Basal Rates

Dawn Phenomenon, Spring Style.

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My levels have been a bit of a mess over the past couple of weeks.

A few weeks ago, I began to notice my blood sugar levels slowly but steadily rising through the night. I found myself waking up to blood sugars of 8 or 9 at around 2am and giving a correction, only to find it had little effect by the time morning rolled around.

After I had ruled out any after effects of afternoon snacking or evening meals, I began increasing my overnight basal rates until I had curbed that steady rise.

But I still hadn’t quite managed to clean up the spill.

To add to my woes, the FreeStyle Libre sensor I’m wearing at the moment to fine tune those rates has been producing long flat red lines through the night – the kind of ‘LO’ readings that make me a walking talking miracle. Thankfully, multiple finger prick readings quickly confirmed that Libre is at fault, and not me.

I’m usually quite tuned into carb counting, protein and how I bolus for my meals when I’m on my feet at work. Yet morning after morning, I would bolus for my breakfast and find my blood sugar spiking into the teens. Those highs would carry through into my morning tea and lunch.

Eating is something that I can’t really afford to be skipping at the moment. I’m working on packing more into my meals to fuel my active days so that I don’t feel so dreadfully exhausted and limping into bed at night. I’m a better person for it.

As I was setting up the basal profiles on my brand new tslim over the weekend, a mental lightbulb flicked on in my head.

If I had increased my basal rates through the night to cover my dawn phenomenon, why hadn’t I increased them to cover my insulin resistance the moment I wake up?

I have been tinkering my overnight basal rates back and forth since I began pumping insulin two and a half years ago.

I have a theory that the lighter mornings during Spring and Summer enhance that insulin resistance in the wee hours of the morning, compared to the darker days of autumn and winter.

After upping my waking basal rates by 25%, in line with what I had done through the night, I’m hoping I have a better week in store for me.

All About That Basal, ‘Bout That Basal

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I remember those inflatable beach balls that I used to get as a kid. The kind that often came in showbags. Inflatable hammers, mascots, and giant fingers for that matter, too.

They were so much fun. I would muck around, and have such a good time with them for a while.

Then they would begin to deflate. They would get these tiny little punctures that you can’t see, and the air began to escape them. Even though I tried to blow them up again, playing with them just didn’t compare to an unpunctured one. No sooner than I had patched up one of those holes, I would discover another. And another.

At the moment, I feel like one of those inflatable beach balls. I feel like I’m trying to patch up these little flaws in my basal rates, and try to stop my blood sugar levels from spiralling out of control.

Since starting out on an insulin pump, I can quite honestly say that my basal requirements in the early hours before waking have been subject to the most fluctuation. I can recall having to make subtle changes every month, or every second month at the very least. It’s been a steady upward trend, which I usually pick up from my FreeStyle Libre, or when my levels stop responding to corrections during the night.

After steady upward adjustments in recent months, I’ve now found myself waking to a few lows in the early hours. Looking over my Diasend history, the downward trend seems to start out at the 4am mark, so I’ve made some subtle changes again.

I am still struggling to grasp the fact that a basal rate that once held me steady through the night, no longer does. One theory that has been hanging over my head in recent days, is the early morning light coming in through my window. Over the past few months, the earlier morning light could have enhanced my dawn phenomenon before waking. But with the mornings now getting darker, could my insulin needs be heading on a downward trend? Time will tell…

I’ve also noticed changes in my morning basal requirements after I wake up. I usually run a higher basal rate for the first 2-3 hours to combat dawn phenomenon, and I’ve had to jack this rate up by 0.1 units per hour. While the new rate gives me much better coverage, this basal rate still needs some more perfecting. Basal testing, particularly morning basal testing, is hard work. There are days where I deviate from my routine, days where my levels might not be ideal for a basal test, days where I can’t handle more failure, and simply days where no coffee is too hard.

Unlike my last problem, I feel like this one has been triggered by a shift in routine. Which brings me to another theory. I think basal rates are a little bit like a cog in a wheel. When you change something here, it might provoke subtle changes somewhere else in the wheel. I don’t know…I’m just thinking aloud here.

