Getting a stable basal rate takes a little work. In many cases you might need multiple basal profiles set up on the Tslim for different times of days or some cases based on activity or illness. It will take some tweaking to get it right.
If you are new to pumping, your endo should be able to set up your pump basal(s) based on your prior long acting insulin profile requirements. She/he should have a ‘formula’ to accomplish this for people switching from MDI to a pump.
The Tslim targets your ‘steady state’ BG at 110. The Tslim will increase and/or decrease your basal rate in an effort to keep your BG at 110 mg/dL. With that being said, you will see your basal amounts constantly changing throughout the day/night in an effort to keep you at 110 mg/dL. (This is done automatically by the pump when you are Control I/Q mode.)
Personally, I make every effort to have no IOB, a steady 90-120 BG, and no exercise (at least 2 hrs) prior to going to sleep. For me, these ‘habits’ help ensure that you wake up with a BG close to the target. Having the correct basal rate to begin with is very important… Having an incorrect basal profile will also affect your meal boluses… They interact with each other.
Get with your endo and request some guidance to get this set correct. Don’t delay… Having ‘low’ BGs at night is dangerous and requires prompt attention.
Thank you so much for the info, I’m trying to wrap my mind around all of the macro/micro adjustments and to develop some confidence in trying things out myself, of course checking in with endo or even discussing it with her prior to making the changes.
Can I ask why you try to have no IOB? Do you tend to adjust basal first? Sometimes when I put my carb counts in for a meal bolus and the pump asks if I want to deliver a correction dose, I’m never quite sure how to respond, is there a certain threshold to say yes or no?
Thanks again.
Per your question, I try not have insulin on board (IOB) too close to bedtime. Insulin will want to continue to lower your BG’s after you go to sleep. I attempt to stop eating and insulin delivery a few hrs prior to sleep to reduce chances of low blood sugars. If you can get BG’s in control prior to bed, you can coast into sleep with just using your basal insulin.
I am in agreement with Chris. This is my 6th pump all previous used for 4 yrs and i have also found that to wake with stable bg levels i must not eat within about 2.4 hrs of bedrime, or exercise. I have found both lead to problems overnight for me. I have learned that my body raises my bg from exercise at first from a liver dump only to drop like a bomb about 2.5 hrs later and I eat high protein mes and I get my meal rise sometimes up to 3 hrs after eating. That stuff is all learned over years and has changed as i get older. Repeatable patterns are your friend especially when you are first setting up your pump. Keep a small notebook and record your changes and their effect , I still reference my changes on sick days or prior to fasting required tests.
Amen to this! I have found that I know what is going on with me WAY BETTER than anyone else – my endo agrees & encourages me to tweak my own settings, but has shown me how to do it. You can do this too – even now – like Larry said “A good rule to work from that came from my Endo. If you are low or high 2-3 hour AFTER a meal, your bolus settings are wrong. If you are low or high BEFORE a meal, your basal settings are wrong. We are humans and those rates will, 100% guarantee, not last” so just start tweaking small amounts and see what happens; do 1 change and then wait & see. – And like Joe said, it takes time to figure this all out, but understanding the Basal vs. I:C ratios and how that works to control blood glucose levels is Step 1. – I love these forums too! They are a great place to learn from other T1Ds, let off steam & share support and encouragement. Yes, it’s technical, but you can do it! You. Got. This.
IOB is the insulin in your system. You cannot not have it – if you inject insulin, it will be there. – Like @thequetip Chris said, he doesn’t EAT anything for 2 hours prior to going to bed (so he doesn’t have to inject insulin for the food). You body metabolizes food differently at different times of day, so limiting the inputs to your system prior to bed is the best way to make sure your basal insulin is the only thing affecting your blood glucose. If your basal is set correctly, it will be like @joe said: if you went to bed at 10pm with a bg of 180, a perfect basal rate you’d be getting up at 7am at 180.
This is terrific information. Thank you for sharing what has worked for you and for making it so clear that I could follow your suggestions. I really appreciate your generosity in sharing your info. Thank you!
You’ve gotten a wonderful carload of instructions and suggestions: yay everybody! But I’d like to add one caution. When you’re making changes of any kind, only do one change at a time, then see what happens over the next couple days. Otherwise, you won’t know which change did what. That slows down the adjustment process, of course, but it’s the best way to identify what’s happening. In particular, don’t make a basal change and a bolus-ratio change at the same time!
–Keith
I definitely know what you mean. I remember back in the day not eating for 24 hours checking my blood sugar every 2 hours so my doctor and i could get a really good look. Now its the new sensor…sensors and the newest pump. It definitely is not easy to get the basal right. It makes sense. Its ever changing. Depending on my mood and emotions.
Your endocrinologist should know how to adjust your basal and insulin sensitivity factor if necessary. My dad just got this pump and visited his endocrine who downloaded data from Dexcom and made changes to new pump.
I would say - being your own doctor and making your own adjustments as suggested above, is fine - once you know how to do it. Work with your doctor to learn, and know that small adjustments can make a big difference. The first time I adjusted my basal on my first pump, it was by a full unit. Boy was that a mistake! Nothing I was not able to handle on my own, but I learned the hard way! Learning is key.
[quote=“joe, post:4, topic:72036”]
Make sure you have glucose or candy with you, always, the first couple weeks.
[/quote]. I agree with Joe and as an additional thought I would like to add Juice Boxes (or pouches) to his suggestion. My Diabetes Educator (DE) suggested that I try them and they work faster for me than anything else that I’ve used. Since they are pre-packaged you know how many carbs you are consuming.
Perhaps you have already tried these but I had not even considered them. I now keep several on my nightstand, next to my chair, in my jacket pockets and in other locations that I frequent.
