El_Ver and I had similar pre-pump MDI therapies. I’ve gone from 155u/day to 72u/day in 3 months time. Many days it’s often 60 or 65 units. I use 3 settings: 4am-11am, 11am-11pm, and 11pm-4am.
Slow, incremental changes are the key here. Please know that once you think you have figured it out you will need to tweak it again. You might find it helpful to go into the Options menu, scroll down once, tap Pump History, tap Total Daily Dose, then select a day to view the percentage breakdown of the Basal and Bolus doses. Basal should be between 40% and 60% of the TDD, I typically have the best management with 50%-55% basal and 45-55% bolus. You’ll soon figure out what works best.
You are spot on increasing basal.
I also would consider being a little more aggressive with moving up then dialing back since you have Basal IQ on your side. When you see a large number of suspensions, then disk it back.
A bonus to keep in mind, as a woman, she may need a different basal for each week of the month to manage hormone changes.
Does your daughter use a continuous glucose monitor? Using a CGM helps me adjust basal rates even without fasting. One thing I learned from Gary Scheiner is to make basal adjustments in 0.1 units/hour increments. This is a significant enough amount to see glucose effects.
I agree with others who see the doctor’s initial rates as simply a starting point. Making basal adjustments is a key skill to develop. These are not set-it and forget-it settings. A person’s insulin needs do change and a competence at making these adjustments will serve you and your daughter well.
Diabetes is a dynamic disease. Something as simple as losing sleep will affect needed basal rates. Setting temporary basal rates is a great way to use a pump. If you find you need to set an increased temporary basal rate at a certain time of day for several days in a row, then that is an indication that a more permanent basal change is needed.
Sounds like you are having success with your changed settings. Continuous learning is a key attribute for managing glucose well.
DD is 17, so should be able to do a miss a meal basal test. There are several insulin pump workbooks on google, that would be worth viewing.
You can also part basal with Tresiba say at 25-30U and use the pump for the rest. I forget the term used for it, so I can’t give a link. Some one here will know. There are some advantages.
Unfortunately with the OP being from Canada, it is my understanding that Basal-IQ is not currently available in Canada with no public timeframe for availability.
(Not counting projections from Tandem Sales Reps and although I am sure they are all great - I really discount anything I hear from any sales rep from any company)
Untethered is the term. Yes, I’ve thought about it, but I am not sure the Basal IQ (when we get it) would work with the untethered method. I would prefer some Tresiba in there for added protection from DKA, but not sure the two would jive.
We are also working to enhance our international offerings with the launch of Basal-IQ technology and the use of the Tandem device Updater in the second half of this year. The timing of our international launches will be a decision that we make in consultation with our distribution partners and will also depend on different regulatory and reimbursement requirements. For those reasons, the timing is likely to vary by geography.
Hopefully. They anticipate the G6 will be here in early fall and Tandem has told me they hope for a Basal IQ rollout soon after. I’ve learned never to count my chickens in this world.
It is amazing how we find a way that is right us. As a pump user for 32 years I have a single basil rate for every hour of the day (1.1) except for the cortisol surge from 4am to 8 am. This rate is .1 higher that twice my regular rate. My goal is as few carbs as possible. Preferably I should have a stable BS with no bonus after a meal. Shooting for 30 to 50 carbs a DAY. Getting a CGM will quickly help identify wether to adjust basil rates. Good luck and you will figure it out.
I actually had put my own settings into my pump before the trainer came over and I kept mine. I had allowed for the drop at the time that I would do between 2-3 am and an increase at 6 am for my dawn phenomenon. I know I had been told that to take my basal rate that I was taking by shot and divide by 24. That didn’t work well for me as I needed a lot less at night and with a pump it turns out I needed a lot less basal all day because I was getting the proper doses at the proper times. But I was also told to always make small adjustments at a time and I usually still follow that. I expect they erred on the side of caution because as medical professionals they seem to always to that, but also because some people do need less total once on a pump. Plus they don’t want it to be too strong at night. That doesn’t mean it’s the settings that will work best for you.
