Basal rates and active insulin time

[becki]

Hi all,

I have been on my pump since monday, my dsn said that the active insulin time is always set at 6 hours but never explained what this affects?

also my basals are 7pm-7am 0.8 and 7am - 7pm 0.7 but some of my readings are:
8pm 17.5
10pm 18.3
1am 16.4
4am 8.7
7am 9.6
9am 6.9
12 12.0
2pm 10.9
4pm 12.8
6pm 10.1
8pm 6.8

any suggestions or advice would be very welcome - thank you x

 

[donnellysdogs]

Hi

What pump are you on and what time do you eat? Are you on Novorapid?

Active insulin time is not always set to 6 hours. It might be for you initially for some reason. I believe many of us are set up wither to 4 or 5 hours depnding in insulin type and how our bodies work.

Have you gone over with your DSNN about changing your basal rates and bolus?

 

[becki]

hi i am on

the medtronic and yes i am on novorapid

i didn't manage to speak to my dsn today (phone issues) hence the wee msg

today was 9ish for breakfast
12 for lunch and 6 for t (but thats because the kids are on hols)

usually around 8 breakfast, 12 lunch and 5-6 for t

 

[donnellysdogs]

Becki

How have you been today, have you managed to speak to your DSN? Have you managed to adjust your basal or bolus to help bring down the high's?

Don't be afraid to try. Try to makesure though that you test very frequently especially in the hours where you may have adjusted your levels the day before. Don't forget if you go high then your basal rates for the 3 hours before your high's will need to be changed...NOT the hour that you actually start to go high.....same in reverse for low's.....

Have you got enough blood strips from your GP, you will probably find for the first 6 months at least that you will use at least an average of 10 a day.

Don't be afraid to change your basals / bolus....at the end of the day, it is you that is living with the diabetes 24/7/365, not your DSN. It is you that needs to master the pump, not your DSN. The quicker you get the confidence to manage it, the sooner you will feel better about what you are doing. Honest, I had huge support from iSA that I will never forget when I went to pump, and still now 6 months on she is always there for me. For the first time ever my husband actually understands my diabetes and what I have to do to manage it, don't be afraid to ask here. Although I am the only one that has answered at the moment, you are not alone, and us pumpers have a lot of everyday experiences that occur, which DSN's and reps etc may not fully realise what we cope with. It is a huge change over in our lives going over to a pump, and honestly, if it hadn't been for the huge amount of support that I got from iSA I really don't know how I would have managed initially.

You will be fine, but the best advice given from me is to gain the confidence to change the basals and bolus. Your DSN I am sure will be happier that you have confidence with the pump to alter things and checking for patterns in levels etc that waiting for her to give advice.

Sent you a pm......best wishes...Sharon

 

[becki]

hi sharon,

thanks again for your support, i have always thought that the carb ratios are too high based on the work i put in with the dietitian pre pump, but dsn insisted these were correct. once small people are in bed i am going to review rates and make a decision what to do. have plenty of strips for 2 monitors.

will let you no my readings 2morrow and see what has happened was much lower last night highest was 9.0, but true to form high after lunch again


becki

 

[iHs]

Hi Beckie

Usually the acting time for most bolus insulins used in a pump is normally set to 4hrs. For people who tend to go very hypo, the acting time can be extended I believe to 5hrs but I've not heard of 6hrs??

I would think that your pump dsn is using the Prof P calculation of working out your starting dose but of course it is only a guide and will need to be adjusted. Have a look on your pump at what the insulin to carb ratio is set to. Mine was set to 1u for 20g carb using the 500 rule but I had a feeling that this was not going to be correct so started to adjust it and used 1u to 10g instead. This stopped me from going high and needing to do a big correction. I next started to adjust the basal rate the next day as I spent the whole nightime going low every 2hrs on the first night and was in and out of bed drinking lucozade until 4am and then I just ate a biscuit as I was desperate to get some sleep.

Once you are able to get to grips with playing about a bit with the settings on the pump, testing your bg levels to find out whether your adjustments are ok or not, then you'll be able to get better bg levels. It will though take a few months for your insulin needs to become more stable and less adjustments needed so good luck and enjoy your new 'toy'.

 

[donnellysdogs]

Don't know why I keep typing 'iSA' for giving me such help, it was iHS.....sorry iHS......!!!!She was and still remains fantastic.....

 

[iHs]

Don't know why I keep typing 'iSA' for giving me such help, it was iHS.....sorry iHS......!!!!She was and still remains fantastic.....

You've got money on the brain :lol:

Although I've been able to give you a bit of support, I've also learned a lot from you too 8)

 

[becki]

thanks guys I have put down my active insulin to 5 hours, and my results were much better last night will see what today brings.

ihs my carb ratio was set exactly the same as yours but pre pump i was 1:10,

I think i am just going to work it out on what i think rather than worrying about dsn as you say it is me who has to live with it.

Will keep it going, nightmare of today is hubby wants pizza for t never good at calculating pizza (asda make your own) think i may gfor something else!