My biggest gripe about diabetes is that it is always changing.

But I truly believe that a well tuned basal, and bolus regimen, is the key to success with an insulin pump.

March on…

Working Towards a Lower hba1c

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I am only two weeks away from finding out what my latest hba1c result will be. And I am dying to know.

In August, I learned that my hba1c had gone up after three months on a pump. I was extremely disappointed at the time, but did take solace in the fact that my BGLs are far less variable than they once were. 

I’ve been working hard at taming my blood sugar levels over the past two or so months. I do genuinely feel like I am making progress and taking steps in the right direction. But there are definitely still some tough spots that are taking time to work through. 

Routine has been key to taming my blood sugar levels. Through the week I generally wake up, go to work, have my meals, come home and go to bed at the same time each day. Having that sort of consistency makes it easier to experiment, compare and make adjustments to insulin doses.

Nights have probably been the most consistent. I still wake myself to check once through the night. Sometimes small correction doses are needed, but I am waking up in range almost every morning.

Mornings are probably the smoothest portion of my day, blood sugar wise. It is still extremely tough to obtain consistent results, because I begin work at 7am with varying levels of physical activity from day to day. While breakfast on Monday left my levels smooth sailing, the exact same breakfast (and an identical waking BGL) yesterday sent me a little higher than I’d like. As much as I try not to beat myself up, this is ever so frustrating!

Afternoons have been somewhat tricky to smooth out. I sit down to lunch for an hour at 1pm after a morning of physical activity, which means I need a higher basal rate in action for this hour alone. I go back out to work at 2pm for another hour of physical activity, before finishing at 3pm where I once again need a higher basal rate of insulin. It’s definitely been a loooong game of trial and error, with many curse words thrown towards the sight of upward trend arrows on my FreeStyle Libre. Urgh.

Speaking of FreeStyle Libre, it is a lifesaver. Having easy and unlimited access to glucose monitoring means I have greater insight into what’s happening with my levels. Adjustments are easier to make, and I can better respond to highs and lows. Like this low, that rebounded high, and ended miraculously in a steady line.

 It’s becoming hard to live without it (first world problem, I know…).

Evenings are probably affected a little by my afternoon levels, and I’m confident that they will be easier to manage once my afternoon basal rate is right. My evening meal is also a cooked one, meaning that my carb counts are more estimated and varied than others. 

I am also being super diligent with my eating. I am putting more effort into preparing my meals and snacks through the day. This has definitely resulted in more variety and enthusiasm towards the food in my lunch box (hello ham and eggs on toasted Sourdough), and less of a desire for junk food and unnecessary carbohydrates. I definitely want to expand on this in another post to come. 


I’m also noticing that my total daily dose of insulin is now both lower and more consistent, which can only be a good sign!

Which brings me to now. I am nervous. I have absolutely no idea whether I have done enough to make a dent in my hba1c. I’m trying not to be too unrealistic about my expectations, but I’d be lying if I said I didn’t have high hopes. If my average glucose readings are anything to go by, I’m expecting that I’ll be sitting around half a point lower to where I was in August.

I’m determined to make these last two weeks count. And not because I’m scrambling, like I did back in my diabetes juvie days. I’m watching my FreeStyle Libre reader like a hawk, and making those last minute improvements that will hopefully make all the difference.

I am absolutely dying to find out where my hba1c is sitting right now. Crossing my fingers and toes for November 9…

Minimise The Lows. Minimise The Lows.

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“Are you alright?”

“What’s wrong?”

“You seem quiet today.”

I knew why my work mates were asking. Diabetes has been affecting me so much at work lately, to the extent that my feelings could be read off my face with ease.

“I’m fine. It’s nothing.”

It wasn’t nothing. But the last thing I felt like doing was talking about it.

