Fed up

4 06 2008

So, I’ve been having a problem with my dinner numbers for a loooong time now.  I brought it up at my last diabetes appointment (not with my endo, but with a diabetes educator) and she had absolutely zero clue as to what to do.  So, time to ask the blogosphere!  Here’s the deal:

  • for most of the day my basal rate is at .55 units/hour
  • 6:30 pm Blood sugar’s fine (90-110), bolus (1:10 I:C ratio) and eat dinner (varies).
  • 7:00 pm LOW LOW LOW, usually around 65-70.  I try VERY hard not to overtreat; usually just have 1 or 2 Starburst and that’s it.
  • 7:30 pm basal rate gets kicked up to .75 units/hour
  • 8:30 pm Typical 2-hour after dinner test yields a moderate blood sugar (140ish) with just about the right amount of insulin on board.
  • 9:30 – 10:00 pm  HIGH HIGH HIGH, easily at 170+ with practically no insulin on board.  Correct heavily and go to sleep, hoping I don’t overtreat and go low overnight.
  • 10:00 basal rate goes down to .60 units/hour for overnight

So, fellow PWDs, what’s going on?  At first I thought it was a combo problem with eating a high-fat meal (i.e. need less insulin up front and more extended insulin to combat fat), but I find this pattern no matter what food I eat.

I’ve thought of decreasing my I:C ratio to maybe 1:11 or 1:12, but I still worry about going high later.  Also, I wouldn’t think that a I:C ratio problem would show up as quickly as 1/2 hour after eating.

I’ve also wondered if the resulting high is a reaction of my body because of the low.  I do try very hard not to overtreat, but maybe my body is still freaking out anyway.

I suppose I could do a combo-style bolus at dinner, but that probably means there’s an underlying basal problem.  However, my last dinner basal test with similar rates (not quite exactly the ones I’m using now, but very very close) yielded steady numbers.  I can probably try a dinner basal test again, which will be much easier with Charlie, but other than that, I’m out of ideas.  Thoughts?

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3 responses

4 06 2008
Lili

If it’s not gastroparesis, it sounds like a basal problem to me. Sorry.

5 06 2008
B

I wish I had a solution, but all I can do is sympathize b/c I’ve had a very similar problem. Mine ends with waking up the next morning 200+, in spite of the fact that I’ve upped my nighttime basal. I don’t want to go overboard, though, I hate those middle of the night, sweaty lows! I’m thinking the first comment is right, though, we should both try tweaking the basals. Maybe bump it up 2 hours after dinner?

13 06 2008
Scott K. Johnson

Hey there! 🙂

I have a couple of quick thoughts on this – might be worth a try.

Maybe your dinner insulin is hitting your system faster than the food is digesting. You could counter this by doing an extended bolus (even just 15 or 30 minutes) so see if you can get the timing down.

I attended a talk once long ago where the presenter said that when our BG’s go low our bodies panic and start spitting out all kinds of BG raising hormones. A couple of those hormones have a very long delay before you’ll see the BG rising. So – if that is what’s happening with you, avoiding those lows right after dinner will be the key to it.

Worth a shot maybe?

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