My 8 yr old dd is scheduled to start pumping (Animas Ping) on Friday.
We are excited and nervous all at the same time.
Can anyone give me some suggestions for basal rate testing at night/day?
DD’s TDD is about 4 units including her lantus. Her average carb intake per day is about 150 - 200.
Any other suggestions will be welcomed! thanks!
Hi - I would check with your daughter's endo about starting basal rates. Her total daily dose is so low that the starting basal might just be pump's lowest possible setting.
Did they give you a starting basal rate? Most folks have their insulin needs drop when they go on the pump because you absorb the insulin better (my TDD dropped by about 15% when I went back on the pump last year). Given her really low TDD, I am not sure how they are going to do her basal rates. I am assuming they will just start her at the lowest (0.025) and go from there.
Formal basal testing basically involves fasting for a period of time and checking BGs constantly to ensure that you're staying within a certain range. The book Pumping Insulin provides a great guide for how to conduct formal basal testing.
BUT....I have found it's just easier to look at all my data (I use the Revel and upload my data to Carelink) and make small adjustments based on that. Sometimes, I will notice that I'm running a bit higher at a certain time of day and make a small adjustment to my basal on the fly. I am not really formal about it and, for me, this works.
Pumping really is wonderful, but be prepared for a rough/wild ride at the beginning as you figure everything out. Her basal rates are going to be changing constantly, but the nice thing about the pump is that, once you're familiar with it, it's really easy to adjust for those changes.
Hopefully they are not leaving the determination of basal rates to you. I was able to get a pump a few weeks after my type 1 diagnosis. I was still in a bit of a honeymoon phase, and was pretty comfortable adjusting my I:C for boluses based on what I was eating and the BGs I was seeing. It took me months to be comfortable setting temporary basals at night, and even longer to actually change my basal without consulting my endo. Hopefully the prescribing physician or her designee will give you all the help and guidance you need initially, while you keep a close eye on BG trends.
Thanks for the replies. My dd’s endo team will help me setup the pump including basal rates and carb ratios. I am just curious how I will test basal rates going forward. I had the general concept. I was really hoping that we could have started pumping last week because she had this whole week off. Oh well I am prepared that for the first few month things will be funky! Her TDD is so low that I figured this was the best time to start pumping. She only takes a unit of lantus so we will be using the lowest basal settings. Please send prayers, good thoughts, vibes!!! thanks! (:
Congrats on the pump. I (finally) start mine tomorrow. From the appointments I've had with my Endo and nurse, they set up everything initially, I don't do anything, they use a formula to convert MDI's (basal - bolus). I was told I would need to wake up in middle of the night for a few days to check blood sugars and will log everything and call them over the weekend, etc...I'm very nervous too, mostly because I know this is just an adjustment - trial and error period. I'm not sure what you mean by basal rate testing...just her fasting numbers, of course. Did they tell you to wake her to check middle of the night blood sugars. From what I understand, we, as new pump users, don't adjust anything at first, especially basal rates. They'll set them and will adjust them.
You may find John Walsh's book Pumping Insulin, very useful. I am not sure how much it relates to children but it covers Basal setting in detail. It will be very useful to you as time passes & her insulin needs increase
the endo and diabetic nurse will teach us how to do this too.
You will get help getting her initial rates set correctly, it sounds like? And you are right, those rates can need adjustment as she grows and changes.
I have a GP instead of an endo, so I have learned to adjust my own rates. Since I've been going through the "change of life" mine vary wickedly with the changing hormones<:( When I start seeing bad numbers at some particular time of day - as in more than a couple times, I first rule out set problems (though set problems will usually create bad numbers steadily - not at a particular time of day - till changed). If the set is ok I go into "basal settings" on my pump, locate the problem time of day in my current program, look back about 2 hours (earlier) from that time, and reduce (if it's lows) or increase (if it's highs) the rate at that point. You'll need the smallest steps if her TDD is only 4 units. In fact I could imagine that the smallest steps won't be small enough, so that you may have to add or subtract carbs from her diet prior to problem times to make up the difference? Which type of pump will she be using? I use Animas Ping which won't do a basal less than 0.025 units/hr. If she needs less than that, perhaps she could just disconnect for x number of hours?
Good luck with it! I'm sure you can get good help here if you get stuck.
As a disclaimer, I'm not a CDE or any way qualified to advise. Just a veteran pumper and long term type 1.
The endo or CDE will initially set her rates, over time and with experiece though you will become comfortable with making adjustments. I have been pumping since end of Nov of last year and I tweak mine all the time now. I do it basically as suggested above. If Im running a bit high or low for a couple of days I will find the problem times and adjust as needed up or down.
It's really individual, some people like and want more support, some, like me, prefer doing it myself. My trainer made an initial suggestion for basal rates, based on a certain percentage reduction of my MDI basal. After that, I adjusted myself. I declined calling in, because it seemed like I would be doing it for them, not for me! But appreciated them being available if I had a question.
Basal testing is a very organized way to find out if your basals are set correctly. Pumping Insulin explains it. I've never done formal testing, but just look at my patterns, like others have mentioned and raised or lowered two hours before any problem times until it came into line.