So, I have been type 1 for a little over a year, and have been on the pump since Feb 1st. I am curious how long it has taken others to get their basal rates into rough shape. It took almost a year to get onto some kind of a system with shots (morning/evening lantus, and novolog), and I imagine it will take some time to get the rates set for the pump. I recently ran into a friend (a designer I print for), who is also an adult onset diabetic, and she described going up to Joslin (Joslin Center in Boston), and getting her initial patterns in fairly quick.
My CDE has a lot of experience with pumpers, but is much more cautious about changes, and was out of the office for much of February, so that has delayed us a bit. I am curious as to others experiences in starting out with basal testing, etc. I may be hitting some kind of emotional wall where I feel like I am just wasting time, but am actually making progress. No one wants to test 8-10 times a day, and continually have A1c’s over 8…
To add one thing to the above, I am still doing basal testing 3 times a week for the overnight basal - which means the daytime rates are still too low, hence the frustration…
it took about 2 months to get an “ok” pattern with my basals when i started. then i started getting more active and losing weight so we had to keep changing them. it will definitely take some time, hang in there =)
The initial set up for your basals i quite simple: Daily intake of lantus divided by 24 = basal rate.
Fine tuning can be done in a matter of weeks, even one week, but it’s not a matter of getting them set and letting them run like a refrigerator. You should retest at least once a year or when things start to go weird.
Some people use the same rate all day long and it works fine for them. I have two rates, slightly lower in the evening and then going up around 4 a.m. Some people have different rates for the weekday and the weekend (called ‘patterns’). One can fine tune all the time if so inclined.
“Pumping Insulin” by John Walsh and Ruth Roberts is the Bible for living with a pump and for testing and setting basal rates. Get it. You won’t be sorry.
Thanks Kristin, et al - that’s just what I need to hear!
I did read the Pumping Insulin book, and am happy to keep testing away. The main reason to switch to the pump for me was because I did in fact need so much more insulin in the evening then in the morning, which made finding a balance on Lantus much more difficult. I think my frustration lies in seeing patterns or suspecting patterns that I would like to address for the basals, but my doctor and CDE with whom I have a good relationship, are both (which they should be to a degree) much more cautious…
You say "I am still doing basal testing 3 times a week for the overnight basal - which means the daytime rates are still too low . . . "
I’m not following. How do you know your daytime rates are too low? What is your daytime basal and what makes you think it has any bearing on your overnight basal?
Just started with the OmniPod 23 January this year. I had to test before and after (2 hrs) every meal and at bedtime…midnight…and 3am. The 3 am was dificult as I have trouble sleeping in the first place. When I went back 3 days later to change out the pod…the rates were adjusted. I went on for another 5 days still checking at the same times and when I went in for the follow-up…the rates were nearly perfect. I was very diligent in counting those carbs…the more precise you are, the better off you’ll find that fine tuning…that’s what you want!!! Summer is coming and I know that I’ll be much more active…so I expect that I’ll be doing some more fine tuning of those daily rates. I’ve seen a drastic improvement in my BG numbers already!!! Yeah Team!!! Hang in there…it’s all worth it.
Meaning the daytime basal has not been adjusted yet to reflect the new readings. In my case, we used the formula you mentioned to establish the starting basal (dividing the lantus dose by 24), but reduced it to 80% of that number to avoid lows (see, they are cautious!). Although there have been some initial basal adjustments, my glucose is still rising most afternoons - so as we try to get the overnight basal correct, the rest of the day has not been adjusted yet.
My daily total is still about 4-5 units less then where I was with the Lantus, I trust going slow will help with more exact adjustments, I guess I am struggling with changes I see need to be made, but that the doctor and CDE want to hold off on until they see more information.
I appreciate the comments - at this point it is a matter of patience, I am definitely ready for more SELF management!
Testing your blood sugar is mandatory on the pump.I test between 12-15 x a day.Since not being able to feel my lows even more.It took me a few months to get my basal rate right.It needed alot of adjusting.Get ready to skip meals.I found that hard when going on the pump after having 3 square meals a day at a certain time.No more,I can delay or skip meals.
I can relate to your frustrations. I started pumping a little over a year ago, and it took me a good month of solid testing every day to get my rates dialed in so my BG would stay level without eating a thing. I used the method outlined in Pumping Insulin and it worked well, it just took a long time, a lot longer than I thought it would. And when I was testing, I was doing it every hour on the hour. Burned through a lot of strips, but also got a lot of data to work with.
I often ran two tests a day: (1) overnight test, followed by a.m. meal, then (2) afternoon test. Follow that with supper, then another round of tests. That let me break the day into quadrants, so I could eat when starving but still accomplish as much testing as was possible. It was also good, because I finally learned it was ok to have a rumbling, somewhat hungry stomache, from time to time. Back on shots, whenever I got hungry I knew it was time to eat, or else I’d be sweating and shaking and going low in the very near future.
My CDE and endocrinologist monitored my changes, but I did the brunt of the legwork. Most of the time, they said “looks like you’re doing good.” Same is still true today. I manage my 'beetus, they are my advisors and cheerleaders. If you feel impatient, don’t be afraid to push the envelope with your testing and basal rate settings. And keep lots of snack on hand for those times when you need them!
Cheers and best wishes,
Mike
p.s. - I’m going through a whole new round of basal adjustments myself. Been doing a lot of cycling lately, which has completely messed up my old sedentary basal rates. Here’s hoping we both get it “dialed in.”
I test a different basal rate at least once/week. If for some reason i have to skip breakfast, I’ll use it as an opportunity to test my morning basal rates. Likewise, if I know I’m going to be in meetings at lunch, I’ll test instead of eat. I’m not as diligent with the over night basals as that would make me set the alarm, get up, test, etc. I value my sleep and my morning BGs have been stable since i got stable on a pump. I still test 8-10 times/day so if I do get out of wack, it doesn’t get to far I can’t correct. Be patient and it will all come in time.
