I understand. I started new hardware about 4 months ago. I am still getting adjusted to it. Its always tough.
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I have .6 from 12 am to 9 am and .35 from 9 am to 10 pm on my work days and .725 overnight and .575 during the day on my off days. Just two rates. I find it much easier to make changes. It is usually just a very small change and most times it’s just the timing of the change.
Unfortunately whenever you change a treatment plan it takes time. I know we all want a perfect fix right away but these things take time and just when you think you have it, you need to make adjustments. I review once a week and make any changes I think is needed.
And yes most medical professionals error on caution and would prefer you to run higher than lower when making a big change like this. You will get this and after a couple of months, things will settle down.
I do recommend a book by John Walsh Pumping Insulin. Very helpful and it’s a resource book I have in my diabetes library that I still pullout once in awhile. Good luck and hope pumping is the answer for you!
Thank You! its just interesting for me to see others’ experiences and basal rates. Not that I am trying to compare myself but it is helpful. I was taking a lot of Tresiba, so my trainer went on the very conservative side which I understad, but in just 3 days we have figured out that I need a much higher rate during the day than we though.
Setting ridiculously “conservative” basals and carb ratios seems to be a common thing for pump starts, and I really can’t think of a good reason why. A major advantage of pumping is the ability to change basal rates on the fly, so why not start at the dose predicted by what was working with MDI and adjust up or down from there if necessary? When my son started on his pump the educators tried to reduce his doses, and when I called them out on it based on the 2 months of CGM insulin and carb data we already had, all they could say was “it’s what we usually do”, and “better not to go low”. We went with our own doses, and unsurprisingly got the same results from novorapid delivered from a 6mm needle by the pump as we did from novorapid delivered with a 6mm needle from a pen.
6 months down the track (after some significant shifts in basal and carb ratios) I ran Autotune on my son’s pump and CGM data, which came back with the following. Getting Nightscout set up and uploading the T-slim data was a bit of a pain, but a worthwhile learning exercise to get the feel of what’s required for looping. Turns out we had pretty much nailed all the doses already.
Parameter Original Value Autotune Result
ISF (mmol/L/U) 7.0 7.3
CR (g/U) 18.0 17.5
Basal Suggestions
Time Original Autotune Result Rounded to 0.010
00:00 0.120 0.144 0.140
01:00 0.120 0.139 0.140
02:00 0.100 0.094 0.090
03:00 0.100 0.096 0.100
04:00 0.100 0.110 0.110
05:00 0.100 0.120 0.120
06:00 0.120 0.144 0.140
07:00 0.120 0.133 0.130
08:00 0.120 0.143 0.140
09:00 0.120 0.143 0.140
10:00 0.120 0.143 0.140
11:00 0.120 0.143 0.140
12:00 0.120 0.143 0.140
13:00 0.120 0.142 0.140
14:00 0.120 0.142 0.140
15:00 0.120 0.142 0.140
16:00 0.120 0.134 0.130
17:00 0.120 0.129 0.130
18:00 0.120 0.140 0.140
19:00 0.120 0.143 0.140
20:00 0.120 0.143 0.140
21:00 0.120 0.143 0.140
22:00 0.120 0.143 0.140
23:00 0.120 0.143 0.140
Daily Total 2.800 3.239 3.190
I don’t quite understand how to read all of the data you have provided! But yeah I found out within the first 48 hours that my basal rates and carb ratios were too low. Im back to the carb ratio I was using when I was on MDI, but the basals still need some tweaking which has been very frustrating.
The long list of numbers is just the ISF (correction ratio), carb ratio, then a basal rate for each hour of the day…(original basal rate, suggested rate, and suggested rate to the nearest 0.01 units).
For basal we just started with Lantus dose /24 for the hourly rate, but in my son’s case because he was in honeymoon and having frequent overnight hypos we actually had the basal off most of the night with just a few 15 minute blips at the lowest rate.
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When setting basal rates, keep in mind that your ISF (correction ratio) and insulin:carb ratio vary throughout the day, and they do so in more or less a gradual manner.
In other words, in the morning when your I:C ratio climbs as a result of dawn phenomenon and other adrenal releasing metabolic processes, your insulin resistance increases, and you need more basal.
For me, I’ve found a two or three step increase of basal levels is far more effective in maintaining a flat line BG level, as opposed to the sinusoidal BG curve that results from sudden spikes of basal (or over bolusing).
Which is why rather than 2 or 3 basal levels, I use 10. Anyone using Automode (Medtronic), Tandem’s t-slim basal IQ, or another DIY Loop solutions will also attest to the fact that their pump makes literally dozens of adjustments to basal levels every 24 hours.
That makes sense. I think starting out with only a few will be less confusing. Also for me I am aware of dawn phenomenon, but I usually wake up on the lower side and tend to need more insulin late afternoon / early evening
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