliminate the low/high
swing you mention.
This method should be carefully checked by waking (over several
nights) on 1 hour intervals 12:00 - 2 first night 1:00 3:00 second
night or something like that. YMMV
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