Can you SHARE your knowledge about using TEMP BASALS?

Type 1 and LADA Parents of Children with Type 1 Diabetes
1

Hi group,

My son SANTi is 2.5 yrs old, dx T1 since last year. We're using OMNIPOD + DEXCOM.

Consider:

Let's say you're treating a serious low (<50) & the KID refuses to eat/drink any sugars (specially while sleeping!!). Do you stop insulin deliverance? Use GLUCAGON or an injected diluted Glucagon solution to re-establish normal levels? Then, do you use a temp basal lower than normal to prevent a low re-ocurrance?, what value to use? for how long?

Now, Consider the other end of the spectrum: (serious high, >350) Do you input a correction & a temp basal higher than normal basal rate to bring him down quick to regular levels? What value to use? For how long?

How about other situations:

1. lets say while playing ( Do you use a low temp basal while he/she plays? How do know at what value to set it at?)

2. when higher than 250 (Do you use higher temp basal rather than an insulin correction?)

3. Does anyone plot the MODAL graphs from the CGM & adjust basals (or temp basals) from the DATA shown? Can you share your knowledge?

HOW HAS YOUR DOCTOR RECOMMENDED THE USE OF TEMP BASALS?

THANKS FOR SHARING!!

2

Hi. Our 7-year-old was diagnosed last July and here is how we operate (based on Doctor’s directions):

– <50 Never been there yet but if the child is still conscious, go “rule of 15”: 15g of simple sugar such as glucose gels or Cake Mate cake icing squirted into the mounth (I have had to do this while sleeping and my son kinda licks his chops and goes back to sleep) Recheck in 15 minutes and repeat as needed to get BG back above 90-100+. Glucagon is for when they are not conscious, seizuring or unresponsive/unable to swallow.

– With pumps (we are new too) we have treated less severe lows (say, 80s) with temp basals of 30% reduced. He comes back up pretty quickly, say, within 45 minutes. I’d ask a doctor or nurse what a good reduced rate would be.

–Treating lows: I do not reduce basal rate permanently… I either treat with food OR reduce basal temporarily. I have been working on our basal rate, which is changing!, and what I am hearing is you have to find the right rate and then meal boluses and everything works better. Otherwise you are always chasing.

– Treating highs: If a high like 350 two hours after a meal, we correct for that and use the insulin on board feature of his Ping pump so that we do not overcorrect. If consistently running high because of a cold or such, we do temp higher basal or set a sick basal setting to run that when he is sick… say .1 or .05 higher, depending on how high he is runnig. Still check every two hours and check ketones if staying high.,

–That said on finding and sticking with a basal rate, we: set basal rate lower after 2pm at school (.05 unit/hour less ; he’s on .5 an hour) when is is most active, and for snacks that he might get a bolus for we do an I:C ratio of 1:20 vs 1:15. I had been also running a lower basal rate than during the day at night and it was working well, but now he has been running high on that. One last deal: We reduce his basal rate at bedtime by .05 for three hours after a very active afternoon or sport – we’re told the latent affect of exercise kicks in.

Bottom line is separate basal from corrections (up or down), unless sick or stressed – when you use a temp higher or lower basal. So, find the basal that keeps your little one in range while at rest and then treat/correct two hours after meal/bolus as needed. Get ready to have to adjust your basal rate as your child changes.

I am ready to be corrected by a diabetes educator :wink: I am a parent who is still learning. It is best to run these questions and any changes by your diabetes team.

I have not yet found a sweet spot for the pump that gets us in range for more than a few days at a time. It’s been furstrating. We were having better luck on injections. But we are thinking it is coincidence with growth spurts, or (remote possibility) infusion site issues. Any advice for a new pumper with a rough start? Anyone?

3

Thanks for the great input. I’ll print it out, so I can ask questions to the Doc.

As far as the pump sites: My ENDO said that after 3-days the site where the cannula is inserted becomes less efficient; thus, the need for rotating. I’m not sure how the PING works, but the OMNIPOD works really well for the 3-days as recommended. Then, a new POD is placed in a separate site (manufacturer recommends at least 1 inch away from the last one), but we rotate them between upper butt chicks to give the other site at least 3 day rest.

Interesting to read about the basal rate & IC ratios according to the age. My 2 yr uses meal boluses between 1:25 - 35 and basals from 0.1 to 0.20. Need to keep reading about the use of these according to AGE… thanks for the input!!

4

Thanks! Yeah, we are changing his metal cannula (Sure T or Contact-Detach-style) infusion sites every three days. What we are finding, however, is good control for about one day then consistent highs. We are not sure if this is happening because of illness or another coincidence. I just faxed over my logbook and we may do a CGM to get a closer look at what is going on.

Hang tough. And let me know how it goes. A lot to learn; so much that I am thinking about going into diabetes writing or education now. Best, Mike

5

I tend not to change his basal rates unless he is being active and low or on a plane or a car for a long time then I amp it up a bit. His endos office is great about changing pump settings if he is developing any bad patterens over a few sites.

6

What insulin are you using? My daughter is on Apidra and it only lasts in the pump for 48 hours before it starts to degrade (this is according to their website). Just a thought…

7

We just went through pump training this week and are working through some of these issues. Our daughter is an active tennis player and the CDE is recommending that in the case of a 2 hour match or practice that we reduce the basal by 30% for four hours. If she only plays for an hour, we will use the same reduction over three hours. She plays three to five times a week. We are very glad she loves tennis because it really helps keep her BG down.

