Pumpers, how many basal rates do you use?


#21

Well I changed it again last night to 4:00-7:00 A /2.00U and was 139 at 7:00 a.m., my two hour after breakfast, woohoo, but then by 10:00A I was 89, so now I have to figure that out.

I hate changing basals something I seldom do, but I am getting closer. :slight_smile:


#22

Wow, I’m a heavy insulin user as well… I am 6 weeks pregnant, but even before that I was using about 30 units a day in basal rates.
My current basal patterns:

12AM - 1.4
6AM - 1.5
10AM - 1.3
6PM - 1.4

When I work out I take my pump off because I tend to go low very quickly. That, and it’s hard to have on me when I’m working out… I can’t believe people can regulate off a .5 or less basal rate!


#23

I have 6 basal rates. And my total amount of insulin is around 135-150units


#24

I have 5 different rates: 12a-530a .100
530a-9a .300
9a-2p .100
2p-9p .125
9p-12a .025


#25

I use four different basal rates but my Loop system can vary from that every five minutes. I could, conceivably use up to 288 basal rates every day.

Dr. Ponder, T1D and author of Sugar Surfing, argues that a single basal rate works best for him. I think whatever works for you is a good setting for you.


#26

My endocrinologist doesn’t like it when I use too many basal rates. I say the same as you. If it works for you then keep it.


#27

Given I don’t have a loop system I use 8 basal rates. If anyone is curious the 3AM basal blast is like a 1 unit bolus without having to awaken, preparing for the hated 5am dawn effect :face_with_raised_eyebrow:


#28

Somehow, the world looks different to the observer than it does to the participant. I don’t think doctors fully appreciate just how hard it is to dose insulin and keep glucose levels under a reasonable semblance of control. Living with insulin treated diabetes for decades is a least equivalent to a PhD course of study. Walking this walk 24/7/365 piles up experience and wisdom beyond the reach of the typical medical practitioner.

That’s a clever way to use the programmed basal function like a bolus. I too have to use an aggressive basal profile to combat dawn phenomena.


#29

My endocrinologist actually suggested to me to use a higher basal rate in the morning. I am actually at .275/hr in the morning but when I test my basal rate I need to put it back to .275. This seems to work beautifully. My diabetes educator is also on an insulin pump and I told her that I read that you shouldn’t use basal insulin to lower blood sugar and she replied, “Why not?”


#30

SAME !!!
:stuck_out_tongue:

Except that our DP doesn’t happen for a few hours later so the timing is off and we run the increased basal for a two hour period and not as high although the total additional insulin is probably close to the same.

Same basic concept here.

We have had a few comments on the number of basal settings.
Normally, I just say that we adjust the basal based on what the cgm shows and leave it at that.


#31

Basal insulin delivery is the primary method used by some closed loop automated insulin dosing systems. With this experience, it’s clear to me that your diabetes educator makes a valid point. The body doesn’t care if the insulin dose is labeled “bolus” or “basal.” To the body, insulin is insulin. You can only control two things when delivering insulin subcutaneously: dose size and dose timing.


#32

When using a pump; the distinction between using basal insulin to accomplish one thing vs bolus insulin to accomplish the same thing makes zero sense to me whatsoever. It’s the same insulin.

I could extrapolate that idea into many hours of discussions with mdi— but that’s only because they’re different insulin.

The only difference with a pump is the timing of infusion—- and most importantly, the users conceptualization


#33

The basal/bolus terminology serves as a way to conceptualize and facilitate insulin dose calculation. The terminology is useful in that regard. More advanced pumping techniques like extended boluses to cover a certain nutrient profile utilize the basal/bolus terminology because that’s how the pump hardware designers configured the pump. The distinction between basal and bolus is important simply as a way to communicate a dosing technique.

