How do you determine your basal rates?

Hi, I'm still fairly new to the pump. I've had it almost a month. I haven't changed my basal rate really since I was put on it. And my blood sugars have been running high for the most part. My fasting sugars have been about 175. Everytime I talk to my endo- she keeps suggesting I change my ratios but i believe it's my basal thats the problem not the ratios. There has been about 2 weeks out of the past month where my blood sugars were good and I had to cut my basal and ratios down- but i was more active those weeks.

I'm usually pretty insulin sensitive. Right now my basal is just .5 and hour and .6 between 3 and 6 am

Should i try doing a small temp increase like .25 and see how it makes a difference?

I'd suggest making changes in even smaller increments. I'll see a pretty significant change from like a .05U/ hour switch and I am pumping .9U/ hour most of the time so even that small amount is a smaller %age than it would be for someone pumping .5U/ hour? I usually figure not more than 10% and sort of ease into it. I had one time in about 4 years of pumping where it changed a lot and I ended up doing something like 25% more before I scaled it back a shade. Pretty much if I'm dealing with awake time I'll change it for 3 days, see how it goes and if it's in the right direction, do some more until I'm where I want to be.

I agree with Acidrock. If you're insulin sensitive, you want to make very small incremental changes. What I will typically do before making a change is look over my data (I upload to Carelink) and try to see if I'm noticing any pattern. Then, I will make my basal rate change to straddle the time period that I'm having issues. Recently, I started running considerably higher in the middle part of my day (from about 10AM to about 3PM). Over a period of several weeks, I slowly started increasing my basal rate during this period until I got to a point where I was running around 120 fairly consistently during this time of day. HOWEVER, I also noticed that I was running considerably higher on days when I was in the office (I generally telework 1-2 days/week and when I'm teleworking, I seem to run a bit lower). SO, on days that I telework, I have to remember to turn my basal rate down during this time of day.

In the book Pumping Insulin, they recommend that you do basal testing. That's the ideal way to test your basal rate, but I just can never seem to get my butt in gear to do it the right way. That said, my way seems to work pretty darn well too :-)

I'm not clear on whether you're running consistently high (like staying in the same 20 or 30 mg/dl range while fasting), or whether you're going higher than you'd like after meals. If they're running consistently high while fasting, you're right, a basal change would be called for, but if it the pattern is going high after meals, and then not coming down sufficiently, then it would be your insulin:carb ratio.

The only true way to test basals is what Walsh recommends in his book, Pumping Insulin, because you want to know what your BGs are doing when there is no food in you to mess up the readings. On the other hand, if you want to test I:C ratio, you eat a standard amount of carbs, and test before, and every half-hour afterward for 4 hours (or until your insulin runs out) to see if you come down to where you started.

And do remember that when you are more active, all bets are off -- you have to figure out how exercise affects YOU -- we're all different.

Good luck! :-)

both--- When my basal isnt right doesn't that throw off my ratios too?

I don’t think so. At least theoretically, the ratio is for food and should be “balanceable” independantly of basals. At the same time, they are sort of tangled up. A lot of times my best results have been when my basal is a bit up and helps cover the meals too.

exactly, i'm trying to convince my doctor that.

At that point, if I were running in the 170s pretty regularly, I would fix it and tell her the next time I see her.

I had a couple of encounters w/ my endo last summer and contacted them more regularly but really the rates are my business. They are usually set pretty accurately but drift and I'm always fiddling around w/ them to make things better.

I have pretty much run my own show since maybe 2 years into my diabetes "career" (c. 1985-6?) and don't really mess around with docs that much. I will say that the doc (in a different town...) who figured out my rates, ratios, etc. based on my garbled logs did a *really* good job getting it straight and was very close to where it needed to be.

good for you. I'm scared to adjust it too much and get too low.

Well, that's understandable but it's sort of like a "trial and error" thing and, regardless of whether the doc is super-reponsive or not, you are the one doing the trials and dealing with the errors so it's always seemed reasonable to me that I just work away at it?

I also suspect you'd be more likely to run lower cranking your rate up .25U/ hour than by taking the more careful approach I'd suggested? If the doc uses increments like that, it may be that they aren't quite familiar with the *buzz* of insulin. If you make a huge change and run low, it doesn't prove that "change" is bad but only that "huge changes" are bad? If the numbers aren't what you want them to be, then you sort of know that you have to fix things. I guess I don't have a lot of experience with dealing with communicating with doctors about changes. Every time I go see her, I'm sure they are a bit different. Stuff just changes and I roll with it. Test, adjust and get back in business.

