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Pump users: how often do you test/change your basal rates??

Discussion in 'Insulin Pump Forum' started by rachel162, Aug 10, 2015.

  1. rachel162

    rachel162 Type 1 · Well-Known Member

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    Hi guys :)

    I've been on an insulin pump for about 7 years now (been t1 for 19), and gradually over time my management has definitely slipped; I generally only do 1 or maximum 2 blood tests a day, sometimes none at all, and all basal adjustments and most boluses are now completely guesstimated. I've recently realised that although I thought my blood sugars were vaguely consistent, my lack of blood tests has hidden some massive fluctuations through the day.

    I'm trying to get back in control and know I should probably do some fasting tests to sort my basal rates before I do anything else (I haven't actually done that since at least 5 years ago when I was ill for a long time and had to drop my rates considerably, and from then on any later readjustment was just guessed). I'm a bit unsure of what I'm doing (despite the fact that you'd think by now I should know everything there is to know about all this!) so thought I'd ask you lovely people!

    How often do you need to change/check your basal rates?? Like yearly or every few months, or more? How many sections would you split your day into in terms of fasting etc? I was thinking 3 sections, ie skip breakfast and test every few hours morning and early afternoon for at least 3 days, then skip lunch and do late afternoon/early evening, then late evening/overnight, obviously adjusting in between as necessary...assuming I have to adjust all my rates and check again for a few days after each it'll take me close on a month, seems a lot of work!! Are your changes in base rates fairly evenly split?? (ie because of my haphazard adjusting of mine I'm sometimes on the same rate for like 5 or 6 hours then different rates every couple, it seems a bit chaotic!) How many different basal rates do you have through the day?? With my levels being all over the place with my current rates anyway, do you reckon it'd be easier just essentially starting over with more evenly spaced and less fluctuating doses and adjusting from that rather than trying to tweak the rollercoaster that my rates seem to be on at the moment?? Sometimes I think just starting with a blank slate might be easier!

    This is all feeling a bit overwhelming at the moment; I know I have changes to make but it just seems easier to carry on as I am just kind of pretending it's not happening and dealing with it as it comes...I just want a week off from diabetes and I know I can't do that, which is just making the thought of having to put even more work in so much more frustrating!

    Any advice (or just a big hug :p) would be much appreciated!!
    Rachel x
     
  2. Galen1595

    Galen1595 Type 1 · Member

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    basal rates can need changing for a lot of reasons( lifestyle, medication, diet, usual time you wake up) and from my personal experience there isn't any way to tell how often they should change. it can be really frustrating because there just isn't any way to predict it, especially if your a shift worker or college student and can't get much consistency in your life. this is why I test a lot more than most people, 8-10 times a day, because keeping a close eye on it is the only way to try and stay ahead of it.

    if your finding it difficult to wait for your appointment with you endocrinologist to make changes to you basal rate then what I try to do if I think a rate needs changing is see if it happens three days (probably in a row) of having the low or high just to make sure it's not being caused by miscalculating carbs or stress or sickness. then I feel comfortable making the change.

    for some reason I have to increase all my basal rates by 20% when I over indulge in ****** processed sweets like deep fried cookies at the fair. and 10% when my site is in my bum.

    big hug! :)
    Galen
     
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  3. himtoo

    himtoo Type 1 · Well-Known Member
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    hi rachel162
    a big [[[[[hug]]]]] from me first

    has your HbA1c stayed pretty good throughout your "living in the guessing world" years ?

    i am about to go on a pump in 6 weeks so don't have the experience yet of changing basal rates but I shall tag some lovely pumpers who should be along with some of their experience
    @noblehead . @Mrsass , @CarbsRok , @donnellysdogs


    all the best !
     
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  4. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Hi Rachel,
    here's a link for basal testing http://diatribe.org/issues/26/thinking-like-a-pancreas
    Very minimum for insulin use would be 4 times a day for testing and a pump at least 6. So with all the cut backs in the NHS make sure you don't lose your pump for improper use. :(
    Buy yourself the book pumping insulin by John Walsh, this is the pumpers bible (can be found on amazon)
    As to how often basal testing is needed that depends on the individual and you would soon see what needs doing with regular testing :p
    Good luck with a pumpers favourite pastime (basal testing)
     
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  5. noblehead

    noblehead Type 1 · Guru
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    @rachel162, the following explains how to do basal testing on a pump in different time frames, have a look and if you have any questions then do come back and ask:

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

    As for bg testing, you need to test far more than twice a day whilst using a pump, if you were to have a set failure or a problem with the pump you could be heading for DKA after a few hours, that is why its important to test regularly and take pre-emptive action if need be.
     
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  6. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    Provided there are no obvious reasons for a change like the seasons or weight change, I tend to review my base basal rates every couple of months..........more recently though I haven't and things are still OK..........

    What kind of support are you being given............

    only 2 tests a day would no doubt have me pulled to the side by the pump team......

    I have 6 rates throughout the day........

    what training were you given?

    it seems you know the basics and how to do it all its just you have lost the momentum....
     