8

Apidra is fine for use in pumps for the full 3 days and longer. I’ve used it 3 days and longer in three different brands of pumps for the last 5-6 years. Do not be concerned about it.

9

Novolog… and we’re told 28 days. Things have sort of settled again albeit on a higher basal. Phew!

10

We pretty much change cartridge, line, insulin and infusion set every three days but I have been priming the new line with any leftover insulin at change time… so max days same insulin is in the pump is 6 days.

11

That is good to know. We have been changing the site every 2 to 2 1/2 days and I would like to make it at least 3 days on it. The pump supplies are just too expensive. I will try 3 days and keep an eye on her blood sugars the third day. Thanks!

12

I was told that you should cut back on basal rates 2 hours before you actually need it. If your basal needs to be decreased at 8:00. You should decrease the basal at 6:00. This can make a huge difference and I have found this to be more helpful. I do try to get my son to do a temp basal rate after his athletic events since he tends to rise during the activity and then plummet 3 hours later ! He doesn’t like to bother with it but I do try to make him do it (he’s 15) . Also, when he is higher than 250, we always correct with insulin. Usually I think it is because we underestimate the carbs or it is a higher fat content. Nancy

13

Hi I’m from Brazil. I wonder to learn more about diabetes.My son had type 1. I must improve my enghish too, so I can talk more. I m new here. Could you explain me what means temp basal ? I look for information about dexcom sensor. In Brazil have not use it yet.
Sonia

14

A temp basal is a temporary basal rate that is set in an insulin pump. For example, if my daughter has exercised, she sets a temporary basal rate of 50% for the next two hours in order to ensure that she does not have any hypos. Hope this helps and good luck with the dexcom sensor.

15

Pump training? Can you expand on this? Was it the CDE teaching you how to set up the pump or was it a class on pumping? I’m a 4.5 tennis player, hopefully my son Santi likes playing too, so thanks for sharing about the lower basal during play… I know how demanding is playing a match … good luck!

16

I am starting to feel the same way, my son has been on his “Ping” for 3 weeks. The first week was spring break and I was amazed at how much difference the pump made in his glucose coming down, we were having trouble keeping him up snacking all the time till we got things under control so to speak. Then he went back to school and BAM he started having highs and we can’t seem to get them down until the afternoon and he usually has a low then back to high before bed. I have threatened to go back to shots. Do others have lots of trouble in the beginning, is there light at the end of the tunnel? Before going on the pump all I heard were good things about it.

17

Ursela,
Thank you.
But unfortunately my son did not use pump and neither dexcom. So temp basal for him is not important, is it?

18

If your son is not using a pump, he gets his “basal” insulin from a “long-acting insulin” like Lantus, NPH, or Levemir and does not need to worry about temp basals because those insulins have their own timing and absorption rates. A pump replaces the need for an injected basal insulin and allows us to make tiny adjustments (like temporary changes) to the insulin going into our bodies hour by hour.

19

Melissa thank you for the explanation

20

Hi. I have no experience with a child so young. I can tell you what we did when she was eight and it is different now that she is 13. In general, we used temp basals less aggressively when she was younger. It was very rare for us to use an increased temp or decreased temp basal less than 20 percent. Now we will sometimes need to go to 75 to 100 percent increase because of the growth spurts. If we were treating a serious low less than 50, first I would give glucose tabs or juice if he could swallow it and I would not hesitate to use Glucagon if I needed to (never had to use it but the endo can also give you instructions for using partial Glucagon shot to bring up BS). If he would not eat, I would disconnect the pump; rub glucose gel (the whole tube) or cake frosting gel or honey on his gums and rub into his cheek from the outside. Once his blood sugar came up I would do a reduced temp basal of 20 percent. Your child may be different and you may need to do a 30 or 50 percent decrease for an hour or two. At 250 I do not need anything other than the correction to bring her down. Serious high 350 plus I would correct and also put an increased temp basal of 20 percent on for two hours, check again in two hours to see if he is heading down. Re-correct and go up in increments of 10 percent if 20 percent did not do the job. You are going to have to learn what works for him (they are all different) and it is better to err on the side of caution. Exercise: Walking around at the mall minus 10 percent. Playing in the yard but not heavy exercise minus 20 percent. Playing in the snow or riding a bike, minus 50 percent and a 15 gram juice to bring up the blood sugar further before the activity. Swimming, take off pump. Bring BS up to 180 before going into the water. Check every hour or hour and a half. After hour and a half pull out for snack; reconnect and give only 60 percent of the insulin she would have gotten for the snack. Check BS every hour to hour and a half. If going high, replace half the basal for one hour. Did not have MODAL graphs from CGM when she was younger and when she does use cgms (not all the time) she uses Dexcom. I adjust via info from my written log which is quite comprehensive. I adjust based on what she is doing that particular day, do look for patterns but do not wait for patterns anymore before changing. I can now see where she is heading most of the time. All the percentages I just gave you are based on what I would do when she was eight years old. I think you have to be more careful with a two year old and need to get info. from Moms with children that age.