for almost a year i have had 2 different basal rates set on my pump; .50 from 6am to midnight, and then .475 overnight. recently, my BGs have been completely bonkers, up down, high low, etc. i am not sick, i feel fine, but crazy BGs nevertheless. i talked to my endo 2 weeks ago, and he suggested that i might be going through a period of insulin resistance, and i could up my temp basal rates. so i did. first to 110%, then up as high as 145%. for the first week, this seemed to work out well, but then the highs and lows crept in. i would go into the 300s, then correct properly by my correction factor, but swing low into the 30s. bouncing all over the place. so today i went into his office early this morning, and he turned off the temp basal rate, downloaded both my pump and my meter, and looked for specific patterns in my BGs.
then, he made changes in my basal profile. but he changed it from 2 settings, to 6 different ones. has this happened to any others of you? is this common? do any of you have this many settings on your pumps basal rates?
all answers are good answers. please help.
thanks, Daisy Mae
I donât think you are describing anything unusual. I recommend reading Sugar Surfing by Dr. Stephen Ponder if you havenât already. The most useful thing Iâve learned is that basal rates and all ratios generally are just starting points and approximations - our bodies have different insulin needs at every second of every day and also absorb insulin differently based on so many different things that are out of our control. I have several different basal rates and Iâm constantly adjusting them and taking corrections as necessary. I will have one week where theyâre absolutely perfect and then a week of work stress or more activity or a new infusion site can throw everything off unexpectedly. Do you have a CGM? Iâve found this to be the most useful tool for this issue because you can make corrections before things get out of control, and you can make small corrections throughout the day or in the middle of the night when the alarm wakes you up. I set my alarm to buzz at 7 mmol (126) and take a small correction if it buzzes me in the middle of the night. If I find I go through a few days where I keep having to take corrections I adjust my basals.
I use 7 segments in my current pump profile. The ability to set multiple basal rates throughout the day wads the primary reason my endo wanted me on a pump - itâs worked wonders!
Note: I used to have a second profile set for weekends, on the advice of my previous endo. After some soul-searching and lots of experimentation (and reading Dr. Ponderâs book!), I decided that, in my case, the separate âweekendâ profile was just plain silly â The endoâs reasoning was to âhelpâ with some higher-carb eating on weekends, but basal should not affected by that - just bolus more! While I occasionally use temp basals for sick days and high-activity days. Basals should be - and the baseline, and therefore, fairly constant â that is, until they change, hence periodic basal testing.
iâve read dr. ponderâs book and found it insane for me. i felt like i had to starve myself to create âaccurateâ basal settings. i would fast and have to continue lowering my basal rates; then, once i added food and bolusing into the equation, my BGs changed dramatically. i keep OCD-type logs on my BGs, the hours of the day, the stress, the foods, the pump sites, insulin expiration dates, exercise, etc etc. this allows me to see when things are âoffâ and when things are âright.â patterns, etc.
i cant say that i am lazy about tweeking my basal settings, i am more of a frustrated sort who would rather live in some kind of denial that i do need to make some changes; i prefer the simplicity of only managing 2 different basal settings per 24 hours. UGH. well, at least i know that i am a ânormalâ D.
also, i used the Dexcom for a little over a year. it was not for me. i am too skinny and could not get accurate readings; also, it would only work for at the most 3 days, and then all the alarms would go off. the company was always having to send me replacement sensors. i was constantly checking and rechecking (OCD) my receiver to the point that it became painful. i have been much better off doing (many) finger sticks throughout the day and during the night (when i wake up to P).
thanks, though. i appreciate the suggestions and the relief of the knowledge that i am not alone. i always love TuD for this very reason. i have been with my husband for almost 26 years now, and despite even bringing him to my endo and my D nutritionist with me on multiple occations, he is not a D and does not âgetâ it. (youâd think he would get it by now
But thatâs the beauty of the pump â IT manages your basals! I currently have 5 settings over 24hrs + 3 profiles (each still with the same times for the 5 phases, but one lower and one higher basal across all of them) that I go through each month since I have clear hormonal fluctuations as a woman as well. Obviously doing this on MDI would have been much more challenging, while on the pump it just happens, with one menu selection at most.
So you should feel lucky that you are able to take advantage of a pump and try to get the most of it, which hopefully will lead to more stability and less frustration. The technology is there to help you.
thank you for the reminder. i appreciate your sharing and your encouragement. i have been on the pump for the past 17 years; youâd think i should know all of this stuff already. i just hate change. ugh. (high-class problems) i wish for stability and consistancy over a disease i cannot control perfectly. but, with D i have to remind myself that glitches are not my fault and i need to roll with the punches and be more flexable.
I understand completely! I would love for it all to make sense and to follow the âpatternsâ most people with diabetes have!? Like there is such a thing.
Unfortunately what works for me probably wonât work for you or any other person with diabetes, because itâs my diabetes, not some case study.
That being said, I have been pumping for about 27 years and really love the flexibility of it.and over the years have finally come to realize all those basal rates I had set, it really didnât need. So after finding a new endo and joining a clinical trail, those many basal rates are down to 2 on my off days and 3 on my work days. I was told most people really donât need many different ones and each one you have needs to start 2 hours before you want the change to happen. So that means you have that same 2 hour on he back side. So the more you have the less likely they are doing what they should be doing.