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  7. rachel162

    rachel162 Type 1 · Well-Known Member

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    @himtoo - my HBA1C has actually shockingly been really good (when I've had it tested which isn't as often as I probably should have done)! I guess I tend to have more problems being lower than higher and if I'm high it's never for long as I hate the feeling and feel awful anywhere above about 10-12 so any problems don't really show up in my HBA1C . And ahh that's amazing, good luck starting pumping :D

    @novorapidboi26 - when I first got my pump I had all the relevant training and had great support from my team, however a few years later I was really ill and a lot was going on and they offered little support and just threatened to take me off my pump pretty much there and then...that was five years ago and I was so scared I just never went back. I don't want to tell them I'm struggling cause I'm worried they'll say I just need to try harder or try and take me off my pump again. I think support instead of threats/criticisms would have been better (I mean we'd all love to be between 4 and 7 the entire time but when I've tried my absolute hardest and they as a nondiabetic are telling me I should be doing better, it just makes me feel like why should I bother if they're not going to try and understand anyway?!)
     
  8. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    So how do you get your supplies and new pump as thought for most people you had to attend a pump clinic and if you failed to turn up funding withdrawn.
     
  9. rachel162

    rachel162 Type 1 · Well-Known Member

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    Erm I don't really know I just ring up the Animas people and order them as I always have, they've never queried it! I mean I technically have a registered doctor etc it's just I never go and see them!
     
  10. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    So how old is your pump? If it's over 4 years and it goes wrong will it be replaced?
     
  11. rachel162

    rachel162 Type 1 · Well-Known Member

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    @CarbsRok Oh yeah I got a new one a few years ago and I've just recently got the letter to say my current one is coming up to 4 years and to ring them up to swap it...should it not be replaced if it goes wrong and its over four years?? No idea!
     
  12. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    i would recommend going back to see them.........

    they wont take you off the pump especially if you say your just need some retraining...........

    basal testing is the first thing you need to do anyway..............probably best starting overnight, and then do 5 hour chunks after that......

    a good guide can be found here : http://diatribe.org/beyond-basals-–-part-ii

    when you have that right you can move on to the carb ratios........

    you will definitely feel more at ease if you have the support of your team.....
     
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  13. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    The pumps have a 4 year warranty, so once that's up the pump company have no vested interest in the pump.
    Who sent the letter the pump company or hospital? As you only test twice a day I doubt your pump would be renewed due to safety fears.
    So start testing and look after yourself :)
     
  14. rachel162

    rachel162 Type 1 · Well-Known Member

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    The pump company, and God I didn't even know they could just not send you another one! Best get cracking and fix the mess I'm in!
     
  15. rachel162

    rachel162 Type 1 · Well-Known Member

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    Well I've (begrudgingly :p) booked an appt so that's a start, and will see what they have to say next week...I guess so long as I go with a bit of an open attitude and show that I'm trying to help myself rather than my more 'a good offense is the best defence' teenage years it may not be so bad! Will start my basal testing in the next day or so so they know I'm making an effort, and so I can discuss any changes I want to make...and I hadnt even thought about carb ratios, I've literally done 1 unit to 10g since before I started on the pump and never changed that either...looks like I've got a fun few months ahead of me ;)
     
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  16. Diamattic

    Diamattic Type 1 · Well-Known Member

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    I have only been on my pump, with a CGM a couple of months now, but I still test my sugars 3 to 4 times every day. I do it when i wake up and before bed every day, as well as before every meal to ensure I am bolusing correctly.

    In Canada we have a program (likely similar to what the UK has) for pump funding. But to maintain our funding one of the main conditions is that we test our BS 3 times every day. If they find we are not testing the proper amount they take away our funding/pump :S

    It has taken me month to get a basal profile I am kind of happy with.. its not perfect yet, but its usable. I tend to use a Temp Basal at least once every day, sometimes multiple times - both to lower and increase my basal due to activity and eating.

    I would reccomend to anyone to re-asses there basal and bolus rates/ratios at least Once per month to at least confirm they are still correct. But that's just my opinion.
     
  17. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    That's the spirit, any diabetic team should be there to help you.........

    did you test more before the pump? or have you just lost focus since going on it?

    its quite common these days still to see people put on a pump without first already being pro active in their testing and trying every which way through MDI to get their HbA1c down.....

    that way when the pump does come along your already in the right mind set....
     
  18. rachel162

    rachel162 Type 1 · Well-Known Member

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    Yeah, when I was injecting I was testing 5-6 times a day minimum, but I just seem to have gradually done less and less without realising since being on the pump, and on a few days when I was on holiday recently and had to do any more than 3-4 in a day it felt like loads! But if I can decrease my tests and not really realise it shouldn't be too hard to get back to doing enough! And aha my HBA1C has always been shockingly good just cause I have so many hypos, so it probably seems like I'm more in control than I really am...
     
  19. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    I completely understand..............

    when I was on the jags and doing DAFNE, I was recording my 6-10 tests a day as well............

    that's pretty much gone now apart from time when I am looking to adjust a carb ratio of basal rate..............even then the adjustments are so fine and few and far between it can be done without writing it down......

    if you can get back in the habit of getting a reading before meals and before bed that the hard part over........
     
  20. Ladybirdy75

    Ladybirdy75 · Well-Known Member

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    I'm basal testing quite a bit at the moment as I'm really trying hard to bring my HbA1c down (67 in May down from 77 in March - think I'll be in range on next one). I base test a couple of days after making some base rate changes to check those changes are working and sometimes if I've had a run of wobbly hypos or highs I'll base test to see what's going on and make changes again....... and so on.

    I test my BG's 6 - 8 times a day , 3 for meals, 1 before exercise and 1 after exercise,1 before bed and then if I'm ill or having a sneaky treat I'll test then.

    You've had loads of good advice off the peeps on here, I'm not as clued up......hence me slipping a but like you but as soon as you start doing some tests and recording and making changes you'll be amazed at how fast your body responds bringing your HbA1c down.
     
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