New Basal Settings Not Working for Me


A couple of weeks ago my endo changed the basal settings on my pump, reducing my early morning (2:00 – 4:00 a.m.) and my morning to afternoon basal rates. She did this for two reasons: the first was that I had been waking up a little low for the previous two weeks, and the second, was that she did not like my basal to bolus ratio. She told me that only overweight type 2’s take 65% of their insulin as basal. I tried to tell her it was because I eat a low carb diet, but she did not seem to listen.

Although I didn’t think I needed a change in my basal settings I decided to listen to the doctor, or at least give her a chance. Since then I’ve been spending my mornings chasing down my blood sugar (bolusing without eating) and going low during the night and waking up high.

I can deal with these periods of out of control blood sugar as long as they don’t affect my running too much. I’ve been working hard training for the upcoming Tel Aviv Marathon and there are only 10 weeks of training left (7 if you don’t count the taper).

Friday morning I planned to a 20 mile run with a few friends I’m training with. The first few miles were supposed to be at an easy pace, but most of it was supposed to be at a pace equal to or faster than my marathon pace.

I woke up at 5:00, feeling very alert, but in a strange way. I checked my blood sugar and was shocked to see it was 275. I knew it was too high for running but I was also scared to take any insulin. I decided to delay setting a temporary basal rate until I started to run. I got ready to go, drank a cup of (black) coffee, and checked my blood sugar again, 253. Close enough, I thought to myself, thinking about the 250 blood glucose rule – you shouldn’t run if it’s higher than 250. 

I reduced my basal rate to 30% and headed out.

I ran a mile and a half to the meeting point and checked my blood sugar again. It was down, but still higher than I’m used to – 214. I met up with my friends and we headed off. I explained to them that my blood sugar was totally off and as usual they were understanding.

We ran a couple miles and stopped to stretch. I checked my blood sugar again. Usually this would be the point where I’d have my first gel of the day, but my blood sugar was still too high 187. We continued running, 5 miles later we stopped to again to drink, take gels, and allow me to check my blood sugar. Finally my blood sugar was low enough to take a gel – 114. We continued running increasing our pace. I felt weak, but hoped it would pass. We stopped again 7.5 miles later. Everyone took a second gel; I checked my blood sugar thinking it would be somewhere around 100. I was totally wrong. My blood sugar was 201. I needed to wait with my gel, although I really needed it. I felt totally empty. I ran another mile and a half with my friends and stopped again. I told them to continue without me.

I felt bad and hoped my blood sugar had dropped which would explain my weakness and allow me to take a gel, but my blood sugar was 186. I ran another mile and a half and checked again. I was desperate, hoping things would some how work out but my blood sugar was still too high, 163. I had run more than a half marathon on one gel, and was too high. I continued for another mile and a little but started feeling dizzy. I stopped running after only 16 and a half miles (out of my planned 20). I felt terrible, both physically and mentally. I walked home, cold and tired.

When I got home I checked my blood sugar again. It was 171.

“That’s it,” I said to myself, “I’m changing my setting back.”

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10 years ago

Hey Mike,

sounds like a difficult training experience…  How low are you on carbs? how many do you consume a day?

Nathan Shackelford
10 years ago

I’m glad you are doing what works for you. I find that our intimate knowledge of our BG trends is a pretty important factor with dosing. Again, your original basal to bolus ratio was appropriate for a low-carber. My CDE said the same thing to me too, but couldn’t quibble with my level of control. It’s like we need a low carb guide to the pump…

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