UPDATE:
I can’t believe it has been a year since I posted this question here. I hired Integrated Diabetes several times, and they have helped me SO MUCH. They helped me with my basal settings, with exercise, hormonal changes, etc etc etc. So the answer to this question is: upload your numbers weekly to diasend and if your doctor/nurse is not paying enough attention, hire Gary and his team will be able to help you out. =)
Hi, guys!
I am struggling with my basal settings. Me and my CDE have been doing the basal tests, but it seems like what works one week, doesn’t work the following week. Sometimes I have lows of 63 that take 72g of carbs to rise to 89. And sometimes the exact same formula causes my bg to go to 294. (There are some curve balls there: exercise, hormones and the feeling that my correction factor is not set up correctly).
How did you get your basal settings to a good number?
How many profiles did you create?
Does your basal stay the same the whole day or you have different numbers throughout the day? For example, I have 8am-12pm at 1.5, 12pm-3pm 1.35, 3pm-7pm 1.5, 7pm-10pm 1.6, 10pm-3am 1.3, 3am-8am 1.4. Is this normal or the number should be more constant and the carb ratio or correction factor should change?
How do you deal with the bg changes? Do you make adjustments to your basal right away, or you just consider it an exception and leave the settings as is?
I also deal only with my CDE and I see my doctor every 6months. Should I look for a doctor that is willing to see more often or can I get the same results from the nurse and CDE?
Last questions, have you ever tried a private consulting company? I have the Think Like a Pancreas book and found out they do consulting over the phone. Has anyone ever tried?
I cannot recommend Integrated Diabetes (Gary Scheiner) enough!
Getting basal rates adjusted is an ongoing endeavor, as our bodies and needs are constantly changing. I’ve learned to not expect to be “there” for extended periods of time, but to enjoy the challenge. Thank G-d for temporary basal rates; don’t know what we’d do without them!
Thank you, @rgcainmd! — So you have tried their services? I don’t want my nurse to feel like I don’t trust her, and I’ve been on the omnipod for only a month, so I should be more patient. But I am looking for a service that will say: “all right, let’s figure out together what works for you for breakfast, when you should exercise, what the basal should be at this time, what the correction factor should be, etc”.
Is this too much? Should I only expect them to help with the basal?
It has been my experience that the majority of CDEs know way more than endocrinologists (unless the endo uses a pump themselves) when it comes to pump settings. Fine-tuning pump settings is a task that is most often delegated to CDEs. And even CDEs don’t have an unlimited knowledge base nor unlimited time to assist you in your pursuit of pump setting nirvana. Gary Scheiner and Integrated Diabetes, on the other hand, have (IMO) unlimited supplies of both. The limiting factor is your wallet. I’d “attend” their “Type 1 University” first to get the most bang for your buck before investing in their excellent one-on-one services.
@M_K_ - Your’e right to try and get your basal rates close enough to give you good results. I have a few thoughts about your situation. Your basal rates seem high to me but this is an individual thing and your rates may be good for you. Can you describe the “basal testing” that you’ve been doing with your CDE?
I used Integrated Diabetes Services four years ago to help me get my basal rates adjusted. Just be aware that almost everything with insulin dosing is a moving target so the most important thing you need to learn is how to adjust these rates yourself. There’s not a month that goes by that I don’t adjust my basal rates. Sometimes I’ll increase certain rates for a several days or a week and then have to reduce them back to their former level. I think the Integrated Diabetes Services help is worth the money.
Your blood sugar variability could come from poorly set basal rates. Overall good control needs a well set basal pattern to build upon. A lot of variability and poor control is the mistaken assumption that you may eat whatever you want and just dose for it. This has been a popular belief among CDEs, doctors, and dietitians. I think that almost every diabetic would benefit from carb limits. When I exceed a certain daily limit, it’s as if all my dosing rules go out the window and my control with it. Eating 200-300 grams of carbs each day is a recipe for BG disaster, in my opinion. Even reducing it to 100 grams/day gives great benefits in terms of variability and control.
