basal rates during the night

[J-a-n-e]

I've started using a pump a week ago. I was told to set up a basal rate: 0.6. With 0.6 my sugar levels are not so bad during the day, although I do some little corrections. Because my sugar levels were too high during the night:
sugar level 10 before bed
sugar level 15 at 3 am - normally 4 units correction
sugar level 14 - 16 in the morning
I've phoned the nurse and asked to increase my dose up to 0.8
When I've increased it I had a bad hypo during the day and again high sugar levels during the night.

After a meeting with a nurse she said me to slow down and if I do any changes stay with it for 3 days. She set up my dose as 0.6 during the day time and increased my night level from 0.6 to 0.7.

I'm happy with my day dose as I'm able to make corrections, but every morning during last week my sugar levels are again from 15 - 17 and I have low level of ketones 0.9 -1.1 - feeling really bad in the morning.

I am new to pumping and don't have a great amount of knowledge with it, but to avoid feeling bad I'm thinking to increase my basal dose to 1 during the night time and to check my sugar level not once a night, but every 2 hours. Need some comments from experience pumpers, as I don't feeling great at the moment and I don't want another high sugar levels tomorrow morning as I need to go to work next week...

 

[dancer]

A week isn't a long time in pumping. Over the next few weeks you'll be looking for patterns and your DSN will help you decide on what changes to make in your basal rates.

Yes, your levels have been high but you shouldn't make too many changes too quickly. I have seen high blood sugars even though I have increased the appropriate basal but the next day (or even the day after that) my blood sugar has come down. This will be why you've been told to "stay with it for 3days".

You don't want hypers but you don't want hypos either. It just takes time and lots of work (and chats with your DSN). You'll have to be patient. If you continue to be high with ketones in the morning, you obviously need more basal at night. It could be dawn phenomenon and maybe you need an even higher basal rate in the early hours of the morning. Ask your DSN about this - she'll probably have you doing lots more testing but it is worth it in the long run.

Good luck!

 

[J-a-n-e]

Thanks a lot Dancer. Perhaps I need not to rush and wait for my next consultation... I just feel bad and this was the reason I've posted here and asked for alternative from DSN opinions.

 

[CarbsRok]

How many time slots have you got set for your basal?

 

[J-a-n-e]

How many time slots have you got set for your basal?

Last time DSN set for me 2 slots:
9am - 24:00 - 0.6 and
00:00 - 9am - 0.7

 

[noblehead]

The beauty of a pump is you can have multiple basal rates to deal with your bodies needs, have a look at the following which explains how to do a basal test in different time frames:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[himtoo]

Hi @J-a-n-e
I started pumping 6 weeks ago after 18 years on MDI.
It was like being newly diagnosed

my DSN started me on a flat 0.5u per hour for 24 hours and my bloods were fairly horrendous the first couple of days but by the first week in we made some tweaks to rates. She said we needed to concentrate on night times first .

I think what @CarbsRok is asking is in a 24 hour period starting from midnight what are the time periods that your basal can be broken down into. so for me so far we(me) have only used hourly slots and starting about 3am have seen the bigger rises ( to allow for the 2 hour delay from changing a basal rate to seeing it in a blood test.) Mine can be broken down into 30 minute time periods if required.

stick with it though -- it is slow to start with as your DSN will be looking for patterns and you will start to see them too

it would help to buy the book --" Pumping Insulin " as well

 

[J-a-n-e]

The beauty of a pump is you can have multiple basal rates to deal with your bodies needs, have a look at the following which explains how to do a basal test in different time frames:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Thanks a lot for that link, Noblehead.
I think I will have an early dinner today, will stay with my dose 0.7, and then will test BG every 2 hours and will wright down all my correction doses. Hope this will help my DSN to set my night dose. Not sure if I'll be able to do this for 3 nights as I'm working and wake up every 2 hours during 3 nights doesn't sound great...

 

[noblehead]

@J-a-n-e, just keep working with your pump DSN, as @dancer says its early days yet and you will eventually nail down those basal rates.

If you've not got the book already then do purchase the book Pumping Insulin by John Walsh & Ruth Roberts, it comes highly recommended by the pump users on the forum.

 

[J-a-n-e]

@J-a-n-e, just keep working with your pump DSN, as @dancer says its early days yet and you will eventually nail down those basal rates.

If you've not got the book already then do purchase the book Pumping Insulin by John Walsh & Ruth Roberts, it comes highly recommended by the pump users on the forum.

Just ordered the book. Thanks a lot for suggestion.

