when to reduce temporary basal rate?

[johnny37]

been pumping for ten months and still struggling to get it right.

When reducing the basal for exercise, when do you reduce? When the exercise starts, or before?

This morning was typical of me. Before breakfast at 8am bg was 3.7 so did not bolus, A 9am bg was 7.6 so bolussed and reduced basal to 0%. Went on a dog walk. On returning at 10am bg was 2.8. Similar yesterday. I guess the answer is not to bolus when Im due to exercise. My endo says I am insulin sensitive.

ie hypod even though temporary basal was zero.

Yes, I know. No need to tell me my early morning basal needs reducing! I will try tweeking it again.

Thanks

 

[ebony321]

Hi,

sounds like you are quite sensitive to insulin,

At breakfast when you didn't bolus, did you eat? if so, what did you have?

Did you treat your 3.7 as a hypo? (with fast acting carbs and if your breakfast wasn't carbs then about 10-15g of carbs to keep your BG's steady)

i'm not yet pumping but i know the pump i will be having prompts me to treat a hypo reading and to re-test afterwards.

I'm thinking maybe that if you didnt sufficiently treat your hypo, you bounced back under 4.0mmol because you exercised.

But like i said i'm not yet pumping just trying to throw some ideas up in the air

 

[shedges]

I was told to use a reduced temporary basal rate for 1 hour before and during exercise, then to go back to normal after the excercise.

Caviat to that is that if my blood sugar went low afterwards, I am to try keeping the reduced rate running for some time after exercise too, until my insulin requirement picks up again.

The percentage that you reduce it by is also important, so there are a few factors to consider. Have you asked your DSN or pump specialist nurse about it?

Sam.

 

[sugar2]

Like Sam...I reduce my basal about an hour before exercise if i can...but it does depend on what my BG is at the time. Not sure why you would bolus, and then turn your basal down to 0..unless you ate a big carby breakfast?

I am insulin sensitive as well...and to be honest, all I can do is what seems appropriate at the time eg.

About to exercise in an hour...test, and BG is say 10, I would do a very small bolus...retest in 1/2 an hour, and then adjust basal accordingly.

About to exercise, test BG its say, 5...turn down basal to about 20% and exercise an hour later.
About to exercise, BG is 3.5....eat some glucose tablets, turn down bolus accordingly...test again before exercise in case I had gone too far.

Not saying thsi is what you should do at all...just I find it interesting to see what other people do, as it gives me ideas about what to try.

 

[donnellysdogs]

I walk my dogs every day and this was what led me to almost a cropper with my driving licence and led me to being on a pump as well.....

Being on a pump has been really difficult as well to cope with the lows after walking. However, nowadays I have got it sorted.....but this may just be what suits me.....

For example I go for my walks at 12.30, and I reduce my basals right down from 10am
9am basal is 0.90
10am 0.39
11am 0.45
noon 0.40
1pm 0.40 (whilst walking)
2pm 0.75

I also always eat 3 ryvita's with a topping of some sort-normally banana before I walk with a normal bolus.

and today for example my readings have been

11am 5.4
12.20 before driving and 5 minutes before walking 7.0
13.55 after walking and before driving home 6.8

and this is regularly so, levels will generally be between 5.8 and 6.3 before walking and between 6.3 and 7.3 afterwards.

Just giving you my basal levels to show you that I have to drop my basals dramatically 2 hours before dog walks and during them. If the weather is warm, or very cold I have to drop my basals further as well, because my BG's will drop dramatically according to the weather being hot or very cold. Hope this helps....

 

[donnellysdogs]

However, I see you are walking your dogs in the morning- I do this as well. However, in the mornings I get extreme high's for 1 hour directly after I get up. I do not bolus anyhting at all until after I have walked my dogs in the morning. The walks in the morning are shorter, only about 40 minutes, but I have to give huge bolus's from 3am to 9am just to cope with my 1 hour huge surge from when I get up at 8am.

