I often think, if I could whip up the perfect basal schedule, what would it look like? Has anyone gotten scientific with their basal settings? If so, how does it look?
Mine are pretty simple: 12am-4am 1u/h; 4-6am 1.2u/h; 6am-12am 0.95u/h. I use temp basals (or glucose tabs) to cover any fluctuations due to ‘abnormal’ activity.
My settings used to be more complex, but I found that I was typically using the basal to cover elevations from meal-time protein (especially overnight) or decreases at times of the day that I’m more likely to be active. I’ve found that handling those with temp basals and the appropriate bolusing has dramatically simplified what used to seem so complicated. But whatever works…
12am-3am=0.3u/hr, 3am-7am=0.35u/hr, 7am-4pm-0.25u/hr, 4pm-12am=0.35u/hr. Depending on activity, I sometimes increase to 120% from 12pm-8pm. In past summers my basal has decreased, but this seems to work okay in the winter.
My basal rates are changing almost every week now because I’m pregnant, but I have different rates for the following time periods:
These keep me stable these days
The Accu-Chek rep and I are still working out the kinks. Right now with the settings we have for basal and sensitivity, I go over 180 mg/dL after breakfast (6:30AM),and stay above that -- 200 or more -- for several hours, before dropping to 100 by noon.
Insulin pumping is much more challenging that multiple daily injections.
I wouldn't wait on the Accu-Chek rep, Khurt, but would start keeping careful records and slowly start tweaking doses. I recommend Pumping Insulin by John Walsh if you don't have it yet. For ISF you want to see if you come down to target within 3 hours and if you consistently don't start tweaking that as well. It sounds like you already have some good information about when you are high and not getting enough coverage (I:C or basal).
I have 9 different "time zones" for my basal which I got my trial and error. I don't know if that's what you mean by scientific, Gluke, but that's the best way I know how to determine dose. Sometimes they do converge and several of the time zones are the same, but I keep the categories so I can make changes as needed.
I have four basal rates:
9PM-3AM - 0.95
3AM-9AM - 1.55
10AM-4PM - 1.10
4PM-9PM - 1.35
At one time I tried to add in some more to "smooth out" the giant jumps from like 0.95 > 1.55 and 1.35 > 0.95 and such, but it just got too complicated.
Also, my basal rates (and all other pump settings) change for about two weeks around my hormonal cycle. They first go way up (by 0.15-0.2 u/hr) for a week and a half, then drop down (to about 0.05-0.1 lower than baseline), and then even out again for two weeks.
I have a bunch. For a long time, I felt like .8U/hr was too much and .775U/hr wasn't enough so I "goldilocksed" up a solution by doing 1/2 hour of each, plus a bit of nighttime boost for DP for a few more rates but I have like 36 separate slices of time identified. I smoothed out the late afternoon as it seems that .775U is working ok then but it's worked pretty well since I made that swap:
Completely off-topic, but how do you handle meals? I've seen a few of your graphs and there are no spiked whatsoever even after eating by the looks of it. Do you pre-bolus? I think you said you don't eat super low-carb?
I've been trying to eat 40-50% protein, sort of going along with this P90X group I joined 01/03/14 that will run for a few more weeks but am still eating about 120-130G of carbs/ day, although that's my pump score and probably includes a few 5-10 "carbs" counted to cover protein. I usually try to aim for about 80 before meals and, while I don't always hit it, I am the chef in the house and can usually arrange at least a 10-15 minute head start for the insulin. On that particular one, it was up around 120 it looks like on the left (this was a new sensor, a Paradigm that worked great and was very accurate, right out of the gate...) which is probably after breakfast, I think I worked out, was at like 90 and just had eggs and veggies b/c I didn't want to hit the calibration with a ton of carbs and then had a protein shake with about 20 more G of carbs and 40G of protein when I got to work, not the best timing of the protein w/ working out but well, I have to work around that stuff w/ the calibrations as I'd rather have an accurate sensor telemetry than a pile of carbs.
A lot of times at dinner, I'll have kind of a snack bolus and have some nuts and beer/ cocktails while I'm making dinner. It's probably horrible but it allows me to sort of "cook" my BG down to 80 before the evening's big food. At lunch, I've mostly been eating this concoction of tuna, 1/2 avocado, Sriracha sauce and chia seeds, with a bunch of black pepper too. It's like 15G of carbs and is REALLY tasty, the big flavor fills me up pretty well. I like it enough that eating it 4-5 times/ week doesn't bug me at all. It's a treat!
Thank Zoe. I will work with the rep for a little more time. I am getting a lot more hypos after breakfast and lunch so that throws off the "discovery". It's a roller coaster right now.
Thanks for the book recommendation. Is is available in digital format? I no longer read paper.
I'm using U50 insulin so divide my rates by 2 to compare to standard U100.
My TDD is quite low and I needed the lower dilution to work with my pump. Could not do MDI without having to eat to the dose available with pens etc.
5:30 - 9:00am. 0.2
9:00am - 4pm 0.1
4pm - 9 pm. 0.2
9 pm -12 pm. 0.45
This keeps me flat overnight when I'm not active, and keeps me from going too low during the workday when I'm on my feet all day.
I will use a temporary rate on weekends to adjust for variations in activity.
Pumping Insulin is available on Kindle, but I'm not sure about other e-book sites.
I don't either, Khurt, but bought my copy pre-kindle. I just got mine in November and haven't bought any non-fiction reference type books. How easy is it to look things up in the index and then go to the info you want? I just ordered the DSMV and was surprised it wasn't in digital!
My basal settings are simple. Previously I was .90 4am-10am, .70 10am-12pm, .50 12pm-7pm, .70 7pm-4am. It was a simple curve. The last few months though since football season ended and I've had more time, I have significantly increased my activity level. Couldn't figure out the perfect basal, so I have simply set a flat basal at .50 and I am starting from scratch. The more I tried to perfect my basal before, the more variables it put into play. Instead of trying to solve an equation with ever fluctuating variables as it is, I honestly think this is the best way.
Like a previous post said, get a good general baseline then use temporary basals as needed, at least this is what has worked the best with me.