Goldilocks And The Overnight Basals…
Overnight basals need to be fixed first. When you’re on an insulin pump, that gets drilled into your head as you work with your healthcare team to get your blood sugars tightened up. If you don’t get them straightened out, the rest of your day is shot. I’m proof of that.
The basal rate that you start with changes over time (I’ve been pumping since 1999, so that’s pretty much a guarantee that it’s not the same.). If your weight fluctuates, if you’re chronically stressed, if your activity level increases or decreases, you can find yourself crashing or soaring repeatedly. Not having a solid and stable basal pattern saps the energy out of you and no amount of caffeine is going to make you feel alert. Again, I’m proof of that.
My overnight basals have been off for a while, but it took my Dexcom to show me where I was off - and it wasn’t what I thought.
Without my Dexcom on, my 2am BG reading was within normal range but my 7am was in the 200s or the 300s. I was convinced that I was Dawn Phenomena-ing it (That rise in hormones, including cortisol and epinephrine, that causes insulin resistance.). I would wake with fuzzy head (which matches fuzzy hair and fuzzy slippers, so it’s a complete ensemble) and correction bolus nudge myself downward to an afternoon and evening of relatively normal blood sugars.
But it wasn’t Dawn Phenomenon. Dex showed me that around 3 to 4am, I was slowly creeping down to the 60s and 50s and staying there for a while until my liver pumped out the sweet goodness that it offers, shooting my blood sugar up just in time for me to curse the alarm (or even worse, my daughter) for waking me up in a groggy state.
I’ve adjusted my basals and changed my Dex notification to “HEY GET UP! GET UP!”. I’ve worked with a CDE and we’ve adjusted them yet again.
Here’s the story now:
One rate is too low, keeping me at 150 to 170 most of the night. Yes, no low blood sugars, but in the long term, not acceptable. If I adjust it 0.025 units/hour during the time I need it, I crash at least once per night. Also not acceptable. I’m exhausted and running out of Glucolift tabs.
I’m Goldilocks.
Too much.
Too little.
Never “just right”.
I think I’d rather sit on a tuffet. Or scrub seven little pairs of socks.
And I’m more of a Cream of Wheat girl than porridge.
These basals will get straightened out eventually, but when you’re in the middle of the fairy tale and you can’t skip ahead to the “Happily Ever After” part (Although I don’t think Goldilocks has one of those.), it’s frustrating. Why? Because I know once I get this overnight basal to work, my body’s insulin needs will change. Again.
Yes. Too bad pumps can’t accommodate in-between needs. :(
What is a Tuffet anyway?
Basals are one of the most difficult things to reign in & one of the most satisfying. Good luck!
I hate feeling like we have to fine-tune all the time. I’d rather set it and forget it! Silly diabetes. Good luck with getting all of the tweaks worked out.
I’m so curious lately about the liver’s sweet goodness. I’m sure it varies by liver, but what’s the timing like on the sweet goodness delivery? Say you’re low—60—and notice right away and have some glucose tabs. Will the liver still try to join in the fun? Or is it only when you’re low for some substantial period of time that it kicks in?
I love your blog.
And that’s why I was skeptical when I sat in a diabetes workshop and heard the speaker ask how many people have more than 3 basal rates. Most of us raised our hands. The speaker said “You’re doing it wrong. The liver does one thing consistently. Produces sugar. If you have more rates than that you are covering for your food.”
Umm… no.
I wonder if you might be able to find some useful dialogue in the CWD forums? I bet a lot of little kiddo’s are very insulin sensitive, too. Might be worth investing a bit of time into (because I know you have TONS of time to invest…).