Basal Changes

[Hooked]

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[iHs]

Look at the time of the drop and then decide whether to change bolus or change basal. If high or low 2hrs after bolus.....chsnge the bolus....if high or low 3hrs after bolus.....change the basal. This is a fsirly good basic rule of thumb that works ok for me due to the onset time of insulin. If high or low 1hr after bolus..change the basal 1hr before the bolus.

If ur not sure what to change do a basal rate test first

Sometimes the basal and bolus need for insulin can mysteriously change.

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[Hooked]

Look at the time of the drop and then decide whether to change bolus or change basal. If high or low 2hrs after bolus.....chsnge the bolus....if high or low 3hrs after bolus.....change the basal. This is a fsirly good basic rule of thumb that works ok for me due to the onset time of insulin. If high or low 1hr after bolus..change the basal 1hr before the bolus.

If ur not sure what to change do a basal rate test first

Sometimes the basal and bolus need for insulin can mysteriously change.

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Sorry, I should have said that the changes were over basal testing.

 

[iHs]

If the changes were done by dsn when you were basal testing, then just change the bolus to see if that stops the lows.

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[Engineer88]

its generally an hour or two before the low ocours

 

[kkkk]

Not an expert at all yet - but I generally drop/raise the dose an hour before my blood sugar starts to change - the general rule if you are on nova rapid is that the basal change doesn't really come into effect until at least half an hour after you have made it (not all of us will be the same) - so try an hour before and see whether that works, if not try 2 hours before.

 

[donnellysdogs]

Agree with iHs. No way do I do the hour before the rise or drop...as on a pump the dose is delivered over the course of an hour so if you do a change 1 hour (in this case 6pm) that full hours insulin dose would not be fully delivered till 7pm and would not actually at its peak working until 8-8.30pm.

In the case of starting to rise or lower at 7pm, then this could be your 4pm or 5pm basal rate.

The 4pm takes until 5pm to get fully delivered...it can then take a full 2hrs to be at its peak working, but may be 11/2 hours.. So peak working could be anywhere between 6.30-7pm. If you are low by 7pm I would if it was me adjust the 4pm.

However, it depends how fast the insulin works in your body at peak...me personally altering 1 hour before is wrong. 2 hours before, does not allow all the insulin to have been fed effectively into me and lowering /rising just when I need it to. 3 hours catches the drop or rise before it actually occurs...




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[Hooked]

Great, that's what I thought, thank you all for the input. I'm going to have to wait till Monday/Tuesday before doing some basal testing again as plans for the weekend are all over the place.

 

[hale710]

I was at the pump clinic today. We have been told to set the basal for 1 hour before you want it to take effect.

ie for me, I rose from 10pm till 2am. I therefore have increased my basal from 9pm. The main spike I have is around 11/12, but I have changed the basal from 1 hour before the issue starts


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[donnellysdogs]

If thos works for you thats good, but both of my hospitals that I have been to with pump say 3 or 2 hours.. Never one.... Its finding what works for you, no size fits all...


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[hale710]

If thos works for you thats good, but both of my hospitals that I have been to with pump say 3 or 2 hours.. Never one.... Its finding what works for you, no size fits all...


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No idea what works for me yet, only had the pump for a week lol but for now I'm at the point if following the dr orders for now!


Blogging at drivendiabetic.wordpress.com

 

[donnellysdogs]

That dr ought to really understand a bit more about how the insulin is delivered and when it peaks to be honest.

I know somebody else who was told to alter the hour when it actually occurred!!

I hope your doc told you bolus peaks 2-3 hours after delivery?

However, even this is all down to timing... If you tested on the hour say every hour, and altered the hour rate before hand then that delivery of insulin would only have just finished going in to your body. However, if you say tested randomly say at 2.50 the insulin for 1.00 may be just coming toward it's peak....

That is why it is so individual, as even timings, iHs has previously advised people to test on the half hour to get better results.