Finally, to answer your question, there is no “perfect basal setting” for anyone. Your body’s needs change from day to day. A perfect basal setting in my world is one that gets me close enough so that I can use micro-boluses and micro-carb doses to fine tune my BG level. Dr. Stepehen Ponder, author of Sugar Surfing and T1D himself, sets one flat basal rate for an entire 24 hours. This works for him given his dosing philosophy.
The effort to get your basal rates set close enough is well worth the effort. Your biggest goal, however, should be the ability to change these rates yourself as needed. Good luck.
Okay, you make me feel like I’m in the right path.
I eat around 100-130g CHO / day, expect when I have the weird lows like the one I mentioned. I agree, it does make a difference. I actually learned this from you last year when I was trying to figure out the best diet. lol
I have Sugar Surfing book as well. It’s very overwhelming, so I try to learn a little bit at a time.
I agree with you, basal rates are the base of everything! That’s why I’m so focused on getting them right, so I can do what you said with micro correcting.
You mentioned you adjust the basal yourself. When I do that, my CDE gets frustrated, saying I can only change after I talk to her and prove with data that it needs to be changed. How do you usually do to change your settings? Do you talk to your team before, or you just own it and tell them to listen to you? lol
I’ll be more than happy to tell her. lol – If it makes you feel better, when I was diagnosed at 16 I thought my mom didn’t know anything! But I miss soooo much all her carefully planned snacks and healthy meals. It took me a couple years to realize how helpful she was. And now that I do everything by myself, I see how much I learned from her. Tell your daughter to try realize that and appreciate her mom sooner than I did.
I would suggest that, as I have gone through this process recently (though it is ongoing), you concentrate on learning HOW to measure and adjust your basal rates (and what comes after that as well). If you learn the process from someone knowledgeable, then you can do it yourself after you’ve had it modelled.
You’ll discover that YOUR diabetes is totally unique. For instance, I need LESS insulin when I’m asleep at night!
It’s your Type 1 and your body. If my daughter’s CDE or endo got frustrated whenever I adjusted pump settings, I’d (excuse my language) tell them to go pi$$ up a tree and I’d find other providers! But that’s just me…
For me, it makes no sense to coordinate any needed dosing changes, basal or bolus, with a formal request of and permission from medical staff. The need for change occurs much too frequently and at odd times to ever be practical to wait for permission. I’m not going to wait for the next scheduled appointment and I’m certain they will not respond to the 3:00 a.m. call for help.
I agree with @rgcainmd. It’s my diabetes and I am in charge. If I need their opinion, I can ask at the next opportunity.
I realize if you are still learning some of these skills, it may make sense for closer contact with the medical staff. But that means that they need to be available when you need help. The best solution is to acquire the skill-set yourself.
My basals vary like may of the others. However, one thing I would do if I am having trouble going low or high; is I would try not to eat anything 2-3 hours before bed time unless I am going low; then of course treat. But I would try to keep my blood sugars around 140-160. This gives me a little bit of breathing room if I drop off. If I am going low I will shave insulin where ever the lows are happening immediately. However, I have found to deal with increasing blood sugars due to improper basals; I only increase one basal at a time and let a full 24 hours pass. I also like to try and troubleshoot a rate in no more than 4-8 hour blocks of time. For me I start with bed time and work forward; but you can do it in any order. But if you are tweaking too many variables at once; it makes it hard to see what impact the change made for you.
Once you get your trends to flatten out you can then bring the sugar ranges down. Like the others have said its important that you understand how to do these rate changes yourself and how the change impacts you. It would also be really good; if you understand how your insulin of choice absorbs. So you know the peak action time and how much time has to pass before you hit that peak after taking a dose. So for example you run low at night at say 2 am; when should you make the rate change so that tomorrow night you don’t bottom at the same time?
