Basal tuning on a pump - am I the only one not feeling empowered?

Ok, a week at the lake doing low carb results in some concerning lows around 2 - 3 am (in the 40’s). As I don’t want a dietitian involved right now, I’d rather not pull in the team to make the adjustment - what are your thoughts about 10 percent adjustment in the basal prior to 11? Would you make the adjustment yourself? I’ve been on a pump for about 16 years and have never been encouraged to do the math myself. Is this off the reservation?

My daughter, who turned 14 today, has been pumping since about 5 months post-diagnosis (which was 2.5 years ago), and we’ve done all the setting adjustments ourselves since week 3. I guess I just don’t understand the concept behind running every little thing by your endo/CDE/D-team for “permission” or instructions, like a small handful of folks here on TuD apparently do. Why would you need to consult a dietician? A CDE, perhaps, but what is a dietician going to tell you about your pump settings? IMO, it’s your body and your diabetes. And, no offense intended, the fact that you “have never been encouraged to do the math” yourself didn’t stop you from educating yourself about everything D over the past 16+ years. It’s not too late to start. I recommend reading Think Like a Pancreas by Gary Scheiner and Pumping Insulin by John Walsh. And continuing to come to this Forum, where I’ve learned (and continue learning) a crap-ton more stuff about diabetes every day.

Making an adjustment at 11 PM for a low that starts at 2 AM is too early. Check out this excellent link:

https://www.diabetesdaily.com/blog/basal-insulin-adjustment-rules-282652/

Good luck!

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I would change your basal rate two hours before the trouble time. If your out-of-tange numbers occur at 2 a.m. then I would make the pump basal rate change at midnight.

I think granting any group of people the authority to decide how to program your insulin pump is poor way to manage your diabetes. I make changes almost every day. It would never be practical for me or the doctor’s staff to bother them with this request as often as I need to make changes. The best thing is to acquire the skills yourself.

I believe that your “diabetes team” is doing you an injustice by enabling you to remain dependent on them for changes to your pump settings. This is your diabetes and you are the only one that must live with the consequences.

Take charge, remain observant, and keep notes. This is not rocket science. You will not only feel better but you will build confidence that you can do this yourself!

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As mentioned by others here, you’re the one who has to live with diabetes, nobody else. You’re the one with skin in the game and you’re the one who has to deal with the consequences of whatever is going on with your diet, medication, etc. To manage diabetes really well you must become your own expert. There’s just no substitute for that. No one else knows your body like you do, and no one else is there 24x7 to do it.

I use MDI, not a pump, but the rule is exactly the same. My medical team isn’t standing here watching and measuring what I eat at each meal and deciding how much insulin to use. Only I can do that. I see my doc every 90 days, and as good as he is, he isn’t here the rest of the time to watch my blood sugar log and determine whether my basal is too high, too low, or just right. Again, only I am in a position to do that.

The one living with diabetes is the one most qualified—and, ultimately, the one responsible—for managing it. Like it or not, the buck really does stop here.

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I’ve been pumping for close to 10 years and I make all of my own adjustments. The pump wouldn’t be very advantageous if I had to call my doctor every single time I wanted to change a setting (which can be multiple times a day at times).

I usually move my basal rates up or down two hours before the time I want it to take effect. So, for a 2:00 low, I’d make the change take effect at 12:00.

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Two hours is a pretty good rule of thumb for adults (one and one-half hours for children), but the most accurate way to know how far in advance to adjust a basal rate is by knowing your own personal DIA and onset of peak insulin activity. It’s all in the two books I listed in my first post.

I think the info conveyed in the Gary Scheiner link resonates with my experience. I went through a several week effort back in 2012 to get my basal rates well calibrated. Diabetes’ tricky secret, however, is that it constantly morphs its requirements. Once you accept this reality, managing diabetes makes a little more sense. The Ponder metaphor of surfing fits diabetes management well.

I now make pump basal changes based solely observing my CGM. For me, it’s a lot less effort, but not one I could’ve done without starting with the old fashioned basal testing protocol.

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For me, the nightly lows were occurring at 4:00am. To prevent them, I had to put a lower segment into my pump starting at midnight. My problem is somewhat complicated by the fact that I also have DP that starts to rise between 4:30am and 5am – so I had to play with it a little end ended up increasing the basal a little starting at 3:00am, and a much bigger increase at 4am.

I started working on this pattern with the CDE who trained me on my first pump, but had to make the fine adjustments myself, over a few weeks. Currently, I have a nearly flat night time BG, though, of course, I have to tweak it a bit herre and there along the way.

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You got lots of good advice here already. The only thing I will try to reinforce is that diabetes is a self managed disease. You know yourself better than anybody. I’ve been pumping for 16 years and I only ask for help when I just can’t figure it out on my own. Doesn’t happen often.

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I tweak my doses all the time on my own. My endo will review my pump settings and numbers when I go for my check-ups and sometimes he has some recommendations of things to try, areas that might need a little more fine tuned but overall I’ve always managed and adjusted where need be. Diabetes is YOUR illness, and you need to be the one ultimately responsible for the day to day managing, your doctor and team are important, but to work together collaboratively, not to make all the sole decisions regarding your care and doses. Good luck.

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Lots of good advice here already, but I would add that if you have a CGM, you should base the timing of the basal rate change not on when you became low, but on when your number started dropping.

About and hour before my number started trending up or down usually works for me.

I think you’re saying that a pump basal rate change should be started two hours before the blood sugar level pivots and starts to move toward an out-of-range low or high, instead of its arrival time at the ultimate low or high. Is that what you meant?

The two hour time can, of course, vary from person to person or from one time of day to another. What we’re acknowledging is the reality of peak insulin action occurring well after the insulin dose is given or the basal rate is changed.

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I so agree. I also make my own adjustments but when I do go in for my “check ups” or as I say check ins, I just tell him what I’ve done lately and why. He can add his input and we go from there. But yes it’s my disease and my life, I need to be able to handle everything that comes my way.

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Yes, exactly - if you’re running over 100, your # can be drifting down for hours before you actually get low.

If you just fix the couple hours before the low you still risk getting low if you ever go to bed with a lower number than the night the low occurred.

This falls under what I refer to as the art of diabetes treatment. In the end, each decision we make about diabetes is just our best guess! With persistent observation, experimentation, and experience, I think we can get pretty good at these things.

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an update - thanks to all who offered the 2hour Humalog basal change advice - and special thanks to those who gave me the verbal “noogie”, pointing out that I really needed to own my treatment plan. short version - I did an overnight basal review and entered a new basal pattern initially reducing by 6 units my daily total basal, then corrected my correction ratio. Saw my endo day before yesterday and my HBA1c is now 6.1. we had a great conversation - she is in total support of my actions. tweaked in one basal number, tightened up my range and sent me off with a smile - thanks so much guys!

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WAY TO GO!

(Yes, all caps, and yes, I’m shouting!) :tada::trophy::+1:t2:

I have been on a pump for 7 months and since I have gotten it I think my team has made one change. I was told by my pump trainer to download daily and call them weekly after they have analyzed it and made changes. Well I called week after week and nothing. Finally I took it upon myself to begin making changes. As I learn myself I adjust my pump and I still am adjusting now. They stress you should not make any changes on your own yet only you know what you are feeling or your trends so it is hard to relinquish that power to people who might look at your numbers occasionally and use protocols to guide them. Your not a protocol. I am not recommending it to anyone I am just stating my views and opinions as well as what I do for myself. Think about it and consider what is best for you and it may be consulting your team for changes.

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