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Re: [IPk] New pump user Basal / Bolus OK, but BG high?

On Sat, May 17, 2008 at 12:33 AM, Mark Dreher
<email @ redacted> wrote:

> Hi all,
> I have recently started on a Medtronic Paradigm 522 with CGMS (self funded)
> about 5 weeks ago, so far my HBa1c has fallen slightly so a benefit already.
> I have so far found this excellent :-). After the initial start and going
> high/low for no aparant reason I have managed to get my BG's level. They
> seem to sit between 9 - 13. Initially they went from about 2 to 20, weekends
> were terriable :-( I have managed to flattern these out and they now sit at
> about 9 before meals rising to 13, which i'm happy with (ie a 4mmol/l
> increase) but it is far too high. I have managed to tweak the backgorund
> dose to remove the dawn phenomenon I was suffering from, but it is just far
> too high. I have missed meals ie breakfast one day then lunch a few day's
> later to see if the backgorund levels are OK and I believe they are (ie it
> stays level), but it is just too high.
> Any suggestions as to the next step?

First off, congratulations!  That level of stability/consistency is
something I only dream of for my daughter.

Something you haven't mentioned is correction boluses -- if you try to
correct from, say, 9 to 7, without food, what happens?  If the bolus
wizard doesn't recommend a correction because of insulin on board,
reducing your insulin active time may help.  If you get a correction
but it doesn't bring it down far enough, decreasing your insulin
sensitivity may help.

If you can correct down to your target but then you bob back up to the
levels you describe, I'd very gradually increase the basals, one at a
time  Since blood sugar levels affect insulin sensitivity, changing
one basal can have a knock-on effect all day.  Getting the first
waking readings in range before tweaking the rest of the basals is an
approach that works for a lot of people -- so I might try increasing
the late night/early morning basal by 0.05 units/hour and see what
that does for a couple days.

mum of Isabel, age 7, pumping medtronic 522 since 2006
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