I'm new to pumping, having used shots for the past 11 years, and my doctor recommended the omnipod. So, basal is a new beast for me to figure out. My trainer said she wanted to start conservatively and programmed 1 unit/hour for the whole 24 hour cycle. I was using 60 units of Levemir (30 morning/30 night) for background. I feel like I'm constantly fighting highs, which she said could happen, but I've really felt awful the whole 6 day I have been pumping. I'm trying to log everything and figure out what needs to change and for what time periods, and was wondering if y'all could tell me your experiences.
I've been reading lots of discussions and learned so much in a short week!
If this issue has been tossed around before, please just point me to the link.
Liz, I’ve been on my pump for over a year now and still have to adjust the basals sometimes. They really do change. It probably took me 3 to 6 months to get them close to where they are now. I’ve found that my basal insulin needs are nearly what my Lantus needs were before pumping except that they are not even throughout the day, I take more when awake than when sleep (which seems to be unusual). If you’re definitely fighting high’s and not seeing lows then go ahead and change them incrementally. Let your doctor know what you’re doing and why and keep detailed records but you’ve got to do what you can to be healthy. Good luck!
I’ve pumped for ten years this June. I’ll let you know once I get my basals figured out. But seriously, it will take you a few weeks and a few bad adjustments before you find something you feel keeps you level. My CDE and I make adjustments every three months (or more often, if necessary). I’m usually likely to compensate for boluses being too low by having my basal rates too high - it can be difficult to isolate any one variable on a pump, to be honest.
If you haven’t gotten the book Pumping Insulin by John Walsh, I highly recommend it. He walks you through basal testing in an easy to understand way.
My Dr. set my initial basal based on the insulin dose I was using prior. And it worked great. I have tweaked it once or twice, but just tweaks. My insulin needs are not comparable to yours, but 24 units a day instead of 60, I could imagine feeling high. Like Rebecca, my needs are pretty much the same as before - my basal went from 12 units a day to 11, in uneven amounts throughout the day. Before worrying about how much you need for certain time periods, I would just work on getting a basal that makes you not feel high all the time, and then start looking into adjusting the basal for different times of day. Once you get it figured out, life will be dreamy! = ). And it will happen sooner than you think!!!
Good Luck!
Kara
Type 1 for 11 years
mom to 2
Crazy similarities = )
Think Like a Pancreas has been like my diabetes Bible - so that’s another book you might want to check out if you haven’t already. Going from 60 units of basal to 24 sounds pretty drastic to me - even beyond “conservative.” That’s less than half of your prior basal, and even though they say pumping often requires less basal - I can’t believe anyone needs half as much. Is it possible that the trainer thought you were on 30 units of basal total? Instead of 60?
Hi Rebecca, Thanks for your thoughts. It’s good to know its not just me not understanding the pump, but other variables that I may not understand yet. I started increasing 10% at a time for 3-4 hours and found that by bedtime last night, I was at 2 units/hour. I woke up this morning at a wonderful 75. It was so good to start the day off normal rather than chasing highs. Now, I think 2 per hour is too much in the middle of the day, so am going to have to figure that out.
Thanks Melissa! After reading through the replies, I have Pumping Insulin, Think Like a Pancreas and a Carb Counting book on the way from Amazon. I didn’t realize pumpingt would be so intensive, that I would have to pay so much attention to everything. My doctor made it sound so carefree~
Hey Kara, Did you have your kids before diabetes? I feel “lucky” to have already had them before diagnosis and didn’t have to deal with diabetes and pregnancy at the same time. I hear it’s very difficult.
I either felt brave last night or just tired of feeling bad, but increased my per hour to 2 units and woke up at 75 feeling much better. I know it’s not going to be okay to have 2 units/hour all day, because I went low between lunch and dinner, but dealt with that okay. I can see now that it will be some weeks/months? of trial and error. Thanks for your help!
Hi Natasha, I have ordered that book and a few others and am hoping Amazon gets them here soon. I think my trainer was ultra conservative because I communte very long hours for work and told her I have this huge fear of going low while driving. I think she was trying to make me trust it more. I did increase the overall basal last night and woke up much better today and have stayed much closer to normal all day. Looking at my total insulin usage over the past week, its been over 70 units a day every day, so I think if I can get the basal right, I can bolus less. I appreciate your help.
Good luck getting your basals right. One thing I found is that my basal requirements change depending upon how much I exercise. I am very inconsistent exercising, so it messes me up. When I have been exercising for several days, my optimal basal rate is lower that when I have been a couch potatoe. I have to find a way to manage my exercise better, so I don’t skip more than one, maybe two, days. Did your Dr or CDE talk to you about setting a temporary basal rate when you exercise? Probably because I am such a couch potatoe, I have to set a -75% rate when I exercise and extend it several hours after I finish, otherwise I go hypoglycemic. Fortunately I have a Dexcom CGM so I can monitor my blood glucose levels when I exercise.
That is my reasoning I used to fight for my son’s CGM. He is very active, but we still have to set a 50% basal starting an hour before, and an hour after and only bolus for half of any carbs eaten right before or during intense exercise. I don’t think it’s because you are a couch potato - according to what I’ve read, that’s pretty standard. But my son’s sports are inconsistent too - different practices, different days, cancelled for rain, different game times on Saturday. He really wants a CGM . . .
this made me laugh. : )
is anything about diabetes carefree?
but it will hopefully be better.
and make sure to take it one step at a time.
the way my doctor tests my basal is one at a time rather than adjusting multiple basals at once. so, if my morning sugars are good, skip breakfast and test all through the morning to see if i stay level. if so, my morning basal is good and i can do the same with other sections of my day… (of course, if you are running so high, you might be doing well to increase them all!)
it sounds like you are super committed, so that will help a lot! it’s a lot of work up front, but once you get it relatively good, it will be a lot easier and you’ll just be tweaking it.
No, I turned 28, got married, and 5 months later I was in the Emergency Room, I always heard the first year of marriage was the toughest - I am surprised my husband didn’t leave me after month 4 - I had turned into a CRAZY CRANKY person! (to put it mildly). My pregnancies were really easy, blood sugar wise. In fact, at the end of each one I used 1 unit of long acting a day. (Down from 6 pre pregnancy, I have always been pretty sensitive to insulin)
You’ll get the basals to a reasonable rate pretty quickly, and then probably tweak for the rest of your life, our bodies change constantly! And it is hard to focus on trends and finding them with kids! I have 3 basal rates, .6 from 4 AM - 8AM, .35 til noon, and .4 for the rest. But everyone is SO different! It is a daily story problem! Good Luck!
When I filled out the paperwork for the CGM, I had to list my hypoglycemic events for the previous 30 or 90 days (can’t remember which). My endo also listed all the reasons that I needed it. I think I also documented when I had to go to the ER.
Did your son get denied for CGM? I can’t remember if I read a previous post from you about his being denied.
Good luck getting approved, and keep good records to support your case.
We were denied once. My doctor has sent in two appeals, and I have sent one, including his records, letter from his doctor, letter from HIM, and lots of research. Unfortunately my insurance company can’t seem to “find” any of the appeals sent to them. I sent the last one with delivery confirmation and they still claim they haven’t received it, even though the tracking number says it arrived . . .
But seriously, it will take you a few weeks and a few bad adjustments before you find something you feel keeps you level. My CDE and I make adjustments every three months (or more often, if necessary). I’m usually likely to compensate for boluses being too low by having my basal rates too high - it can be difficult to isolate any one variable on a pump, to be honest.