Changing basals etc-how often

[donnellysdogs]

Can I ask how often pump people find that they have to change their basal rates or bolus rates?

I'm still having to do this fairly often, but I don't know whether this is pain related or because GP alters my pain medciation so frequently, or whether other people are also finding that using a pump that they find their basals rates are having to be altered as much as me.

I am not trying to get 'perfect' levels', I just find that I can go a while with normal blood readings, then I find I am fighting hyp'o's and then get back to a normal keel with my blood readings and then after a couple of days I will be fighting of high levels.

My activitys are routine all day, everyday really, as people know me here, they will also know that even my eating routines are pretty routine as well....so I really can't see why I think I am running at tickety boo levels one minute, hypo's for a while, het them balanced off, and go back to normal readings and bang my levels will raise again.

Is it possible to actually have say a month without touching any basal or bolus rates on the pump?

 

[SophiaW]

I'm not really sure because as you know we're still new to the pump ourselves. We've made a few changes to basal rates but that's really the initial setup rather than anything else I think. I'm thinking that once the basal is set up it shouldn't really change much unless weight, growth or hormonal changes need to be adjusted for. I have noticed that some days Jess may run slightly lower or higher than usual but nothing too significant and on these days we treat hypos with glucose or do the odd correction bolus to bring things back onto target. My thoughts were perhaps that the cause of these differences are emotional, activity levels or how good or bad absorbtion at the infusion site is.

 

[donnellysdogs]

Thanks Sophia, if I knew for definite that I am having to alter my basals more often than other pump users, then it could be more attirbuted I think to the trials that the GP is putting me on for my fibromyalgia pain. I would be able to tell the GP that trialling all these drugs isn't working and affecting my levels everytime I go on, and then come off drugs....my last trial of lyrica ended up with me having chronic itching all over my body with horrible raised welts from all my scratching. I got advised to come off them immediately by the Chemist/GP that phoned me. So now I am just down to taking ampitrypatalene and citilopram for my fibro. However, when I go back again on 9th March the GP I see will probably want to trial me on duloxitene-another drug that is meant to help. To be quite honest I am feeling like a guinea pig in a laboratory. I had great levels prior to citiliopram, and these lowered me so that I was hypo nigh on 24 hours. Got them stabilised again, and since then with the trials of different drugs I just keep getting say a week of lows, I change my basals and then I will get them level for perhaps 2-10 days and then I go high with my bgs, and then the cycle of lowering basals again.

I alter the basals wither lower or higher because the high/lows will affect me all day, and I will do fasting periods to check it isn't my bolus's that are needing changing.

I don't know whether everybody has to change basals regularly, say every week or 2 or whether it is me. It isn't even different at weekends or set days. When my BG's go up, they go up all day, not just for 1 reading. I am now on my 2nd day of raised levels (in the 11's), and this is despite me doing corrections and 200% or 250% TBR's. Yet 2 days ago my levels were a brilliant 5.8=6.9's all day and nights.

I went to my appointment with my DSN yesterday, but she was on holiday, and I had not been contacted. There was no-one else pump related that I could talk to. Another DSN left a message on my phone today is a pump user but left a message that she would phone back, and I haven't had a phone call back.

I just wondered how often fellow pump users find they have to change either their bolus or basal rates. I wish I knew whether it was me or the drugs to be quite honest. It is so frustrating expecially as my life is so routine, if I could blame extra exercise or less exercise or not eating a meal or stuffing myself I wouldn't be feeling so frustrated, but I'm not. My sets in my legs are the stainless steel Rapid d 6mm ones, and they are where I have been wearing them for the past 2 months, and they always go in lovely and come out clean as a whistle, and I really don't know that they are there.

I hope that Jess is finding the pump ok, and finding her way round coping with the swimming and the minority girls. Your posts are so wonderfully full of love for Jess, it comes over in every word that you write, and makes me quite emotional when I think of any child AND parent coping with diabetes.

Thx for your response, every little info gives me something to think about..

 

[SophiaW]

It's really tricky trying to nail down the problem. Is there a reason you must trial all these drugs, can they not keep you on one type? If you could stay on one type for a while then you might be able to find out if it's the constantly changing drugs that are affecting your basals. I've found that keeping routine and things constant in life really goes a long way to helping predictable readings.

Jess is on half term holidays this week so we haven't had to deal with the girls at swimming problem yet. We went swimming today but as a family, not school swimming. The holidays are great, and we're having lots of fun and days out, but it does make diabetes more difficult to manage. We've eaten at different times and out quite a bit so having to guess the carbs, can't say her readings have been as ideal as they should be. Routine is good for us, we get much better readings when she's at school rather than school holidays.