So you go by TINY amounts. That's what pumps are good for. Amounts that you could never give yourself by shots! :-)

Also, give yourself at least 3 days between changes, because the other hormones in the body don't adjust that rapidly (which is why big changes in time zones are hell!), and remember that it'll NEVER be perfect. Highs and lows are GOING to happen, but the idea is to have a few and as mild as possible. Good luck!

It can too be perfect!! ;-)

Hahha i have way too many highs, my last a1c was like 8.3 :(
What does it mean if my sugars don't respond to correction units?--- and i know my canula is inserted properly etc.

possibly a number of things. I usually attribute them to carb counting errors, gravy being a recent culprit but stuff like vegetables, sauce, dressing, etc. can figure in too? Do you have a food scale? It's sort of cheesy (no pun intended but cheese runs about 1G of carb too...) but can help if you are seeing a lot of off numbers. I don't usually attribute problems to off canulas or whatever as those don't seem to have been a big issue for me, except for some catastrophes last summer. I use IV shots (****danger danger danger****) as a fallback, if it just won't come down or if it's been awhile.

I usually fix hights pretty rapidly, bolusing for what I guess the missed carbs were on top of the CB and then I take the dog for a walk, not scientific or anything but it usually will cause a drop?

Yeah, it can be perfect under YOUR definition!!! But that definition probably includes wearing a WEIRD cap that looks part Russian and part Snoopy! No thanks! LOL!!

I mean i bolus for my food- but my sugars are still high- so i take more insulin to cover it and it doesn't come down.

Ooops,I couldn't get the "reply" to the right post, I so I'll start over...sorry!

If you bolus for food and your BG doesn't come down, it means that either your ratio is off or your carb counting was off or your gizmo isn't giving you the insulin properly, or perhap an insidious combination of multiple factors? Or maybe that you are sick or something like that too, there's a number of reasons. I usually assume it's either carbs I missed or, if it happens for like 3 days in a row, I'll adjust ratios if it's post-parandial numbers that are off and basal rates if it's apparent in fastng.

Despite all the hyper posts, I am extremely lazy so I will usually do one at a time and see how it goes. There's all kinds of ways to play with numbers but I hardly ever see 170s so I would like to think I'm doing ok?

Tom wrote: I mean i bolus for my food- but my sugars are still high- so i take more insulin to cover it and it doesn't come down.

Usually when that happens to me, it means that I still have food in my stomach, and the continued digestion is keeping my BGs up. Maybe they'd go higher if I didn't take another bolus! But what it tells me about myself is that if I eat too much, my digestion is slower than the insulin, and I have to plan to take more insulin in order to cover it. Some people can do a dual wave bolus, and take part of their insulin up front, and spread part of it over a couple of hours. That doesn't work for me, so I just plan on testing at 3 hours, and correct, and then again at 6 hours and correct again if I need to. You DID see my Thanksgiving graph didn't you? I'll post it again for your edification. It's a case of where I DIDN'T correct enough, and/or the food was still digesting over a LONG time. PLUS, when I've been high, I tend to go higher the next day, even if I behave myself. Anyway:

hello... i occasionally do the fasting test...stop eating 3 hours before you do your final test the night before the test.. your blood sugars need to be around 100 the night before and the are around 100 when you wake up.(if night and morning BGs changed without the influence of food or bolus adjust your night basal). don't eat anything until half way through the day...don't dose yourself...(and watch closely what happens) monitor closely, as your blood sugars can go either way... if you dip too low, eat something... (now you know that your basal is too high for that time frame) if your BG runs high, (then you know the basal is too low for that time period.) adjust have to check your BG every hour on the hour to get an accurate idea of how your current basal are affecting your BG.. then on another day, do the same, but this time. repeat it in the last half of the day..don't eat 2 hours prior to starting...this keeps food from affecting the test..your basal rate is supposed to keep you on an even keel, it is what maintains the right amount of glucose in your system to keep your autonomic system working (that is your heart, lungs, brain and vital organs).. remember exercise is going to affect this test.. you don't need as high a basal if you are swimming 50 laps.. :) ... don't try to do it all in one day.. that can be dangerous..and i recommend that you talk to your endo before you do this as i don't know the details of your condition... wishing you all the best... rob