So the last few diabetes related posts I have mentioned that I was experiencing some lows, a lot of them actually, and usually at night. Now that really isn’t so bad. Honestly I like keeping my blood sugar lower than higher, but there were a few times where it gone down right annoying and scary. There is nothing like having your pump go off almost every 2 hours telling you your bg is low and you need to do something about it. Having to get up, go downstairs and get something sugary (mostly because you forgot to put something sugary next to you side of the bed…again!). Then you have to clear the alert and hope that what you had to eat/drink will bring you bg up, but not too high. Now imagine that for almost 2 weeks straight and you have my last two weeks up until Tuesday.
What happened Tuesday you may ask? Well, I decided to change my basal rates. What is a basal rate you ask? Good question. We all people have basal insulin, well all those except Type 1s I guess. It is the background insulin always swimming in your bloodstream for “just in case”. Type 1s like me need either long acting insulin or a pump to take care of that basal insulin need. For a better definition have a look here or here. Most pumps allow for quite a few basal rates, some as many as 24, one for every hour. Thankfully mine are not that complex. My basal rates really haven’t changed that much over the years and I am not sure if that is a good thing or a bad thing. Right now I have 7 different rates or profiles if you will. Mine are such that I get a little more insulin during the day(my bg tends to be high in the afternoon) and a little less during the night(when I am not so “active”). Well, here have a look at them:
What you see is that I get a little over a unit of insulin on average an hour. That means about every 8-10 minutes I get a little squirt of insulin. This helps regulate my bgs over the course of a day so I don’t have to eat at certain times if I don’t want to. That is one of the beauties of the pump. You see on shots, your insulin only lasts so long. Regular short acting insulin lasts 4-6 hours, while the longer acting insulins can last anywhere from 8 to 24 hours. You can look here if you want some more info. On shots once your insulin is out it is out and you either need another shot or your bg goes up. With insulin comes food. On a pump however, the basal insulin is always going 24/7 and you just bolus when you eat. I’ll get into boluses in a later post.
Ok, so why am I changing my basal rates? You see over the last few weeks I have been having lows for reasons I can’t really explain. I haven’t really eaten any less, at least as far as I can see, and I haven’t really changed anything else in my diabetes regimen. But I was seeing a pattern develop where I was low right before lunch, before dinner, and overnight. I was always getting a low warning from my CGMS. I was willing to live with it until that one day before dinner when I thought I was feeling good and decided to test and saw 35 come up on my meter. 35! Yowza! The lowest I ever really remember being is 32, really feeling it, and that was scary. Here I had a 35 and thought I was feeling fine. I saw that and just asked my wife to get me a juice box (or 5…I HATE bad lows, as I described here). It was then I decided I needed to start thinking about changing my rates to see if that had any affect.
So I started to just think up what I could do in my head. You see (for reasons I will get into in a later post) I have always hated changing my basal rates. If it ain’t broke don’t fix it. But really since my rates haven’t changed in so long I know that I have. I eat different. I exercise different. I take different medications now than 14 years ago when I started, yet I have always been reticent about changing my basal rates. This time I figured what the heck. I was going to do some complicated math and do all these fancy changes, then on Monday night I noticed I started going low again. I was about 80 when I went to bed and just knew that my LOW BG alert was coming, probably at 1 or 2AM. I then said to myself…Self! Let’s try a temporary basal rate reduction…only 80% of your normal rate. And with that I set my temporary basal rate at 80% and went to bed. I woke up the next morning and realized I never did get that LOW BG alert. I looked through the graph on my pump of the last 24 hours and saw that from about 11pm to 6am my bg stayed right around 80-90 and never dipped lower or rose higher. Not bad I thought.
So on Tuesday I broke out the software and hard ware to program my pump (my pump came with the ability to program it from a pc, you can do it manually on the pump but that just confuses me and being in IT I trust myself to program it better than by hand). So I hook everything up, start the communication and take a look at my settings. I backed them up and saw that I can have 2 additional basal profiles besides the one I use. Nice touch, I can test out these changes without messing up my main rates. So I decide on 10% and 20% reductions for these two profiles. And that is across the board. Just as a test I want to see what happens. So here is what my profiles look like now:
So Standard is what I started off with. Pattern A is Standard -12% while Pattern B is Standard -20% give or take a few hundredths of a unit when you round and I am a generous rounder. Mind you I did this on Tuesday morning …while at work…and started Pattern A right away. So far it has been 2 days and I have seen some differences. I have noticed that my bg has been higher than usual. Not bad higher, just higher. Like going to bed at 110 instead of 80 or having my pre-dinner bg be 149 rather than 90. How do I feel about this? It’s nice not to be woken up for 2 nights with a LOW BG alert but I have to wonder if I went to far. Time will tell really. I figured I would give myself a week on Pattern A, if I like it I will keep it. If not I will either go to Pattern B (-20%) or possibly create a new one that is -5%. Time will tell and I really like not waking up in the middle of the night. I’ll keep you posted and I’ll see what changes stick.