Me, my testings are totally random times and on needs such as driving and eating, so never timed to the hour or half hour.

I would however be very suprised if you low at 2pm and you altered 1pm... That this is going to be correct...


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[iHs]

An awful lot of using a pump is a bit down to trial and error and trying one lot of advice and if that doesnt work, try something else. There is no one size will fit all and there are a few brands of pumps that will work in different ways. Also, Novorapid tends to have a slower onset but longer acting timd whereas Humalog and Apidra are a bit faster but not so long action. All these thngs can affect basal rates and carb ratios and whether low carbing or higher. I use Novorapid in the Vibe and set the acting time to 4.5hrs. In the Combo it was set to 4hrs until I experimented and changed it. It can at times start to become a mine field when you are not sure what to do as there are so many settings that can be adjusted but it pays to not change too many and whatever you do change, remember to write it all down

 

[K8tie_x]

I have found that novo rapid has always peaked with its use at around 2 and a half hours so of my levels were rising between 7 and 10pm if up the basal 3-4 hours prior to that then test again the next day and see how this has affected it. Only adjusting one hour prior to the change wouldn't be any good for me and I'm guessing it won't for you either
I have to agree its alot of trial and error, lots of testing and small adjustments at a time. Good luck!

 

[kkkk]

It is interesting and insulin works differently in all of us - I wear CGM which massively helps with all this - but I know that the insulin starts to peak about 1/2hr after it is in, and then by 2 1/2 hours it is mostly done - and even though my pump might tell me that I have more insulin on board I know that if my sugar is higher than I want then I will need to look at correcting as it isn't going to go down much. With exercise they told me to do my temporary basal reductions 1/2 hr preferably before I exercise - and that seems to work for me - so I guess even by then I am not getting as large a peak of insulin as I would on the previous rate. When you set a new basal rate - in that hour the amount of insulin you are having is reduced...so it's not like all the insulin that has gone before disappears but the rate that it goes in is reduced and I would expect that if you reduce it by the end of that hour your sugar level would have started rising. Also for me I know that the minute that I stop exercising I need to pop my basal rate back to normal or I will go high quite quickly (some people have to increase their basal for a little after exercise because of the way our bodies deal with using up lots of energy). I guess 2 hours before would be a good place to start as that is somewhere in the middle (Also I see the rise from when it starts to happen whereas I guess with testing you know it is some point in that hour but not exactly when so it could be early on in that hour and then increasing it from 2 hours before would work well) Hope some of that makes sense

 

[donnellysdogs]

All different aren't we.. Gardening etc.. And having my cgm proved that on normal living without bolus's my rates needed to be changed 3 n 2 hr before.. Never bolus pre work ever, no matter what. Have food 1hr before work (whilst driving) and totally stable....

Just goes to prove that we all have different acting times. Mine probably different cos I literally work out all day being physically active...

We all have to fine tune our own machines according to lifestyles n eating patterns and fitness etc..


Loving life

 

[SophieH]

I would say to knock it back an hour before it starts to go low, and go from there! Have you thought about doing one day of testing more frequently in that period/th run up? Might give an indication as to how quickly it is dropping x

 

[Hooked]

I would say to knock it back an hour before it starts to go low, and go from there! Have you thought about doing one day of testing more frequently in that period/th run up? Might give an indication as to how quickly it is dropping x

Yes, I'd been testing at least every two hours, and then hourly as I hadn't been getting hypo symptoms until quite low. All sorted for now though, until my body decides on a change of game plan again!

 

[novorapidboi26]

I adjust one hour before and it works OK, have a look http://diatribe.org/issues/26/thinking-like-a-pancreas

 

[donnellysdogs]

When you have a slow digestive system then 3 hours and 2 hours is what suits me, and this is what my consultants from 2 hospitals advise(d) too.

Everyone is different. I don't get hypo's and that suits me fine.


Loving life