New pumper - odd method of establishing rates and ratios?

#1

So my DD (17) just started on the x2 and we’re brand new to pumping. The Endo set a 24 hr basal at 1.2u/hr. They do not require any fasting to basal test, and have set the I:c ratios. The bolus and corrections do not bring her down anywhere close to target. So, they have tightened the I:c ratios to a point where she’s taking a larger bolus than she ever has (I really dislike this). I suspect her basal is too set too low during the day because she has always required more basal during the day than at night on MDI. I have never heard of this non-fasting basal testing and frankly I am skeptical. Anyone ever heard of this method? Seems to me the cart has come before the horse, no?

#2

You have to start somewhere.
I would hope the 1.2u/hr was based on your child’s weight with an appropriate formula.

Hopefully that is close enough so you can do basal testing and fine tune it.

My suggestion (and how we do it).
We own the pump.
We do not ask nor communicate with the Endo when we change settings. We change pump settings when we feel it is appropriate.

During our 3 month Ped Endo appt, the Endo looks at everything and may make a suggestion for a change. The Endo does not touch the pump and changes nothing. We sometimes go with the suggestion and sometimes not but certainly consider it. In any event, if a change needs to be made on the pump then it is my child who puts the change in.

With an older child who soon may be away from the house, IMHO it becomes even more important for the child (soon an adult) to take more and more ownership. If the Endo seems to be getting in the way of that progress than perhaps the Endo needs a reality check.

My approach is really not terribly subtle.
I also don’t care.
:smile:

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#3

What type of basal insulin was daughter using pre-pump? Once or twice a day? And finally total daily basal dose while on injections?

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#4

We will definitely be doing our own pump setting changes. It’s just the getting started that’s very rocky. I have increased her basal .1u/hr. From 6am to 9pm to see if that makes things work better.

#5

Tresiba 38-40u/day. Was between 70 and 80 TDD

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#6

Endos always advise starting basal rates below what was taken with MDI

Basic math tells you 40 U divided by 24 hrs equals 1.67U per hour (all other things being equal).

Are you using Humalog as pump insulin?

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#7

Novorapid the same rapid we used by pen.

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#8

I don’t mind the starting low, but jumping into increasing meal insulin ratios to 1:4 or 1:5 is far more bolus she has ever taken. I don’t like that they haven’t increased the basal, just bolus ratios and they’re still not working.

#9

The key is to make small adjustments gradually and monitor it and test it. If it is not enough, add a bit and wait a few days and see how it goes. Do not make a bunch of changes at the same time. Be patient with it.

I have 14 different rates on my pump for the 24 hours. Having the same rate for 24 hours is not the way I go. If she needs more at night, then add more at night!

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#10

Sounds like your larger bolusing is needed to correct for low basals

Don’t forget Insulin dosages required to correct highs is typically much higher than what’s needed for normal BG’s.

Get rid of highs with higher basals and the bolus’s will come back to what you’re used to

Eddie’s comments about the same basal 24hr / day are on point as well. Mornings will be higher as everyone has dawn phenomenon to some degree

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#11

Yes, we will do just that. She’s not typical in that she’s always required more basal through the day than at night. The 1.2u/ hr holds her beautifully steady all night, but daytime is where we are having trouble.

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#12

Yes I agree totally. With MDI, when the basal needed fine tuning, we adjusted until we got it right then everything fell into place and worked. Right now we’re fighting an uphill battle - literally!

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#13

2 weeks from now it will all be bad memory :+1:t4:

I can’t see how anyone believes they can fine tune basals without fasting

Have patience - it took me a good 2-4 weeks to become one with my pump, and I questioned my judgement for abandoning the status quo MDI

#14

Thank you. I have never heard of trying to establish basal rates while consuming regular meals. It makes 0 sense to me. My DD isn’t a huge carb eater anyway, and we hover around 150 carbs per day (which I know is a lot for some). Delivering 15u of insulin at a time will take years off my life. Let’s hope this is short lived!

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#15

@Sprocket1 it sounds like your endo is being cautious since many new pump users sometimes see a reduction in basal needs by up to 20% or sometimes even more. . Personally I saw a 40+% drop in basal/bolus from Tresiba/Humalog. My TDD went from 160u/day to 71/day in 2 months.

This is sound advice. Like @Eddie2 I also have ~9 different settings /24 hour period.

Sage advice! Have fun tuning your pump. There is lots of self help here if you need it,

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#16

Thank you everyone. I love this board!!

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#17

This is a great start, because getting the overnights down is the first key. FWIW, I never did basal testing when I started with my pump, and after 20 years, I still haven’t done full-fledged basal testing. My endo at the time gave me basal rates based on my weight and my TDD, however, she gave me significantly lower rates overnight than during the day.

Having said that, as others have pointed out, I quickly got to the point of making my own adjustments. With my current endo, I periodically let them know what my basal rates look like by leaving them a table that shows my rates throughout the day, but beyond advice, I make all the settings.

You will get there … cheers!

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#18

One thing to keep in mind (and forgive me if you already know this) when adjusting basal rates is that you usually need to make an adjustment about 2 hours before the time you need it to take effect. In other words, if your daughter seems to run high every day starting at 5am, try raising her basal rate by 0.1 at 3am. If she tends to run low at 1pm, try lowering her basal by 0.1 at 11am. It took me awhile to trust the two hour difference, but it is usually spot on for me.

Another thing to keep in mind is that she may need major basal adjustments (+/- 10-40%) during different parts of her hormonal cycle. Ahhhh, the joys…

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#19

When I started on my pump my cde / doctor figured out the basal etc. Over time I adjusted it but only with temp rates now because I’m very insulin sensitive and I have to be careful. It is such a pita. I am at 160% increase alot of the time now due to thyroid meds but I can still drop like a stone at any time and I have resistant highs too. Oddly enough the thyroid meds with t3 added helped me even though I need more basal. If I miss the t3 bg goes crazy.

#20

OP updating here. AFter just one day of increasing her daytime (4am to 6pm) basal .1u/hr, her graph is much better. Blood sugars coming down nicely, corrections working - we just need to tweak a bit. Success!

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