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[prue super]

I wanted to bounce this off of some other pump users to see if I have a thorough grasp of what I am attempting to accomplish.

Blood sugars running too high in the morning. Awake at 6:30 AM and fasting BG of 215...I have increased my basal rates slowly and now my fasting BG is 165. I know I am running in the 200+ range around 3:00 AM due to dawn phenomenon but my mission is first to lower my fasting level to 115-125.

1st. adjust basal rate to obtain fasting level of 115-125.
2nd. address the DP with secondary basal
3rd. adjust my insulin to carb ratio if needed.

J have John Walsh's book and this is all still new to me. I am a Symlin user as well.
Thanks in advance for the feedback.
Prue

[gigem99]

It sounds like you have a great grasp on what you are trying to accomplish. I think that once you do get your morning rates up to acheive your fasting goal (something I still can't do, BTW, even after 4+ years of pumping w/ CGM), you'll be well on the way to getting the dawn phenomenon licked as well.

It is best to just work on one thing at a time, as you've indicated. Once you feel comfortable with your basals, then you can tinker with the I:C ratio - but I think I played around with both basals and I:C when I first started. I feel very fortunate that I never had to change mine much, and the tinkering I did was very minor.

Once again, it sounds like you have a good handle on decent goals and how to achieve them.

How does the Symlin work for you? Isn't it supposed to make you feel full very quickly? How often do you have to take the shot?

Tom

[prue super]

It sounds like you have a great grasp on what you are trying to accomplish. I think that once you do get your morning rates up to acheive your fasting goal (something I still can't do, BTW, even after 4+ years of pumping w/ CGM), you'll be well on the way to getting the dawn phenomenon licked as well.

It is best to just work on one thing at a time, as you've indicated. Once you feel comfortable with your basals, then you can tinker with the I:C ratio - but I think I played around with both basals and I:C when I first started. I feel very fortunate that I never had to change mine much, and the tinkering I did was very minor.

Once again, it sounds like you have a good handle on decent goals and how to achieve them.

How does the Symlin work for you? Isn't it supposed to make you feel full very quickly? How often do you have to take the shot?

Tom

Symlin for me acts like a humalog or novalog supercharger. I take the injection with meals. At first it made me feel nauseous so I didn't want to eat but that side effect didn't last long.
60 microgram injection for light meals and 120 for large meals.
Thank you for the feedback.
Prue

[bkh]

Blood sugars running too high in the morning. Awake at 6:30 AM and fasting BG of 215...I have increased my basal rates slowly and now my fasting BG is 165. I know I am running in the 200+ range around 3:00 AM due to dawn phenomenon but my mission is first to lower my fasting level to 115-125.

1st. adjust basal rate to obtain fasting level of 115-125.
2nd. address the DP with secondary basal
3rd. adjust my insulin to carb ratio if needed.

Hi, Prue.

Your approach is reasonable. Here's the thing. If you drive your fasting BG down to 115-125 with a single 24-hour basal setting, you may find that you're getting too much basal in the afternoon, and not enough in the early morning hours. Watch for this to see if your BG is rising in your sleep (if you're not on CGM, set an alarm and measure at 3am, then measure as soon as you wake up.) Similarly, watch for your BG dropping all by itself in the afternoon or evening several hours after you eat.

You might think about starting your 2nd step before you get the 1st completely done. For starters, set a little bit higher basal starting at 1am (since you are finding yourself high at 3am), and drop it back to the lower basal at your normal waking time. You can gradually increase the 1am basal until you get it adjusted so that when you go to sleep with a reasonably good BG, you have a reasonably good 3am BG and you wake up with a reasonably good BG. (You don't want so much basal in your sleep that your BG is dropping overnight.) When your night time basal is working reasonably well, you can continue to adjust the daytime basal until your BG doesn't tend to rise (or fall) all by itself, several hours after your last bolus or correction or carb intake.

The insulin to carb ratio is pretty independent, in that if your basal is anywhere in the right range, the insulin to carb will have the major influence after a normal or large meal. If your BG is good before a meal, and you know exactly how much carb you are eating, and you take the calculated bolus for it, watch what happens at 2 hours and 4 hours after the bolus. If you find that you're usually below 100 at 2 hours and going low by 4 hours, try slightly less insulin per carb. If you find that you're usually over 140 at 2 hours and still high at 4 hours, try a bit more insulin per carb.

Sure the basal and insulin-to-carb do interact, but you can generally distinguish the two effects by watching what happens to your BG in the few hours after a bolus, by comparison to what happens to your BG several hours after your last bolus. When you see a consistent pattern, that tells you what needs to be adjusted: insulin-to-carb, basal, or both.

Small changes. Watch what happens. Adjust it again until it's reasonably good. Then relax until you start to notice that it's not working quite right anymore.

This post has been edited by bkh: Apr 18 2012, 02:18 AM

[Linda B]

You DO need to get your basal right before worrying about your insulin to carb ratios, as bkh already said.

The ONLY way to get your fasting BG right is to stop the 3 AM rise. So that needs to be your first task.

But before we can be sure that it is your BASAL that is causing the 3 AM rise, you need to do a test. If you are having a bed time snack, it could be the carb ratio for that snack is causing you to be high at 3 AM. Are you sure you are not high at 1AM? Are you only waking once during the night at 3 AM? If so, then we really don't know enough info to fix your problem.
Do not eat anything after 7 PM, and test at 1 AM, 3 AM, and 5 AM without doing any corrections. Do that at least twice. THEN you will have enough info to know what changes to make.

Since you have pumping insulin, refer to the basal testing section for even more details about how to figure out what is wrong.

Hope this helps,
Linda B.