 

[CarbsRok]

Last time DSN set for me 2 slots:
9am - 24:00 - 0.6 and
00:00 - 9am - 0.7

You need to look at your manual and set up more time slots on your basal. Where you have a massive hike ie, 3AM then you need a hike in basal at 1AM.

So start some basal testing and see exactly where you are starting to rise and write the lot down. If you post the results on here I'm sure you will have plenty of input to help you out.

 

[iHs]

This is a good guide as well on how much to adjust basal rates by to get the targets required.
http://diatribe.org/issues/26/thinking-like-a-pancreas

I was using the Combo pump when I first started pumping and my 24hr time slots were 0.50u.
This was not too bad in the day but was way too much from midnight to 3am and instead of having a bg of 6mmol, mine were 2.5mmol so I had to change them to cover the 4mmol drop so I changed the 0.50u to 0.28u and that did the trick.

 

[Spicey245]

Hi Jane, I have been on my pump now for 7 weeks and am loving it. I have still got a lot of work to do re basal rates but they're pretty spot on to be honest. Once my basal rates are sorted I will then be able to fine tune my carb to insulin ratios (these are pretty spot on too although think I need a tiny bit more for my evening meals as tending to go quite high beforw bed). I too have noticed my BG rising a bit in the morning but thankfully only by a few mmol but will just take time to get the times and basal rates correct. Small changes at a time. ;-) I am on three separate basal time slots now but that may well be increased over time. I want to go on CGM soon to do some basal testing and really see what my patterns are. It can take a number of months to get the levels right and is hard work but worth it in the end!

 

[-Artemis-]

I'm almost 4 months in and still adjusting... And have 7 basal rate time blocks now...! Think I'm nearly there...

 

[Hollieandethan]

Hi, I'm new to the form but not new to pumping. I've been pumping for nearly 5 years and my son is about to go onto the pump at 17months.

As people have said the beauty off a pump is you have all the different time slots so if you think going to bed at 10 is too high increase the insulin at tea time poss up to the time you are wakening in the morning. But don't increase by loads do it in short doses 0.1 at a time if that's right for you.

Really hope you are loving the pump as I love mine!

Here if you need any info I'm on the accu chek spirit combo.

 

[donnellysdogs]

@J-a-n-e

Its important that you get involved with decisions and learning around changing basal rates etc.

The nurse will initially help and direct but you should really have to think that your nurse in a while won't be there to change rates etc... So really read up, do the basal testing.

You will not stop changing rates... Whether its basal/bolus or correction. Whether its cold weather, hot, emotions, colds, types of food etc you will always have to be making some changes at some point.

Start to think for yourself. What you think you should do.. Even if you do wait for nursey. In a few weeks you need to have the confidence and ability to stand alone...

 

[ewelina]

My basal differs from one hour to another. It took me a while to get it right but its nearly spot on now. You need to learn how to do that by yourself because you will have to tweak it from time to time. I think its a nonsense to put someone on a 24 h flat rate. Most of us will need more insulin in the morning and less in the evening. My first profile set by consultant was like this and I worked from there.
Good luck and don't be afraid to make small changes.

 

[donnellysdogs]

Thnx to a special person here when I was first on pump.. This special person from this forum got me changing mine within 24hours! By time I went back a week or two later I had fully changed and altered my basals etc and was basically well on way to mastering my control.

I would recommend getting the full understanding for yourself asap. Nothing worse than relying upon nurses... You need to look at your own bloods and activities and eating etc and sort for yourself. You'll get there.. Just don't rely upon nurses.. They don't treat you as an individual... You need to get the confiddence and knowledge to look after yourself asap...

 

[iHs]

My basal differs from one hour to another. It took me a while to get it right but its nearly spot on now. You need to learn how to do that by yourself because you will have to tweak it from time to time. I think its a nonsense to put someone on a 24 h flat rate. Most of us will need more insulin in the morning and less in the evening. My first profile set by consultant was like this and I worked from there.
Good luck and don't be afraid to make small changes.

On the Combo pump I only had 2 basal rate time slots the same and that was the midnight and 1am. The rest of them were all tweaked slowly over time hour by hour with virtually all slightly different as I was trying to get the same bg target every hour. I was trying to walk along a tightrope though and about every 10 days my bg levels started to change and once a pattern started to occur (the same thing every day), after 2 days of the pattern, I then made some changes to the bolus first to see what that did and if not ok, adjust the basal. I have a feeling that all AccuChek pumps are like this. I also did a bit of meal staggering where I delayed eating food by 2.5hrs so instead of breakfast at 7.30am, eat it at 10am and then see what bg levels are at 7.30,8.30,9.30am to determine if the basal is ok still or needs a tweak.