So as hard as it was for me, we wiped everything out and went with one rate for the whole day except for the much lower on work days. And magically they were both right. I have the daytime rate and a little higher one overnight. I just have other rates for carb and correction sets for different times but basal pretty steady. So every two weeks, I pull my dexcom reports and see if there is a need for an adjustment. Sometimes there is sometimes there isnât. My biggest frustration is the no pattern. I could have three days where I go up after breakfast and than the next two I go down. And so, I donât make any changes to basal and just watch and check back in two weeks later. Never easy, always a challenge or a pain the in you know what. But I will say I am taking some much less insulin now, which is I think one reason I have been losing weight. Not feeding the insulin any longer.
Donât know if this was helpful but sometimes just a complet reboot is ok. And even after doing this for 46 years, I understand that I donât know it all. Good luck and hang in there!
I also have no patterns. Occasionally I will spot something that lasts for more than three days and make a change, but then often within another few days Iâm having to reverse it. So who knows. Iâve started to use more temporary basal rates. One feature I really wish pumps had is the abillity to âscheduleâ a temporary basal rate to both start and end at a certain time, so that you could program it before you actually need it (such as if you wanted it to kick in at 1:00 AM while sleeping).
I have seven basal rates on my pump. Iâve tried to cut that down, but every time I do I eventaully end up âtweakingâ it back to seven.
That is something I wish all doctors understood! The patient-to-patient differences are so critical to success. Hopefully the days of âpersonalized medicineâ are getting closer.
I wonât pretend to have knowledge that matches your many years of experience, but for many people, one or two basal rates should work; however, there are many others that need more granularity to achieve optimal results. Only a lot of experimenting can determine the best approach for any individual. Like you said, sometimes, a complete reset is necessary to get there.
I am a little confused â if I understand your wish correctly, thatâs exactly what you can do with a âbasal patternâ (or profile) , at least on the Medtronic pumps.
With a basal program, at least on my pump, you have to program in the entire day from scratch. I was thinking more of being able to set a temporary increase/decrease with both a start and end time. For example, when exercising if set a temporary basal rate for later that night so that I wouldnât later forget. Maybe thatâs getting too complicated, though, since the vast majority of people donât use any of the pumpâs advanced features.
Yes, it is one of my biggest frustration in general that what works for one person, might not work for the next. Heck for me, itâs what works today might not be what works for me next week. I remember when we talked about going on a pump, I had that terrible overnight climb. So to fix that, I went on a pump as we wanted to have a child and I needed perfect blood sugars. So went on a pump and sure enough that crazy nighttime climb disappeared. Go figure! And I so wish I could one of those who sets their basals and they donât need to touch it again. For me, it is a ongoing battle. So yes, what works for me might not work for the next person and it will probably not work for me next monthđ
I guess there are people like that but I suspect more of us fiddle with our basals regularly. There are also people who donât change their basal rates yet respond in other compensating ways, like adding a correction when needed.
Ever since I read Sugar Surfing, Iâve come to appreciate that the dynamic nature of basal needs is probably more the norm for diabetes than the genuine set-it-and-forget-it routine. Thatâs my take on Ponderâs book but surprisingly heâll often set a single basal rate for 24 hours and deal with the rest dynamically. I think heâs on MDI now.
I think expecting changes in diabetes regimens is a healthier outlook in general.
Itâs incredibly reassuring to read these posts. Iâve been on the Omnipod for four months (after more than a decade of MDI) and while I wasnât expecting miracles, Iâve been so frustrated by the constant tweaking of basals and ratios that yield minute improvements and then a week later everything is out of whack again. Someone posted on the Flatliners topic that theyâd been on the Omnipod for three weeks and had a 24-hour period in which their CGM never went out of target range. I can only dream! I keep wanting to find the right blend of numbers that means I can maybe get more than one day a month of in-range tests, or I can get through a night without having to do a small correction ⌠but maybe I just have to accept that this is life.
this is exactly what i have just tweeked; i had been on just 2 basal rates per 24 hours, one for the daytime, and one for over-night. .5 from 6am to 10 pm, then .475 from 10pm till 6am. easy breezy
now, my endo tweeked me and i have 6 different settings for the day and one for overnight. the changes are minute. i dont get why they even matter; however, after just 2 days, my BGs are back into range and i feel like a happy camper again. phew. but it is beyond me why this happens. he tweeked a .5 basal to a .525 for one hour here, and then a .5 to a .65 for one hour there. how this makes such a difference is beyond my comprehension. prior to these changes, i was on a temp basal of 145% just to keep everything in check. now, with these very minor changes, i am no longer on any temp basal. its nuts.
I probably have about eight different settings in my profile, and most of them are pretty close. If you think about it in terms of percentages, the changes are more significant: .5 to .525 is a 5% difference. .5 to .65 is a 30% difference. If you do basal testing, you can see that during certain hours, your insulin needs do change and that it doesnât take significant amounts of insulin to address the different needs.
Yes, I have wished that scheduling feature for temporary basal as well. With me it has been more a case of say as an example, at lunch when Iâm doing a bolus, eating etc. I think, I must remember to set a T.B in an hour or so because I have that âbusyâ midafternoon thing happeningâŚthen I forget and end up eating fast carbs to handle the low. The different Programs feature would only work if that same activity or need, was daily because I could see myself forgetting to cancel it at the end of the day. If I didnât remember to do the T.B. I probably wouldnât remember to cancel that Program, ha, ha.
