Back to basal!

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?

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).

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.

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..

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?????

donnellysdogs said:

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?????

Click to expand...

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.

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!!!!!

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

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.......

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

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

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.

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..