Back to basal!

[leggott]

Hi. we are two weeks into pumping and although it has been hard work I have to say we are so pleased to be off MDI.

Anyway, we are having problems with the basal at night. The lowest I can set the Basal per hour is 0.05, which between the hours of 12-2am is too much for my son, which is therefore sending him hypo! The hours leading up to this from about 9-11pm his basal needs to be significantly higher at 0.45 units per hour and I think that perhaps this insulin given at this time is still working after 12 and therefore making him drop too low in the early hours. The hour between 11-12pm has just been dropped down to 0.05 to see if this makes a difference.

Although we can suspend basal or set up a temporary basal it means having to get up at 1-2am anyway, which if something that after over a year of doing is something that we are trying to avoid.

I'm not sure there is an answer to this, but if anyone has any suggestions then I would love to know as I'm desperate for a full nights sleep!

 

[jopar]

It sounds as though you need at some point of time suspend the basal, no need to get up to do this..

Just set the profile to zero for the time the basal needs supending...

What pump are you using?

 

[SophiaW]

If your son is having hypos at around 12 to 2am then it's at least 2 hours before that which he needs the basal to be reduced, so around 10-11pm. You may need to compromise and have his basal from 9pm reduced, even if it means his BG rises slightly, so that he has a higher reading for the basal to work on between 12 and 2am. When I say a higher reading I don't mean excessively high but just slightly raised, maybe around 7-9mmol/l so that there is enough leeway for his BG to fall to no lower than 4 mmol/l between 12 and 2am. If you were to suspend basal on a temp basal at 1am it will only have a full effect on his BG around 3am (that's my experience with Jess, although your son may have different reaction times).

 

[leggott]

Thank you for your replies. The minimum basal is 0.05 and you cannot set to zero! We can suspend but cannot set this in advance!

Jopar, we are using Omnipod which I have to say has been easy to get along with. Some features aren't great like the fact that you cannot set basal lower than 0.05 and the remote is a bit cumbersome, but apart from the that we are lovin it! This is our first pump so I cannot compare it to any others.

I think Sophia that you are right in the fact that the we may have to accept a slightly higher rate to allow for the fall. It seems to be taking us some time to get this right. If you don't mind me asking, how long did it tAke you to get Jess's basal right?

Thanks.
leggott

 

[SophiaW]

I just looked back in my notes and the last time we changed the basal was mid-March which was two months after starting with the pump. We got a pretty reasonable basal right from the start based on our DSN's calculations, we did some minor tweaks and everything seemed fine for a few weeks. Then Jess started getting hypos and the basal and carb ratios needed further tweaking. I'm not sure if that had something to do with the winter finishing or whether the better control with a pump took a few weeks to settle down and resulted in further tweaks being necessary. Our consultant has advised to do periodic checks at different times of the day and night to keep track on how the basal and carb ratios are working. With children growing and having growth spurts at different times and inconsistently the basal and carb ratio is something that will probably need tweaking occasionally. We have also identified that Jess needs a different basal at weekends and school holidays than that during school weekdays so we have two different profiles set up. Even once you have his overnight basal fixed you will still want to test maybe once every couple of weeks or once a month during the night to make sure the basal is still working right for him. Unfortunately with growing children the pump settings are never going to stay the same but it will get easier and the changes will have to be done less often once you get over the first setup phase, for us I'd say that was about 2 months.

 

[jopar]

I am surprised by that as with all pumps if you do a temperory zero then you and set a zero basal rate... It might be an idea to give their customers/techniquical help line a bell to double check, as you can always find in a manual a unclear piece of info or two..

Yes once you pinned the basal's down you do need to check them periodically, even as an adult basal requirements can and do change over time..

If you find that you can't zero it out or finding that you can't adjust to compensate the fall without going too high, perhaps consider a little snack to preven the hypo before bedtime..

Another thing is yes start the adjustment 2 hours before you want it to happen, but remember as sophia pointed out that you do need to check whether this so in your case, as with me I change the hour before and would so it nearer than that if was able to do so.. We all tick differently..

 

[leggott]

Thank you.

You can set a reduced basal but it does not hAve the facility to set a delayed time on it so I would need to be up an hour before and do it then for the specified period of time. I am amazed that you can't just set the basal to zero for that period, but there you go.... They are making changes to the handset which will be available at the end of the year along with the new smAller pods so hopefully this problem will be rectified.

We do normally give him a small snack to take his bg to around 7-9. I will have a go at adjusting the basal a few hours before the time we expect the drop and see if that helps a bit.

Thank you again for taking time to reply.

 

[donnellysdogs]

Can you not just alter the hours before hand to 0.00 on the permanent basal rate setting? Not talking about a supsension or a temporary basal rate...does your machine not allow you to go to 0.00 for 2 hours or so?????

 

[SophiaW]

Can you not just alter the hours before hand to 0.00 on the permanent basal rate setting? Not talking about a supsension or a temporary basal rate...does your machine not allow you to go to 0.00 for 2 hours or so?????

I did a quick google search and other people seem to have had this problem and say that the Omnipod cannot be set to 0.00 unless it's a temp basal so looks like leggott has it right.

 

[donnellysdogs]

There is a way around this.......

It may be rather than adjusting for 2-3 hours that levels have to be adjusted for 5-6 hours but with less impact.......i.e instead of doing a 0.45 for 3 hours beforehand....do a 0.30 for 5 hours......

