Hello! If you’re noticing you have an after meal spike at breakfast (not a bad one going up to 180 at most) then declining but not back to where you started the meal (so for example this morning I was 93 before breakfast and at the 3 hour mark I’m at 157) would this be indicative that I need a stronger IC? This has happened 3 days in a row now, so I’m going to try 1:8 tomorrow instead of 1:9 but first wanted to ask others if they thought basal could be at play too.
Hi @Tee25 you can’t get good I:c if your basal rates are off. The way you tell is by skipping a meal and seeing if your blood sugar is rising or falling during that time. I always try to check basal first. If your basal was good, then what you are saying seems right and you could adjust your I:c for more meal time insulin if you feel comfortable changing that setting. Of course, morning is the hardest one in my opinion. Good luck.
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Taylor @Tee25 , generally I’d agree fully with @Jioe that basal check and adjustment comes before I:C change. But knowing that you have recently worked hard at validating your basal, I suggest that your U:C might be your current choice. BUT, rather than dropping from 1 to 8 to 1 to 7, you may want to try 1 to 7.5 and see what happens.
One other factor that comes to mind, is the weather is cooling and cooler temperatures often require more insulin; so it is possible that both basal and bolus might need adjustment.
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My body is less sensitive to insulin in the early morning. I use a 1:7 ratio for bolusing at that time of day. I use a 1:10 ratio the rest of the day until late evening when I use a 1:15 ratio.
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My personal experience/way to deal w/ fluctuations is to monitor basal from before bed - around 11:30 - through next morning - around 10:00. If my levels are stable, then I take this as a good indication that basal is correct. Keep in mind I do MDI, so by “monitor” I mean, if my bs is good before bed (generally 90-120 is good, relative to when I last took insulin), and I’m not low overnight, and if the next mid-morning, before eating anything, my bs is around 100, then my basal is good, so fluctations are probably due instead to bolus.
At the same time, sometimes I might go to bed good, but end up high in morn., and this could be b/c I didn’t take enough bolus for dinner. This may be the case even though I eat at 6:30 and don’t eat anything for the five hours before bed. In this situation, if it happend just one or two days, I assume it’s a bolus amount issue. However, if I persistently am high in the morn. (i.e. three days in a row), I then assume it’s basal (I do a split w/ Lantus, usally 8 in morn., 1 at night. 1 unit is usually enough to tamp down dawn phenomenon for me. If high in morn. for 3 days in a row, I then do either 9 in morn. or 2 before bed, something like that).
I’ve found that even waiting five or six hours between meals may still not necessarily indicate whether it’s bolus or basal that is the issue, b/c my bs can go up that long after eating simply b/c I didn’t take enough bolus insulin (I always split my boluses too, for this reason, to prevent going low in the short-term and then high several hrs. later).
Anyway, it’s tricky. I too would suggest tweaking carb ratio first, see what happens, then tweak basal if bs seems to still continuously trend upward. Hope that helps.
Thanks all! I think it’s a basal issue again so going to do some good old fashion basal testing again. Diabetes is never dull 
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Sorry another question on basal that I’m noticing. It seems to be okay during actual meals. But if I got 5-6 hours without eating, I notice I start to climb. Sometimes slow where I wouldn’t say it makes that big of a difference because I’ll be at 99 for a bit and then 120 at hour 6, but sometimes it’s more aggressive. Like yesterday at about 5 hours I was 136 after being 98 at the 4 hour mark and then noticed I was continuing to go up so I took a small correction since I knew I would be taking my dinner bolus in a bit anyway. Is it possible that I need less aggressive ICs then and actually more basal? But the other thing I’m unsure of is since I usually eat at 4-5 hour mark and I’m obviously at a decent starting point there, should I just leave it alone? Sorry for the random question but I’m at least starting to see a pattern so that helps!
that’s my guess. but it is important to note the time. the best part of pumping is the ability to increase/decrease basal at the time it is appropriate.
btw, 99- 120 isnt a trend (not truly significant one you consider meter error) but 98 to 136 (IMO) is, even if it is just a little bit. for the period observed, you start about 1 hour before you noticed the trend and adjust basal. basal changes, especially small ones, can take 3 weeks to see a difference in some people. if you make a change… leave it be for at least a week before retesting, if you get into the habit of “its not working, I need more” you may end up “chasing your own tail”
Thank you! That’s also helpful 