Basal and bolus meaning can be blurred with how they are deployed. Basal insulin in a pump can be used in a bolus fashion. One example I read today was someone who had a 30 minute basal period starting at 3:00 a.m. with a basal rate that delivered 1.5 units in that half hour to neutralize a strong dawn phenomena.

Or a bolus can be extended for many hours to match an extended fat/protein digestion process and look more like a basal delivery.

People on MDI also call the long-acting insulin as basal insulin and the short acting insulin as bolus or meal insulin.

I agree that the black and white definitions of pump basal and bolus are not, in practice, neatly and clearly defined. Instead, like many things, there’s a spectrum of function that overlaps both of these terms,


#34

I think the confusion surrounding “basal” insulin and doses stems from the perception we all had when we did MDI using two insulins with significantly different action profiles.

Since the long acting insulins were always referred to as “basal”, psychologically we became conditioned to believe “basal” doses were only for background glucose.

This conditioning persists in some for far longer than others :thinking:


#35

I have 3, but really 2 basal rates because it’s the same basal rate before and after midnight. My schedule is super unpredictable though, so I adjust on a daily or hourly basis by either bolusing or reducing the basal rate. When I exercise heavily, i suspend the pump for an hour before, start it again when I start exercising, and then bolus 1 unit at the end, along with eating a carb heavy meal and bolusing 50% for that. It gets complicated, but it’s a fairly fine tuned system. Still not perfect, and my cde gets frustrated when she sees dexcom say a 39 standard deviation with no discernible patterns. She is pulling her hair out that even a machine cant figure me out lol, but I’ve made my unpredictability work for me as best I can.


#36

I use 7:
12:00am .275
3:00asm .775 for dawn effect
7:00am 1.10
10:00am 5.50
12:00pm .525
5:00pm 1.00
9:00pm 0.300

Seems to work okay.

Ken


#37

This is such an interesting topic. And as always, your diabetes may (will) vary. I for many years played and tweaked with my basal rates to the point where there was just to many and they were literally stacking on top of each other. If it takes around two hours for a setting to take affect, they can start to pile on top.
So taking the advice of one of the research endos I work with, I just went with one for the whole day. And I was very surprised to see, it worked pretty well. Yes, I do have 2 settings now, one for daytime and one for overnight. That clean sweep, wiping everything out and just starting fresh was liberating. But I had rates that were .025 differences and I discovered it didn’t make that much of a difference.
Now I do have two different profiles, work days and off days. My work day is much lower during the day at a .4 and my off days are higher at .7 but my overnights are the same at .625. So much easier to make adjustments.
And when we did the clean sweep, the doctor did that math calculation with my weight, which gave us the starting point of .6. And that formula worked pretty well for me but again may not for everyone.


#38

I use six different basal rates. I also use short temp basals on an almost daily basis.

I think the “basal” and “bolus” terminology will disappear in pumping as closed-loop systems are developed. After all, the body doesn’t have “basal” and “bolus” insulin. Those are really made-up concepts to distinguish pre-programmed/injected doses versus as-needed corrective/food doses. Though even that is a bit blurred, because a 30-minute extended bolus and a 30-minute increased temp basal could literally deliver the exact same amount of insulin, and then there’s no difference between the two except one is presumably to cover food while the other is not.


#39

Yet people will swear they yield different results… which of course is not possible


#40

I’ve never heard that comment, but then TuD and FUD are the only two diabetes sites I tend to hang around (and Facebook a bit). It’s just a preference for how you want to calculate things.

The way I think of the two is that basal is a steady drip of insulin over time, while bolus is a rapid delivery of insulin all at once. I mean, I’m pretty sure hospitals use this same type of terminology. I’ve seen the term “bolus” on emergency discharge summaries where I’ve received IV medications. And I know someone with a feeding tube who uses the term bolus (not quite sure of the details there).

I think the automated closed-loop algorithms are where the power of having a computerized pump that can check BG and make decisions every five minutes will really shine. And when that happens, especially when true closed-loop systems come about, basal-bolus will really be irrelevant.