How much Basal doses are you on?

[Martin Z]

I have been diabetic since 1966 and for nearly 2 years now been using a Medtronic 722 pump, I started to need greater amounts of insulin to survive as I developed inuulin resistance ! Since going on the pump it's got better but reading a few forum quotes I notice people are on low doses of basal, i.e. 0.6 units per hour etc, I am on anything upto 2.8 units per hour, as I vary it throughout the 24 hrs. Is anyone else on such a large dose or is this just me??

 

[Alzibiff]

Martin,
I have had my pump since last May, T1 since April 1967. (but it wasn't called Type anything then as far as I can remember!).

This last week, I have been sorting out my basal rates by being carb free - at least during the day! I get up, cook myself a couple of rashers of bacon, scrambled egg and a few mushrooms, cup of coffee - and then take BG readings every 2 hours. Dinner time - lump of cheese - and snack on lumps of cheese throughout the day until tea time (when everyone is back home from school, college and work). At that point - carb-free goes out the window!

At the start of the week, I was taking correction doses every 2 hours and changing the basal rate for the next day appropriately. (Working on adjusting the basal 2-4 hours PRIOR to a "too high" BG reading. In the afternoon, I know that in the past I have tended to dip low, so took BGs ever hour.

By the end of the week (it's Friday now), I think I have got it sorted and am looking forward to going back to cornflakes next Monday! Results - I am starting the day on 1.4u per hour which reduces to 0.65u per hour in the early afternoon. At night time, I am on 0.6u per hour.
I have yet to do a carb free evening and when I do, hope that I can sort out the rest of my basals within a day or so as I think I am quite close already. Now - all the foregoing applies to my working week, Monday to Friday. I have come across the "patterns" feature in my Medtronics pump and will need to adjust things and use a different basal pattern for weekends I think - generally more physical activity and later getting up on Saturdays and Sundays. Interestingly, when looking at what I normally have for breakfast, dinner and tea, my weekday basal amount is pretty **** close to 50% of my total daily insulin dose - which means that the "books" are absolutely correct.

Alan

ps. Since posting this note I have had a PM from another member of the forum suggesting that my method for adjusting my basal rates is somewhat flawed and I shouldn't be trying to adjust basals rates "when stuffing face full of protien as it raises blood sugars too". Now this is a fair comment and a fair point I guess and although I have no doubt that there is some merit in this note, I can, with hand on heart say that I am not going overboard with either fat or protein. My PMer gave a link to adjusting basals: http://www.diatribe.us/issues/13/learning-curve.php

Which again, is fine and dandy but when it starts talking about cutting out any caffeine drinks because this too can affect BG levels, I start to roll my eyes to the sky - thinking that I've got no chance of ever getting a flat BG profile in the absence of food!

No day is identical to another in terms of that other BG factor - physical exercise - the number of times I run upstairs today is unlikely to match the number from yesterday or tomorrow - so cutting out cups of coffee is a wee bit extreme in MY view. We will NEVER be able to control all variables in an effort to achieve PERFECT BG control, it's a case of whatever works for the individual. I have described what I have done over the last week - no doubt there will be more adjustments to come but this is MY personal story and I am NOT a health care professional suggesting that it will work for everyone.


Stay cool - don't get obsessive!

 

[phoenix]

50% of my total daily insulin dose - which means that the "books" are absolutely correct.

John Walsh says :
50% :basal normal for most people
40% eople who are quite active, people in the first five years after diagnosis(with some residual insulin function), or on high carb diets
60%: some adults, many teens, people with insulin resistance or taking drugs like symlin (not available in the UK I think)

I need about 41% basal, I'm fairly active, could still have some insulin function as within 5 years of LADA diagnosis and eat a high/moderate/low carb diet you choose {about 150g a day}(It'sconsidered high carb on this board, moderate in my opinion but probably low in Walsh's terms :? )
My rates at the moment are between 0.4 and 0.5 units an hour

I've just read the edited view above... I agree about the protein, it effects glucose levels. If I eat a totallyy non carb meal, I would still need to bolus for the protein.

We vary considerably in out weight, how active we are, age, gender etc. As to residual insulin function...almost 20% of Joslin 50 year medalists still have some so that probably plays an important part in reducing some peoples needs.. It's impossible to compare.

 

[kegstore]

At the moment between 0.5 and 0.9 units per hour, adding up to 16 units per 24 hours, which is around 40-45% of my TDD. Usually needs a fine-tune every 3 months or so, which I do over 3 days, missing one meal on each and hourly testing. CGM helps in this process, sometimes...