Going up to 7 before bed is higher than I would want to be......I know that i can get my levels to stay at a static 5 or 6 all the way through and this should be the same for anybody else....just getting the levels level before, durting and after....and there has to be a way!!!!!

 

[jopar]

Leggot

I'm getting a bit confused by your OP, can you expand a little with BG readings and what time he's experiencing his hypo's.. And perhaps some more earlier details..

As there is a possiblity if changing at an earlier time might be the answer, but if not there is anothe method that you might try that might just work..

It's using the profile of his insulin, and hiking up his insulin, then dropping it right back for about an hour or so, then returning to the dose required, Sometimes this can actually use the insulin profile to limit the rise and avoid the hypo... But do need some more info though

 

[donnellysdogs]

Yep, agree with Jopar....there is a a way around this but need a little bit more info....may need testing for EACH hour up until hypo point for a couple of nights...but there is definitely a way around to get you out of the difficulties you are experiencing.......

 

[leggott]

Thanks guys thAt does help enormously. We are going to amend the basal before bedtime and take his readings. I will let you know in the morning the results we get so you can help me tweak things. I know we are so close to getting it right but being new to pumping we have lots to learn.

thanks again.

 

[jopar]

A good book to invest in is a book called Pumping Insulin by John Walsh it's known at the pumpers bible.. Very good info indeed

 

[leggott]

Hi again!

Last night didn't exactly go to plan! I've listed below my son's readings so you can give me an idea of where to make changes.

His basal settings are as follows : 22.30 - 6.30. = 0.05
6.30 - 7.30 = 0.15
7.30 - 17.00 = 0.05
17.00 - 20.30 = 0.10
20.30 - 22.30 = 0.45


My son's bg readings last night are as follows

Tea at 4pm with 30 min extended bolus
Bg at 7.30pm = 6
Bg at 8.30pm = 5.7
Bg at 9.30pm = 3.9 (gave juice)
Bg at 10.30pm = 2.8 (gave juice)
Bg at 11.30pm = 2.3 (gave juice)
Bg at 1.30am = 6.9
Bg at 2.30am = 7.3
Bg at 3.30am = 8.1
Bg at 4.30am = 7.3
Bg at 7.10am = 10.7

I can see that the basal when he goes to bed is too high and that the basal first thing in the morning is a little to low. It might help to know that yesterday his blood was in the 6's at 6.10am, but had risen to about 10 by the time he had breakfast at 7.30/8am. The basal is set to go up in the morning, but I think this needs to go up a little earlier.

Any advice would be appreciated, I know I'm not a million miles out...

Thanks, leggott

 

[josie38]

Hi leggott,

You may find that his bs this morn is because of the hypos in the night. I think it is called a rebound effect. Sometimes when i have a hypo there are certain things i cant have as they push my bs too high.

Does this make sense?

Josie

 

[SophiaW]

These are my thoughts:

I think his readings between 1.30am and 4.30am are good, they're only moving by just over 1 mmol/l which is pretty good especially for children. Right now I wouldn't make a change to that if it were me.

At 7am his readings are climbing (based on two days) so I'd increase his basal at around 5am and see how that goes.

His basal between 20.30 and 22.30 is too high and possibly the cause of the hypos between 9.30pm and midnight so I'd reduce that down a bit and perhaps start the reduced rate from 7.30pm rather than 8.30pm. Effectively what you might be doing is moving forward the 22.30 to 06.30 basal of 0.05 to start at 7.30pm.

Let it run a couple of days, get some more readings and then take it from there.

Also, I'm sure you know this, but we didn't have pasta or pizza or any high fat foods until we had the basal worked out because those types of food interfere with BG readings for quite a few hours in our experience so it would have been difficult to identify if it's the bolus or basal that causes the problem.

 

[leggott]

Hi Sophia, those are might thoughts too. I just wasn't sure at whAt time the basal should be reduced at bedtime and at what time in the morning it should go up, So I will adjust at 5am, but not sure how much to increase by and also by how much to lower the basal at the early part of the evening. It was only a few nights ago that he was going up between 9 and 11pm so we increased basal.

Yesterday he only had one piece of toast and a kiwi fruit at 4pm. We always allow 3 hours before they go to bed after having their tea so that 3 hours has gone so we can get as accurate reading as possible. He hasn't had pasta or pizza for a while now so I know the rise a few days ago wasn't down to that.

Gosh this is hard!

 

[jopar]

Looking at those results I don't rekon your problems lie in the basal profile...

The hypo look looks like it was caused by the extended bolus he had with his tea! Then Josie said he's rebounded a bit with hypo treatment..

You need to see if his tea time ratio's are out..

Two ways of doing this..

Doing a fasting test eek, get everybody to do it, have plenty of Sugar Free Jelly handy as this doesn't impact on sugar levels..

If you don't fancy that method..

Is to go for a simple carb meal but with a standard bolus..

As it seems that his basal may be correct, difficult to tell has the rebound would have faffed the results so need to see what that teatime ratio is..

 

[leggott]

Hi, I really don't think it's down to bolus as it was only extended over 30 mins so by 4.30pm all insulin would have been given. He also only had a small tea - one piece of toast and a small kiwi fruit. In our experience the novorapid in him usually peaks at 2 hours and has pretty much done it's thing after 3. He was ok until about 8.30/9.00pm so that would of been at least 4 hours after bolus given.

Thanks for your thoughts,

leggott