 

[donnellysdogs]

GP is trying to find me some pain relief for fibromyalgia, but now I am beginning to think that I may have to accept that I am not going to get rid of pain permanently. I have been referred now to pain clinic, waiting list is approximately 1 year...am trying to find out if we can pay to go privately to get there sooner. I think I am now in the situation where I might stay on the ampi and citilopram only until I can get to see someone that specialises in pain managemtn, at least then I can figure out what is going on, and then I would know if it is the different drugs that have been affecting me, or what it is just that something goes awry when the full moon comes!!!!!!


It surprises me though that there hasn't been anybody coming back and posting that they can go a month without changing anything, so perhaps I am expecting too much from pumping?? I have only been pumping for 8 months, so I know that pump reps and nurses say gve it 6-8months, so perhaps I am just expecting too much?

 

[barkbark]

There are so many factors that influence your blood sugars that I personally see management of my Basal and Bolus amounts as a living / evolving matter. Weather temperature, stress, exercise, viruses (be it a small cold or full on flu) all impact your blood sugars to differing degree’s – then combine these and food and you know all too well that matters are fluid. Replying to your specific question – I evolve / vary my Basal rate by small amounts once a month, maybe twice but I have a very varied and non-routine life. The adaptation of my Basal and Bolus amounts can move my insulin up or down but having now had my pump for 18 months or so I have learnt one thing, over a 3 or 4 month period I always end up around where I started a few months earlier but with blood sugars running between 4 and 8, usually settled around 5.5 unless I have eaten something which had a different impact that I thought it would or I am stressed over something that I did not anticipate or as often happens I have picked up a bug but do not know it yet other than through my blood sugars but 24 or 48 hours later I have a bad cold (this really can kick my blood sugars up for what at the time appears to be no real reason). I do have 3 profiles in use on my pump, each aligned to varying situations be it being in one time zone different to my normal one for say 72 hours or not exercising as much as normal or simply pigging out on lots of food or drinking. As you know your body is a very complex thing and having read many of your posts I wonder if you are getting stressed without knowing it and this is impacting your control.

 

[donnellysdogs]

Hi Barkbark

I appreciate what you are saying about getting stress affecting my levels, but previously I recognised that the flexilink plus's were affecting me, and now they are withdrawing them....I know I can get hung up on trying to establish what affects my levels to change, but having established with other flexilink plus users what was going awry last time, I just wondered whether it was my medicines or whether others find they have to change things as often as me. In fact speaking to iSA today, I think other things may be affecting me, so I will just work things through and see if my patterns of changes will equal out. Thanks Sha x

 

[donnellysdogs]

Having seen a number of pumpers here saying that they were told to load one cartridge at a time rather than three because of the reaction with the plastic, I have looked back over my records/logbooks.

I write down everytime I do a cartridge change, and also where I put my sets when I change them over, i.e top, middle left leg, or top, outer left leg etc....

When I have looked back I can see that my levels are going up on a regular basis when using the 3rd cartridge stored in the fridge....so I am going to change to loading up 1 cartridge at a time and see if this gives steadier levels.....

I was told by rep that I could load up 3 cartridges at a time, but thanks to the information from other users here, and looking back over my records, I feel that I can see a pattern to the changes that are occurring in my levels over a few weeks, and it does go hand in hand when I use insulin that has been stored in plastic cartridges.

Worth while checking I think......

 

[Cycleman]

I find I have to change my basal rate every week or so. It tends to stay steady at about 20 units/day and then I can suddenly have a period when I'm permanently low. I keep dropping my basal rate and eventually I stabiliseagain at a lower level. A few weeks later the reverse will happen.

Currently I am running at 13.5 unit/day. I expect that this will need to increase again.
There is sometimes a reason for the basal rate needing to change, but frequently I don't think there is one.

I work full time and have a steady life - cycling to work (pretty much 8 mile in total per day) and have very similar types and quantities of food at regular times. I don't get stressed.

My daily tests are not very steady - I can test at about 10.30am and one day can be 17 and the next day 2.5 without any change in insulin or exercise or how healthy I feel.

The consultant doesn't have much idea what to do about it.

Hopefully this will cheer up those people who don't have a very tight control of their blood sugar level with little basal variation!! or maybe those who do can suggest something they have tried.

NB - I've been diabetic for 30 years now and apart from the first few years my levels have varied like this and my basal insulin needs have varied.

Still happy though

 

[LittleSue]

I find I have to change my basal rate every week or so. It tends to stay steady at about 20 units/day and then I can suddenly have a period when I'm permanently low. I keep dropping my basal rate and eventually I stabiliseagain at a lower level. A few weeks later the reverse will happen. <snip>

There is sometimes a reason for the basal rate needing to change, but frequently I don't think there is one. <snip>

NB - I've been diabetic for 30 years now and apart from the first few years my levels have varied like this and my basal insulin needs have varied.

That's pretty much what happens to me too. Not on a pump (yet) but DAFNE revealed that my basal and bolus needs change frequently.

I've been blaming female hormones - but I see you're male - pop goes that theory!