Funnily enough, my basal pattern follows a very similar track to my insulin/carb ratio (more in the morning, less in the evening), now I wonder why that would be...?! :wink: (and before anyone posts back yes that is a rhetorical question)

 

[Martin Z]

Thanks for everyone's posts on this subject, a lot of food for thought if you pardon the pun!
I was interested in not eating carbs through the day and only at night, I have done that if my BG is high but not thought of doing it and snacking just to keep hunger at bay, a good way of dieting isn't it?
Well many thanks to everyone again...Martin

 

[bonerp]

The great :shock: thing about being T1 on a pump is that you are individual and what works for one won't work for another.....doesn't for me anyway ! :roll:

Basal testing (for me) is painful as I drip feed /graze on food all day!!! So going without for best part of 5 hrs is hell!

I also noticed a fry up still increases BGs - must be the protein element.

My basal rate is 28.2 currently over 24 hrs and bolus was 35.5 yesterday. Basal goes from .3 to 1.5.

 

[DiabetesTom]

Current Total of 33.58U/24Hr
Im still adjusting them but so far the new doses are working perfectly, barely moves at bed time from 10pm-9am. During the day stays within my target 4-7.5mmol/l.
1:5Carbs Ratio
1:1.1mmol/l Correction
Attached a screen shot of my table of hour to hour use currently using new doses.

 

[Alzibiff]

Wow! Thank you for posting your spreadsheet - I have something similar although my "graph" of basal rates over a 24hr period isn't as rocky as yours.

Since my post towards the top of this thread, I have taken a more scientific approach to my basal testing - starting a basal test five hours after my last bolus/food and not taking food of any kind during the basal test period itself. Like Naps and as I test every hour during a basal test, I have my pump set up with a basal rate for every hour which enables me to make adjustments as and when required.

I am interested in your thoughts on adjustments though as my understanding is that BG levels should remain within 2mmol/l or so of each other during a fasting period and if I have read your table correctly, you seem to be making adjustments for the tiniest variation - is that right? I would also be interested in hearing how you decide which basal rate to adjust - if I get an unacceptable rise or fall during between hourly readings, I have adjusted the basal rate 2 hours prior to this change rather than during the hour that it takes place - for me, insulin delivered by my pump takes 2 hours before reaching its maximum effectiveness.

Thanks again for letting us see your rates chart - but one thing - how do you get a negative basal? There are one or two of those in the rightmost column!

Alan

 

[DiabetesTom]

That would be correct to some extent its just a math formula to figure it out based on correction factor. Since I did it on excel I just copied the formula to every cell to cover the 24hours.

Deviation=(Start-End)*-1
the *-1 just inverts the result for correct direction of flow e.g. up or down.

New Dose=(Deviation*Correction)*OriginalDose
Correction is to 1 mmol not 1 unit change so 1.1mmol change would be 0.91units for 1mmol.

so for examle started at 5.7mmol ended at 7.9mmol which is 2units correction for me at 1unit to 1.1mmol at original dose

Deviation=(5.7-7.9)*-1=2.2mmol
New Dose=(2.2*0.91)+1.4=3.4Units

Might not be a perfect but it gives some idea to what to change and how much by.
For new doeses that go into negative numbers i just removed the negative and go from there to be honest I assume its telling me I actually need sugar for that point in time so its just set it without the negative sign and do a fasting test for that time and see how it goes, its just a idea I thought up to work it out. The idea was to see if I could use maths to figure it all out. Im working on a bunch of Formula's for working out all things diabetic e.g. how much insulin is still in me? What is my correct correction factor(if basal is correct)? and a few more, if anyone has any ideas please post them.

EDIT: The theory behind it is if your blood sugars raises, then you would use your correction to bring it back to target. So instead of using the correction it would be included within the basal automatically. So if it works to bring it down; it should also work to bring it up since the sensitivity doesnt change(well it does but im not thinking about that right now and since I havent come to that hurdle where I have that problem I didnt include it in my calculations altho its simple enough to change it to your liking.)

I'm not the best at maths...pretty useless actually so this information can be incorrect nor am I any where near any sort of medical professional. Been on the pump since the end of may started with the Accu-Chek Spirit which had no sort of bolus calculator or reporting fuctions to be directly linked with a Monitor which triggered all this maths stuff off with home made calculations to figure everything out for 100% control or near abouts. Now I've got the Accu-Chek Combo 've slowed down making the calulators and researching it. But slowly but surely.

 

[Jerryshort]

Most of the day I I average about 2 or 3 U/hr basal on my Medtronic 780g pump except for late afternoons when I need 8 U/hr from 3pm until 6pm then back to 3 U/hr.
Does anyone else have such huge jumps in Basal to stay within range?