Adjusting basal on a pump?


#1

Hi,

I just switched to an omnipod a couple weeks ago from mdf. Right now I have two profiles 0.50 from 12am to 6am and 0.65 throughout the rest of the day.

I am noticing a jump of about 80 points from 2am to 5am. Assuming this is dawn phenomenon.

If my ISF is 40 do I adjust a block between 12-3am to be equal to 2 whole units to counteract the DP?

I also tend to spike 40 points upon waking up. Any suggestions around this? It has been frustrating trying to basal test as I seem to get different results depending where the pod is.

Are adjustments usually recommended in .10 increments?


#2

I started with Omnipod about 18 months ago. My last few years on MDI I developed pretty rotten DP and was usually 160-180 in the morning. Even if I used a small evening shot I would sometimes go to the 40s during the night. Sounds like you have one profile with two time segments on your PDM. My DE set my initial basal profile to .55 12am-4am, .60 for 4am-7pm, .55 for 7pm-12am. She felt the evening drop was important to counteract DP. That really worked for me as the DP disappeared almost immediately. A few months later I tweaked on my correction factor because it seemed if I went high the corrections were not strong enough. Neither my insulin or correction factors we’re adjusted in the first few months. We worked on confirming the basal settings first. I now have 2 stored basal profiles, a “high” and “low”, both use the same three segment time profile above but the high delivers more insulin. I use it for travel, cruises, days when I don’t have exact carb counts. When I stick to a steady plan I drop it to low.

So you might consider breaking into three instead of two time segments. I use .05 increments but I am on a concentrated insulin (off label for Omnipod actually but 25% of my DEs pod clients use it so I’m totally comfortable with that). The absolute numbers I use vs what you use don’t matter as .1 may be right on for you. When you are working on getting your basal rates right I strongly recommend that you use similar infusion sites, follow a steady meal plan, keep variables the same as much as you can so you can reliably see if the basal change you made worked or not. Also don’t over tweak by changing factors and basal rates and time blocks at the same time. I think my DE was right on in getting the basal rates nailed and then tweak the bolus factors. I checked in with her on changes I thought I needed. Omnipod is wide open to set whatever so just be methodical. :sunglasses:


#3

When making your basil adjustment, also keep in mind that the insulin takes some time to actually start working - I use 30 minutes of “buffer” time so that when the spike starts, the insulin is already working to stop it. Build that time into the basil so you can avoid the spikes.


#4

Short answer, yes.


#5

Doing a basal rate testing will help even out the bumps in daily blood sugar trends. Here’s a good article on basal testing.