Hi I recently have moved over from MDI onto a pump for the first time. With the arrival came much elation but some issues have followed the initial celebrations.
My pump can only deliver Basal increments of 0.025 when less than 1 u per hr. My dilema is this.
After 18:00 when my Basal dose is set to 1.45 my glucose levels rise very slowly when fasting. When I change this to 1.50 (the next step up) my blood sugar falls slowly but fast enough to require me to constantly snack or eat glucose tabs.
I use Apidra in the pump !
What I would like to know is how do all you pumpers deal with this? I know most wont have the issue since most people fall into at least one of the dosage settings. I am sort of stuck in between two !! Clearly, if I was able to set it to 1.475 this may solve my issue.
I have tried setting 30 minute increments and having 1.45 then 1.50 interchanging every 30 mins. I did this hoping to get an average dose of 1.475 but I still cannot get equilibrium. When I do this my level rises slowly !!
Does anyone have any suggestions or tips please on how to get this rise/falls issue sorted with a Basal setting when you cannot set 0.025 increments when the dose is > 1.0 u/h ?
Whilst you may be correct I am lost as to why I cannot fine tune my dose at this time of day. As stated, any single increment up or down affects my BG level and I cannot get a straight line. I am using a CGMS and this is confirming the symptoms I am getting when too high or too low. Does anyone have any suggestions on how to work through this ?
I would try alternating in hour increments. You may lose a “pulse” in the 30 minute increments. I find we do because the pulses are given conservatively - if an odd number of pulses in an hour, the extra one is given in the second half hour.
Fantastic. I knew the theory of what I was dong was correct I just could not understand why it was almost as if I never had it set. The explanation of pulse explains it perfectly.
I am sure most people reading this will think how can such a minute amount of insulin make so much of a difference. Well, I would agree. Lets face it we are after all talking about one pulse of insulin
The point is it does make a difference so I’ll set the evening to alternate hourly and see if it works.
Are you doing this to avoid the issues I am running into ?
My son is very sensitive to insulin, so I understand. .05 makes a big difference to him. I have not had to do this, but when he first started pumping, his basal needs were so low, that it was recommended to program .05 and zero in alternating hours overnight. Unfortunately we could not do this bc the OmniPod does not allow a zero basal program. We worked around it by me getting up and setting a temp basal of zero in the middle of the night.
I have, however, set temp basals for Caleb. For example, if he’s a little on the low side before going to bed, I will reduce his basal for the next hour by .05. His basal program is so tailored however, that his settings can vary by hour and unless I am changing his basal exactly on the hour, reducing it can have no impact at all because of this pulse issue.
Anyhoo, I hope it works for you. It’s at least worth a shot. If the alternating by hour doesn’t work, it may be something else. It sounds like you have indeed isolated to a basal issue though. Keep us posted!
Thanks. Ah ha so you are the mum of the famous Caleb. Thanks for that info.
In fact to get around this problem I have turned into a pancreas and to avoid the creeping BG up or down I have been setting temp basals. I cant help but thing is this normal ? Do many people do this ? SUrely I must be able to automate tit to deliver the correct dosage.
In many ways, MDI was great since you inject and forget about it unless you need to correct or eat. its all over. The fine tuning of the pump is really a challenge and I cant wait to get the equilibrium set so I can go back to living.
I am 20 years older than Caleb and since jumping onto the pump after 23 years, only now do I feel diabetic with the constant tweaking of the bump and looking at the CGM.
I think once you get things set, it will calm down. Getting settings defined was tough for us. I don’t know if everyone has that trouble when they start. Once we have a baseline, it’s easier to keep up with just the little changes. It also depends on your level of what is acceptable. The tighter control you want I think translates into more work.
Caleb was on injections for only a few months, but I agree that pumping is by far more work. I find the flexibility it provides and the improved A1Cs worth the work though. So I think it will always require more diligence than injection therapy, but will get less cumbersome that the initial transition period. Just my humble little ol’ opinion :).
I was still dropping from 5mml to less than 4mml in 2 hrs so I think the higher portion of the alternating 1hr Basal may still be too much. However, it is not longer dropping a quickly nor is it rising so the has worked to a point.
I have tried something a little different now in addition to your suggestion, by extending the lower dose from two hours earlier. My Endo suspects that the drop may be due to some left over Apidra from the earlier higher Basal rate three hours prior; even though its meant to be quick acting. So, I dropped this yesterday and testing today.
The later part of the day has improved but still hypo-ing early afternoon so I may need to cut the dose even hour before that as well. Ho hum…
This evening will be the real test. If I avoid hypo’s this evening (as I am fasting) the alternating 1hr Basal would have worked. Lets see…
For us? Never! Haha. It changes constantly with a growing boy. It also varies greatly depending on what he eats. Good enough though. One day at a time.
