Low Basal Profile

I got the Tslim pump on the 22nd of June and was hooked up to it on the 25th. When I researched this pump I didn’t look into what the minimum basal rate was. My diabetes Educator believes that they can make a profile in that pump to match what I have now. I need rates like .025, & .075. The tslim doesn’t do quarter units. Has anyone who has a low basal rate used the Tslim?

My Omnipod goes as low as 0.01.
Traditionally, Omnipod has far more accurate delivery accuracy than MT.
I’m just gonna throw this out there - I really doubt if your MT pump was delivering to that level of accuracy (I know they say they do, but testing of the devices indicates that they achieve nowhere near that - error was much higher).

Could you try a 0.02 and a 0.07, just to see? Are you running that now?
Your rates are soooo low! Tricky business.

Yes, my actual basal profile is, 12a.050, 5am .175, 9am .075, 3pm.125 9pm.025. The profile that the nurse gave is a program that will deliver a total daily Basal of 2.225 which is my total basal on the medtronic 630. It is very confusing and how am I suppose to make adjustments to this? Unless they can match it to my needs I a afraid that the Tslim isn’t going to be suitable for me, and yes I am a type 1. I just have a low basal rate. I am not making any insulin of my own.

Personal Profile: Timed Settings

12am Basal - 0.1

2:30am Basal 0

5:00 am Basal 0.175

9:00 am Basal 0.1

11:30 am Basal 0

1:00 pm Basal 0.1

3:00 pm Basal 0.125

9:00pm Basal 0.1

9:15 pm Basal 0

10:00pm Basal 0.1

10:15pm Basal 0

11:00pm Basal 0.1

11:15 pm Basal 0

Total = 2.225
Even if this profile did work for me in the Tslim, how am I suppose to make adjustments if my numbers need increasing or decreasing?

I, personally, wouldn’t make any adjustments to this. Focus on data collection for 2 weeks. That will be enough work. Let me look at this - gonna take a minute, lol.

Basically, I see 3 or 4 different basal rates - a black one, an orange one, a blue one, and a red one.

Are these your MT settings or your t:slim? I thought t:slim didn’t go down to 3 decimal places. I think you got a typo here… and in the orange section, 0.175 - should only be 2 decimal places?

I think this is gonna work fine, but lets talk about it a little to make a simplified way of thinking about it.

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The medtronic basal rates go from.025 and up in .25 increments. The Tandem only does .1 per hour basal at it’s lowest. I am thinking that this pump isn’t going to work for me. Way too many basal segments on the tandem basal profile. The personal profile is what the Tandem nurse made up for me in order to match my medtronic profile. My medtronic basal has only only 5 timed segments. Do you understand?

What pump are you using in the basal schedule listed above?

How are you delivering a dose of 0.175 with a Tandem pump that

That profile isn’t gonna work, but she might not have finished it. I’m gonna look at the black basal.

Can someone confirm how many decimal places a Tandem goes out to for delivery and what it increments at?

Several people have suggested looking at diluted insulin. I found this article describing use of diluted insulin in pediatric patients with very low insulin requirements. I copied this excerpt below because it mentions pump delivery reliability at low dosing amounts. Here’s the link to the full article.

I think diluted insulin is a viable, and possibly more reliable, method of reaching your goal - regardless of pump used.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939443/

“Despite pump manufacturers’ claims to dose in increments as small as 0.025 units, the observations by Mianowska et al.1 raise concern over how reliably very small basal and bolus doses are actually delivered to the patient in low flow situations. This case series describes three young children between 1 and 4 years of age treated by insulin pump. Despite prior insulin pump therapy and families being adherent to the recommended medical regimen, all three had suboptimal blood glucose control (mean HbA1c, 8.1%). After switching to diluted U10 insulin, HbA1c levels improved at 3 and 9 months (7.3% and 6.7%, respectively). Moreover, when two of the patients changed back to U100 insulin via pump, HbA1c values deteriorated to 8.5% and 8.7% within 2 months. Glucose variability also improved significantly as measured by blinded continuous glucose monitoring at baseline and 3 and 9 months of U10 therapy.”

Yes the tandem does .175 just like my 630. The Tslim doesn’t do .025 or .075. That is what I need.

I see. I’m still looking at it. Something about this basal profile doesn’t look right.

Ok, I think this is what it is delivering. Can someone double check?

@Dee_Meloche, your right, this is complicated. You really gotta look at it. Does this look like what it should be delivering? I’m not 100% sure about this. Does anything stand out to you as wrong? Is there supposed to be NO insulin delivered between 2:30 am and 5am???

Can’t you set it to zero and allow the pump to manage your basal rate? You are using so little insulin I don’t see how you can cut it down otherwise

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No it is probably correct. The diabetic nurse set it up. Even if it is correct it looks very hard to be able to manage it for adjustments. This is what needed to happen in order to give me what I need. It would suspend if going less than 4.4mmol. The problem with that is 4.4mmol is too low for me. The basal insulin starts back up when I get to 4.5.

Yeah, that was the theory. It suspends at 4.4mmol and that number is too low for me. I have my dexcom wake me if I go less than 5.0mmol.

That 's what scared me is that big gap with no basal.

I think one thing that might help non-Tandem users understand what is going on here Is that the minimum basal rate for Tandem is 0.1 although you can have 0.0. But the incremental rate on top of that 0.1 is 0.025. So although you can’t have a basal rate of 0.025 or 0.075, you can have one of 0.125 or 0.175.

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So would .2 be .05?

Thank you for putting it in perspective by highlighting the hours when it is still delivering.25 in the hour. I think I might try it and see how it goes. I have my dexcom, so if it goes too low or high I will be protected.

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For each of these 1 hour slots you are netting .025 per hour, but all in first 15 minutes, which may send you low.

So one tweak might be to start with 0 first leg (9-9:15), then .1 for 15 min, then 0 for last minutes of each one hour block.

When/if you go low during a 0 basal segment, basal-iq can’t help with suspend.

OMG, you guys. The ex-state attorney general just called me on the phone. My blood sugar was low and I had a minor freak out where I didn’t make any sense. God help me. Just venting here where not many people see it. I’m an idiot!

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