basal rates

[johnny37]

I have been on the Accu-chek for three months and am struggling to get my control right, even with input from the pump trainer. HBA1c is currently 9.3. It was 7.1 before. I have been more agressively increasing my basal doses lately to try and get a grip on nightime highs. After five days of regular increases I was hypo during the early hours today.

Question:

If I am hypo at 1am should I reduce the two preceeding basals slots (11pm-00 and 00 to 1am)?

If I am hypo at 4am should I reduce the 2am-3am and 3am-4am slots?

My logic is that the tiny doses the pump delivers every 3 minutes still takes 2hrs to peak.

Thanks

 

[Alzibiff]

My best response to this is to explain what I do .......

I have my pump set up with a basal rate for every hour of the day - from one hour to the next some of the rates are the same but I worked on the principle that in nature, nothing changes abruptly and by adjusting rates hourly I am able to produce a smooth change as my basal requirements vary.

When I first got my pump, I spent ages trying to get my basal rates right and although one year on I am still chasing the "perfect day" in terms of BG measurements, feel that I am pretty close.

First off, before making changes to any basal rate you need to understand that it is no good trying to make changes when other factors are playing a role in raising or lowering your BG levels. Working on the basis that insulin stays active for around 5 hours, make the decision to take insulin and a meal at one point in the day and then nothing else other than water or sugar free cordial for the next 10 or 11 hours - on a day when your physical activity is as typical as it can be.

Test your BG 5 hours after your meal and if on or about on target, continue to test over the next 5 or six hours every hour. Keep a log of the results. You are looking for a BG variation of no more than 2mmol/l from your starting value - if it dips below 4mmol/l though - hypo time and the basal test stops right there.

Analyse your results - if BG rises by say 2.5mmol/l from say 3pm to 4pm, increase the basal rate on your pump at 1pm - it's the 1pm insulin rate which isn't high enough - your BG was rising 2 hours after the rate at 1pm.

Take a look at this article which Carbsrok sent to me:

diatribe.us/issues/13/learning-curve.php

My basal rates rise from midnight, peak at 8 and 9am and then fall to their lowest point between 12noon and 4pm before climbing again until 9pm ... fall for 3 hours and then up again...

As you will read elsewhere, from day to day, week to week, month to month basal requirements vary - so you have no chance really! (sorry) Aim for perfection but don't be too disappointed if you don't get there and be prepared to have a set of basal rate tests every now and again.

Hope this helps - would like to hear how other people approach this basal thing and whether anyone else has their pump set up on an hourly basis which makes it easy to make subtle changes..... or is it just me?

Alan

 

[johnny37]

Thanks for that, I feel a bitr more reassured. I am on hourly rates btut nothing seems to work with me. My pump trainer knows the basics but whatever we agree nothing seems to work. Only thing is I have fewer hypos but many readings in the high teens and 20s. When I started to push up the night time rate with no hypos I though 'Great!' I seem to be going in the right direction, so now I have hypos I need to ease off a bit to achieve the optimum but dont know which time slot to adjust downwards to stop the hypos I mentioned earlier. I emailed the trainer but no reply as yet.

 

[Alzibiff]

It can take a while to get your basals sorted - take it steady - it is a real pain to do but once you are there, subsequent basal checks and adjustments are so much easier - and quicker to do.

The problem I suspect you are going to encounter is having to cancel a basal test because your BG has risen more than 2mmol/l over an hour or two. If that happens, stop the basal rate test, adjust your basal rate for the period in question for the next day and have another go a day or two later. Eventually you will get it right - or as close as you can realisitcally get.

Good luck, if you think I can help any more - please ask.

Alan

p.s. the full web address for the basal test link which I referred to above is

http://www.diatribe.us/issues/13/learning-curve.php

(Not sure what happened in my last post)

 

[mary123]

This information is really useful, especially the detail on the website. I have only been on a pump for seven weeks and knowing that I need to concentrate on basal rates to optimise pump advantages is invaluable.
However, it does seem as though you need to line your ducks up before you can shoot them! I set myself up to do an overnight evaluation on Monday. But my 2hour post supper BG was only 3.2. I took corrective action and by 11 (a further two hours on) it was 9.7 so carried on to do the evaluation. However, it may seem that I wasted my time and a decent night's sleep because the low would have skewed my results. I have therefore adjusted my evening basal to see if I can bring those evening figures up and will then give it another shot. That will also give me a chance to find another place to sleep, my husband is not appreciating the disturbance especially as it also included waking the dog at one point!

 

[Debloubed]

Hi, I too have my basal set up hourly, with many changes made thoughout the 24 hours in a day. I also find that these need tweaking from time to time, just today I have changed my 10am and 11am dose from 0.50 to 0.45 as I have noticed I am going hypo just before lunch every day, but I've had to do some tests to be sure. By testing, I mean keeping track of what I am doing and eating rather than just dropping the dose based on the BG's, which I have done in the past! I think I have finally got my bolus levels correct by tweaking the dose changes from 9pm-10pm. Such a simple change but it makes a big, big difference if I have a late night snack!

 

[mary123]

Hi!
Well my BG's have settled down quite nicely now so should I rest with that or should I still pursue the basal rate evaluations? :|