Going to work with the insulin pump has really tested my patience. I’m on my feet and moving around for much of the day, which makes insulin a lot more sensitive than normal. My work day is a prolonged period of physical activity, and not simply an hour of exercise. I guess what makes the insulin sensitivity more of a big deal with the pump, is that my basal insulin is being delivered to me live and continuously as I’m working, unlike Lantus. 

For a few days last week, the hypos were relentless. I recall having at least three on one day, in particular, last week. Three. Every time I crack open a fresh canister of skittles, I hear my diabetes educator’s voice ringing loud and clear in my head.

Minimise the lows. The first thing we need to do is to minimise the lows.

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Hypo unawareness is my biggest fear. With every passing hypo, all I think about is was whether I can feel it or not. I think about how much longer I will be able to feel them. At the end of it, all I really want to do is succumb to the defeating exhaustion that follows.

I had talked over my work day with my diabetes educator in the beginning. On a scale of 1 to 5, I’d rated my level of physical activity at around a 3. We’d anticipated a reduction in basal insulin requirements while I was working. I just never anticipated that the taps would take so long to turn down. I’ve now reduced my basal rates to about one seventh of my normal rate, and it finally seems to be holding me steady through the mornings.

The other factor that I am also starting to consider is the insulin I take to cover my meals at work. I’ve been plummeting quite quickly after my lunchtime insulin dose, and I’m starting to think that I might need to reduce my bolus by a certain percentage.

I’m hardly a role model for physical activity. I’d never have guessed that it would be such a significant issue for me on the pump. Not in a million years did I expect to be here, writing about physical activity and diabetes!

But I’m close. I’m really close to nailing this.

Back To Work With An Insulin Pump!

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I felt a lot more comfortable adjusting to the insulin pump at home, despite the enormous patience and mental strength it required. I didn’t have the added stress or pressure of being at work, or anywhere, at a given time. By the end of week one, my overnight basal rates were holding me steady through the night, and my diabetes educator was confident in my ability to justify the decisions I’d made around my basal rates. I saw out the week with a greater level of confidence in the device that was attached to me.

Going back to work, however, threw a curveball into the mix. It was a great relief to be able to pull out the pump and show everyone that it wasn’t a surgery, or a great big computer strapped to my back. But suddenly, my pump workload had doubled. I had two very different days, with very different activity and insulin requirements to consider. 

My job is quite a physical one. I am on my feet for much of the day. Some days I am simply standing around the table where my team breaks down deliveries. Other days I am climbing ladders, lifting things intensively, or furiously unblocking the cardboard chute. The intensity of my activity often varies throughout my work day.

My biggest setback in those first few days was hyper programming my pump settings, without being patient enough to see them through the day before making changes.

I had initially set my basal rate to drop back a notch at 7.30am, half an hour into my work day. In response to a 17.0 on my FreeStyle Libre on Thursday morning, I gave a 2.5 unit correction that my pump suggested.

The ease of access to glucose data through my FreeStyle Libre tested my patience that morning. I was compulsively scanning. Scanning, scanning, scanning, way too frequently. Upward trend arrows, hitting glucose levels of 18, 20 and 22 within minutes. I was impatient, and set a temporary basal insulin rate of +10%.

Within half an hour, my levels were starting to fall. Feeling satisfied, I cancelled the temporary basal rate.

Half an hour later, I was still falling. I kicked my basal rate down again.

Half an hour later, and I found myself hypo. I set a temporary basal rate of -50%, and treated it.

My biggest mistake in those first few days at work was trying to micro manage data after meals, before the insulin had finished doing its work. My diabetes educator had told me that the first thing we needed to do was to minimise the lows. Yet I couldn’t get that stupid high off my mind.

I know damn well that insulin takes time to kick in, but I ignored my better judgement. I probably upped my basal rates unnecessarily, which was essentially extra rapid acting insulin in my system in the hours that followed.

I paid for my compulsion throughout those first few days with some very exhausting lows.

This week, I am trying not to hyper program my pump. I am setting basal rates the night before, and sticking with them through the day before making changes. 

I am trying to remember that what goes up, must eventually come down again.