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does this mean I have not been getting Basal?
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<blockquote data-quote="irrationalJohn" data-source="post: 1008308" data-attributes="member: 187593"><p>I've been waiting for someone else to comment about what I assume was your basal profile as shown by the graph in your original post. On the one hand, I don't want to cross some line since all I am going on is my own personal experience and what I have read. But on the other hand, if that graph is a relatively accurate representation of the basal profile that your DSN has implemented for you, then I truly don't understand what the heck is going on.</p><p></p><p>It has been my understanding that the current prevailing approach when starting people on the pump is to start with <strong>only one</strong> basal rate for 24 hours. In the context of your graph that would be a fixed, flat horizontal line from 00:00 to 24:00. I believe this approach is taken for at least two reasons.</p><p></p><p>First, the person starting on the pump was most likely previously using one of the basal insulins such as Lantus or Levemir. Because of the characteristic lifetimes of these insulins, the basal is usually given only once or twice a day. So many people are coming from a background where they essentially had a single 24 hour basal rate. I believe the intent when starting a person on a pump is to mimic their previous treatment regimen, so usually a single basal rate is chosen to start with and then refined in small, incremental steps.</p><p></p><p>Second, it is easier to try to dig out the patterns such as Dawn Phenomenon or other quirks in a body's insulin requirements when there is only one or at least a small number of rates. It is easier to see what is going on when there is not a lot of "noise" muddying the picture.</p><p></p><p>The basal rate settings indicated by your graph are not what I would expect.</p><p></p><p>It's not just that you have multiple rates during multiple time periods. It is more that the rates jump/jerk around so much. I have never seen that before and it makes no sense to me. Most people's BGs do not instantly respond to sudden changes in basal rate. So dropping the rate for one hour and then immediately raising it again is over complicating things and I would think it would hinder getting a clearer picture of your body's basal insulin needs.</p><p></p><p>The graph below, stolen from <a href="http://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/getting-down-to-basals/" target="_blank">this Gary Scheiner article</a>, is an example of a more typical set of basal rates during a 24 hour period. Notice how it tends to flow smoothly when it rises and falls.</p><p><img src="http://i.imgur.com/QpkZNdh.png" alt="" class="fr-fic fr-dii fr-draggable " style="" /></p><p></p><p>Is this excessively busy and jumpy basal setup <em>truly</em> what your DSN wants? I can't help but believe that there is some unexpected communications misunderstanding going on here. The way these basal rates bounce around just seems weird to me.</p><p></p><p>But if this <strong>is</strong> what your DSN has specified, I would be very interested to hear what her rationale for this approach is.</p><p></p><p>Has your endocrinologist (consultant?? not sure of your terminology) seen this?</p><p></p><p></p><p><img src="http://i.imgur.com/H1UZaXJ.png" alt="" class="fr-fic fr-dii fr-draggable " style="" /></p></blockquote><p></p>
[QUOTE="irrationalJohn, post: 1008308, member: 187593"] I've been waiting for someone else to comment about what I assume was your basal profile as shown by the graph in your original post. On the one hand, I don't want to cross some line since all I am going on is my own personal experience and what I have read. But on the other hand, if that graph is a relatively accurate representation of the basal profile that your DSN has implemented for you, then I truly don't understand what the heck is going on. It has been my understanding that the current prevailing approach when starting people on the pump is to start with [B]only one[/B] basal rate for 24 hours. In the context of your graph that would be a fixed, flat horizontal line from 00:00 to 24:00. I believe this approach is taken for at least two reasons. First, the person starting on the pump was most likely previously using one of the basal insulins such as Lantus or Levemir. Because of the characteristic lifetimes of these insulins, the basal is usually given only once or twice a day. So many people are coming from a background where they essentially had a single 24 hour basal rate. I believe the intent when starting a person on a pump is to mimic their previous treatment regimen, so usually a single basal rate is chosen to start with and then refined in small, incremental steps. Second, it is easier to try to dig out the patterns such as Dawn Phenomenon or other quirks in a body's insulin requirements when there is only one or at least a small number of rates. It is easier to see what is going on when there is not a lot of "noise" muddying the picture. The basal rate settings indicated by your graph are not what I would expect. It's not just that you have multiple rates during multiple time periods. It is more that the rates jump/jerk around so much. I have never seen that before and it makes no sense to me. Most people's BGs do not instantly respond to sudden changes in basal rate. So dropping the rate for one hour and then immediately raising it again is over complicating things and I would think it would hinder getting a clearer picture of your body's basal insulin needs. The graph below, stolen from [URL='http://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/getting-down-to-basals/']this Gary Scheiner article[/URL], is an example of a more typical set of basal rates during a 24 hour period. Notice how it tends to flow smoothly when it rises and falls. [IMG]http://i.imgur.com/QpkZNdh.png[/IMG] Is this excessively busy and jumpy basal setup [I]truly[/I] what your DSN wants? I can't help but believe that there is some unexpected communications misunderstanding going on here. The way these basal rates bounce around just seems weird to me. But if this [B]is[/B] what your DSN has specified, I would be very interested to hear what her rationale for this approach is. Has your endocrinologist (consultant?? not sure of your terminology) seen this? [IMG]http://i.imgur.com/H1UZaXJ.png[/IMG] [/QUOTE]
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does this mean I have not been getting Basal?
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