These are all things that the only way to figure them out is to test and repeat. For me personally I have found that my insulin resistance levels vary through out the day. So something I eat early in the morning I need a significant larger dose; than if I ate it for lunch or dinner. Stress also plays a role and its a bit like hitting a moving target.
I agree with many of the things said, especially the part about your provider getting “frustrated”. I am the only one who controls my D and the only input I get from doctors is ordering an A1C which is required for me by Medicare. There is no way any provider has the knowledge or experience with MY D which is different from the next person’s or the changes and patterns I see. Managing my D is a 24/7 prospect and I am uniquely qualified to do that. I am probably at the extreme of the spectrum as my saying about doctors is “Ijust want them to write my prescriptions and leave me alone.” But I do think many if not most of us get comfortable with making our own changes.
For me, though I have a pump that records all the data, I prefer using an old school notebook. I record my blood sugars, my carbs and my corrections and one page takes about 3 weeks. I highlight highs in yellow and lows in blue. So then at the end of the three weeks I can review and see what patterns exist. I would never change a basal rate based on one or two outliers but will wait to see a pattern. I can judge from the pattern whether it is a need for a basal change or a I:C change. This is the system that works for me. For me, the basal changes are a lot more common; I just tweaked my I:C for the first time in 9 months. I have 11 different “time zones” ; though currently they are all pretty close, they haven’t always been so. Mine hover around the .550 range but like someone else said, we are all different.
As for basal testing, I will be honest and say I’ve never done it. When I went on the pump in 2011 my trainer gave me a starting point based on my previous long acting insulin dose, but since then I have tweaked it based solely on trial and error. When I see a pattern of highs at a particular time I add a tad to the “time zone” two hours prior to that. Lows and I do the same to reduce it. I add or subtract in very small increments, for example .525 to .550 in one or at most two “time zones” then see how that works for a while before doing more. Like Terry I sometimes make a change and then end up returning it to where it was. Even using my “3 week system” there are still anomalies that don’t persist. I’m sure if I took the time to check there would be not much range in my total basal - it tends to hover somewhere almost exclusively in the range of 11.00 to 13.00. But the small tweaks definitely work for me.
Sorry to say, I’m going to agree with everyone else here. It’s your diabetes and you need to understand what to do when things come up. There is no perfect basal rate. And even after 25 years, it is still changing. I got into major adjustment mode and ended up with way too many rates during the 24 hour period.
So while I have 3 different profiles, off days, work days and work day with early start. But they are basically just one rate with lower rates while working.
And just when I think I have it, something changes and another adjustment is needed. Blood sugar rising at midnight, so I’ll make the adjustment around 10 pm. I don’t call my doctor or CDE. I just fill them in on what I’m doing and why when I see them. It’s a work in progress and many are very lucky to find at perfect rate and it holds for a long time. I just have so many variables that it’s always moving. Good luck with your tests. You will get it. Just remember that many women have different profiles based on what time of their cycle they are currently in. The joys of being a woman and those wonderful hormones!
I have told doctors in the past that they may have gone to school for years and have a lot of knowledge, but I am the expert on my body. So, I make adjustments when I need to and when I go in with different basals, I explain the reasoning behind the changes. And like everyone else has said, it is better to be able to work on changing the settings yourself because you will always be making adjustments. Diabetes changes every day.
One other thing that I have to consider and you might too is where your infusion set is placed. I increase my basal just a tad when it is placed in certain parts of my body. My CDE thought it was a good idea when I told her about it AFTER I did it. Everyone is different though. You will figure it out…
I have 5 basal rates, or maybe it’s 6 by now. They evolve, nothing stays the same. My CDE did the changes at first, now if there are consistent trends I do my own changes. My carb ratios also change during the day. I have better luck using temp basal rates at night to adjust, as I am very sensitive to insulin at night. I love the TCOYD book–several hundred pages of info, I learn something every time I look at it.
My CDE has never told me not to make changes, as the proof is in the pudding.
