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Re: [IP] Basal Testing!--Q&COMMENT

In a message dated 11/22/02 11:09:44 AM Pacific Standard Time, 
email @ redacted writes:

> 2.  I am still struggling with the issue you described below about 
> sleep-time BGs.  If I eat ANYTHING with carbs after 8:00, it doesn't matter 
> what it is and it doesn't matter how perfectly I count carbs and bolus, I 
> wake up HIGH at 2AM; then I take my correction bolus, go back to bed and 
> when I wake up again around 6:30AM I usually have not gone down at all!  
> But if I am able to not eat anything after 8PM (VERY HARD FOR ME!) I 
> sometimes wake up low at 2AM.
> I do know I need to do a basal test overnight!  But aside from that I need 
> help to figure out my bizarre metabolism during the night!  I am wondering 
> (help anyone?!) if I need to change my bolus ratio for the 8:00-bedtime 
> span or should I just try to strictly prohibit any food intake at night 
> (which would help my weight loss efforts)?   Last night I had pizza and I 
> guess I over-bolused a bit b/c 1.5-2 hours later I was 47, I had some juice 
> and felt better.  I tested an hour later (before bed) and was 52.  I did 
> not eat anything else and went to bed b/c I KNEW if I ate/drank anything 
> else I'd spike in my sleep.  So, went to bed at 52!  I woke up at 2AM to 
> test, feeling high and was 227!  I took 2.5u and went back to bed.  woke up 
> at 6:00AM and my BG was 220!!!  I'm very frustrated!  this isn't new but I 
> don't know what to do.
> I have an endo appt. Dec 5th but frankly, I don't know if he'll have much 
> help to offer me on this!  He is the one who told me he didn't care much 
> about basal tests!--this is my most recent endo (3rd one) I have had to 
> switch to b/c my insurance dropped my previous awesome endo & CDE/pump 
> trainer who got me on the pump and doing great!  I'm a bit frustrated, 
> looking for suggestions, and wanted to say, Summer, that I was glad to read 
> that at least one other pumper has been experiencing what is my biggest 
> frustration!  Although, I certainly hope you get yours worked out soon:-)
> If anyone has any words of wisdom or suggestions, or even any endo's in 
> Dallas, TX who are covered by CIGNA-HMO I'd love to hear anything:-)  I'm 
> trying to get pregnant too!  So, I want to stay in tight control!
> Happy Friday everyone!

    Hi, Janet,

       I can totally relate to those two problems. It sounds like you may be 
having that "Dawn Phenomenon" effect in the early morning, in which you liver 
causes a release of glucose.  When you do your basal testing, you may find 
that you need to increase your basal rate in the early morning to cover those 
highs.  That way, you can eat your bedtime snack to prevent the 2am crash, 
and not get the 6am high.   

         As far as pizza goes, when I think I'm counting the carbs and 
bolusing correctly, I'll still crash an hour later, and then wake up high, 
also.  When I talked to my CDE, she said that a lot of people have that 
problem with pizza.  I haven't tried to use the "Dual Wave"/"Square Wave"  
bouls features on my MiniMed 508 yet, which allows you to give yourself part 
of the bolus at the regular rate, and part of it at a slower rate to cover 
the delayed rise in BS (and I've read on this list that there are other was 
to set your pump if you don't have this feature), because my Dr. said he 
didn't think I needed to, but I think I need to in order to reduce the risk 
of going low too soon, and high many hours later.  

  YMMV,   Debz
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