 

[iHs]

thanks guys I have put down my active insulin to 5 hours, and my results were much better last night will see what today brings.

ihs my carb ratio was set exactly the same as yours but pre pump i was 1:10,

I think i am just going to work it out on what i think rather than worrying about dsn as you say it is me who has to live with it.

Will keep it going, nightmare of today is hubby wants pizza for t never good at calculating pizza (asda make your own) think i may gfor something else!

Hi

Now that things are starting to get a bit better I would alter the acting time to 4hrs tomorrow and see what that does to your bg levels.

When I first started to use the pump it was estimated that I would need about 24u of insulin per day and that 12u would be basal and 12u bolus. This is where the 1:20g carb came from using the 500 rule. My basal rate was set to 0.50u per hour all day but like I said because of going fairly low from midnight onwards I then started to reduce it but also allowed for the DP from 4am onwards. My basal is now just under 12u and my carb ratios have changed for different times of the day but my basal is just under 0.50u for some of the day and then a bit above at other times.

Before you start making changes to the basal rates alter the acting time first and alter the carb ratio maybe to 1:15 to start off with and then alter it again according to what your bg levels start to show up. Once you've got yourself somewhere near having ok bg levels again you can then look at the amount of bolus you use per day with the amount of basal and whatever that adds up to you divide that into 100 to work out what your correction factor needs to be set at.

You can then start to do a bit of 4hr fasting to see how the basal is affecting your bg levels if you want to.

Pizza tastes great I know but it's one of the main causes of poor control bg wise because of all the fat (they are swimming in it)!! so only eat it now and again. Don't like to be a poo poo on this but think you'd be better avoiding the stuff until you get your bg levels a bit better and even then, you'll probably have to use some sort of wave on the pump so it means a lot of messing about with trial and error until you find pump settings will work ok for you eating pizza.

 

[donnellysdogs]

Well done Becki, your last posting shows that you are starting to take control of your life with the pump as your new best friend..albeit with perhaps a blip with a pizza for tea!!!!

iHS.....I never refer to you correctly, for some reason I always mention you as ISA....I know money!!! Foggy brain as well I thinks!!!! Thanks anyway for always being there for me.

The magic of speaking'typing to people that live with a pump, is that they actually live with it....Dsn's and consultants etc have a great knowledge gained from other patients, theory, training etc, but they only ever see a snapshot of your life.

I'm not being awful to my DSN, but last time having a look at the snapshot of my life I was encouraged to raise some basals.....in fact I have had to lower them because of various other things that were going on in my life. I'm not being horrible about my DSN as I really appreciate her input and help she gives to me, but it is just that I have realised that the snaphsot she sees is not the same as what is actually occuring in different days of my life, and it is only me that can deal with it, and learning so much from other people that are pump users on this forum.

Becki, your last posting seemed more positive, I really hope that you are managing to get those high's down. ISA sorry iHS is brilliant with her advice, can only say if you need anything at anytime, I am sure we may be able to help....take it one day at a time though...and keep testing (and changing).......
Best wishes..Sha

 

[becki]

hi,

will be seeing dsn tomorrow bad night last night, partly due to pizza and have stinking cold plus had a funny turn (felt sick dizzy pale) but not hypo. Think it has had a knock on effect tomorrow is a new day, changed some basals today but don't think this will show till tomorrow and will change Active time again.

have been off this week, on advice of dsn and really not sure whether to go back to work this week (there not the most supportive, promise time but never get it)

thanks again

 

[donnellysdogs]

How are you getting on Becki?

 

[becki]

Hi,

getting on ok, had good readings from morning fast all rates where they should have been was planning a lunch fast today but, when i changed my set yesterday there must have been a few of those small niggly bubbles and was having horrendously high readings but they kept coming down so have just c hanged my set again and will see what happens (readings were 20.6 ish) not sure if this lunch is the best time to fast after this hiccup so may have to do that tomorrow can't even do tea time tonight as we have friends over for tea.

Have changed by active insulin time to 4 hours, adjusted basals for morning which has proven my am is ok.

Maybe its just me but sometimes my readings make me think that i am just not getting the insulin fast enough, but then could be my carb ratios, so will look at that after the fasting.

Sorry for the ramble

 

[donnellysdogs]

Hi Becki

Glad you are starting to see some levels that are okay. When highs at 20, then it maybe that you may wish to put yourelf on a positive temporary basal rate for approx 2 hours to help bring yourself down quicker. I try not to do it for longer than this, as if you are doing an extra correction bolus as well, it could make you crash beyond the 2 hours. Saying this, it is only what works for me. I get frustrated when I go above 11 and I get impatient not wanting to wait for 5 hours to bring down my levels.

When you changed your set, did you look at it so see if it had a kink or blood on it? I generally find now, that if my set is painful on trying to put in, then it won't be in a good position and will cause me high's. Now I am on a steel needle I can actually pull it out and resite it to a better site because it will just be that I have hit a blood vessel or muscle on it's way in. Again, i have only had it happen twice , but two times I have experienced stinging when do the first bolus after a set change, and levels afterwards have gone up, so now I know if the bolus stings then I have also got a bad site.

You are doing all right, and seems that you have confidence, which is great to have when managing the pump. Well done.