Another item to keep in mind that your overall insulin usage should be as close to 50% for Basal and Bolus. I would think if her Boluses for a day(s) far exceed the amount then
There might be a need to increase the basal rate. I have at least 6 different rates set on my pump, much like Eddie. I agree with both Eddie and Jim. It will take some time and taking before and after meal (2hrs) BG will help you achieve the balance. It’s all a balancing act
Similar situation in Australia. I’ve been informed (by the rep FWIW, but the same company does both Tandem and Dexcom) that Basal IQ is already approved by the TGA (our equivalent to FDA), and will be available as soon as G6 is approved.
One big bonus that we do have with the G5 here in Canada is its integration with the X2 pump. The CGM information is used to calculate without having to input glucose readings. I understand that is not the case in the US with the G5. Correct me if I’m wrong. Likely because the introduction of the G6 came so much sooner for them they didn’t bother with the g5.
So resurrecting my original thread for a lengthy follow-up rant. My daughter (17) has been using her new X2 pump together with the G5 for a month and is really liking it. We are seeing a real difference in blood sugar swings and overall control.
We had her first doctor’s appointment yesterday after starting the pump. Due to the pump start, her A1C was 1.3% higher than her last appointment (so 9% this time - her highest ever), but we knew that was due to her pump start and dialing in the rates and ratios properly and also factoring in the time still on MDI that wasn’t super successful. As I mentioned before, I don’t agree with how her endo establishes basal rates and ratios at the same time. Everything I have learned from here and the other billion articles I have read emphasizes how important it is to get the basals right in order to get the carb ratios and correction factors right. So we loosely followed the endo’s recommendations as a starting point, but took our own path to basal test and make adjustments to ratios - a project we are still working on, but dialing in slowly but surely. I told the Dr. it was my understanding that we needed to make sure her basal rates were set properly before we started adjusting her carb ratios and correction factor and he said “no, wrong”. I asked why and he never answered - just told me about his vast experience and knowledge. Since her diagnosis 6 years ago, I have become very familiar with her patterns and varying insulin requirements throughout the day on MDI. I have made a career of educating myself so I can help my daughter as best I can. I am a “take the bull by the horns” type of person when it comes to helping her manage and changing things up when they’re not working and teaching her along the way. Well yesterday, we were berated, disrespected and told we weren’t following Dr.'s orders and that he and his team know a lot more about diabetes and pumps than we do. They hand us a piece of paper with the new recommended settings and ask if we’d like to put them in now and I refused. By the end of the appointment my daughter and I were in tears we were so furious. He wanted to change her morning settings (which we have set perfectly) because of “the cortisol surge that everyone has between 6 and 8am”. I said “everyone”? and he said “yes - everyone”. My daughter doesn’t have an issue with morning blood sugars - never has. Her breakfast ratio is a bit tighter than other times but that’s common I am sure. He also sets everyone’s duration of insulin action time to 3 hours - I reset it to 4 - my daughter’s actual time.
Most of the time we have been seen by other doctors on the team. We’ve avoided this one because we have locked horns with him before on other management issues. This doctor about a year ago very heavily pressured my daughter to get a pump when she wasn’t ready and was very happy on MDI. Just this winter she made the decision to start pumping because she was getting a bit burned out and was looking for a new and easier way to manage . She’s headed off to university this fall to become a registered nurse, so she wants things as simple and manageable as possible. Now, a month into having the pump, he’s telling us we’re not doing well, not following orders and listing off all the complications that are going to arise from having a high A1C. We went to this appointment feeling like we were making good progress in the right direction and left feeling defeated and beaten down.
Sorry this is so long and rambling - I just felt a need to vent - to the folks I know would understand this best.
read again. 4-8am is twice plus .1 unit. That’s 1.1 to 2.3 units/hr Total daily basil about 29 units and total daily bolus is 10-20 units 