Although I bolus before my lunchtime walks, I do not bolus before I walk my dogs in the mornings, I do have to keep pretty much to routines. I test at 7am, and my levels were 6.8 this morn, so I start to get up, but I don't actually manage to get out the door to walk the dogs before 8. I come back from walking the dogs, feed them and medicate them and have a cup of coffee, by which time it is genearlly about 9.30 and like this morning I will sit and do another blood test, and this morning it was 6.0 and at 11am it was 5.4. Nowadays I have a brunch of my ryvitas and toppings before I ten walk the dogs again at 12.30.

For some reason I have my mind set nowadays that I will not bolus before I have walked the dogs in the mornigs, probably because I know that my levels stay so perfect every morning with the routine that I have.

Sometimes after my dog walks in the afternoons I will still go low and I know the occasions are now around problems with my carb ratio and bolusing rather than my basals being wrong.

 

[jopar]

It is really a case of trail and error to find the best time to set TBR for exercise...

An hour before hand is a pretty common time slot for a lot of pumpers, hence it's the suggest starting point... But does need fine tuning indeed..

I find that I can wait until I'm almost out the door before I set my TBR, but that's because I'm sensitive to insulin so setting a TRB an hour before ment that I became too high before I started,

But if I do set a TBR really depends on what I am doing with the dogs, as the dogs go out several times a day, and what sort of training I'm doing while we out walking, if it's mind stimitulation games then for me it's not overly active but if we are doing obedience or search and retrieve I'm a lot more active so TBR is set..

It may be that you have to set 2 TBR's to cover, A small reduction to start, then reducing it again nearer, as you start or even during the exercise period to compensate for your sensitivity

 

[johnny37]

Thanks for the replies.
Yesterday, with no change in routine, bg before breakfast was 7.4, then 7.6 one hour later. I reduced TBR to zero and went on a dog walk. On return one hour later bg was 4.4. I wish it could be like that all the time. From the above replies though It looks like the pump is not the magic solution I was expecting. For me a few less hypos and lots of corrections. Not unlike MDI without the injections.

ps I do have a high carb breakfast. 100g muesli + 5g nuts and seeds + 200g semi skimmed milk.
carb total is 75g and ratio is 1:25, ie 3u bolus.

 

[donnellysdogs]

Ok, good starting point here....it seems to me that you need to lower you basal rates 2-3 hours before you walk your dogs..... putting a temporary basal rate on just before walking your dogs will not counteract the exercise....that temporary basal rate will only truly being hitting your body 2 -3 hours after you have done the exercise.

My advice would be to lower your basal rates by 50% for the 2-3 hours before the dog walks.

Also your breakfast, are you having it before your walk or after? I wouldn't worry about your bolus for that at the moment. To be honest, I find skipping breakfast and testing true basal rates is the easiest of the basals testing to be done. It could be the bolus for breakfast, but I would start off lowering your basals 50% for 3 hours before you walk the dogs and put breakfast back a few hours, get a true feeling for what is happening with the morning dog walk. It is easier to sort out high's than low's.

And yes, I too have felt that MDI was a lot easier and had far less impact on my life than the pump. To be quite honest I believe that my better results with my pump have only come from testing so much more than when I was on MDI, and I honestly can't say that I actually feel wonderful about the extra's that we have to do with the pump compared to the MDI. However, these extras are only minutes of our life's, and hopefully the better control on a long term basis will more than compensate with giving us less complications and a longer life. I find it very difficult to understand at the moment how people say that a pump has given them their life's back, but when I think about the actual time and my actual readings now, it does give me a better balance to thinking about it. I do wish however, that I was given more information prior to having the pump at about the exact needs of testing and amending rates etc, but now I don't think I would go back to MDI, but I honestly don't have a huge elation about having a pump....

Best wishes Sharon

 

[donnellysdogs]

Concerned that you can be still dropping by 3 during a dog walk. I really would start by dropping your basals 3 hours before walking. Switing a tbr to 0% is effectively turning the machine off, and I was told that this can lead to occluisons and other problems with pump if constantly setting a TBR to 0% or turning the pump off.

Might be that you need to lower basals 3 hours before hand and then also have a tbr of 50% whilst walking etc.

I no longer use TBR's for any of my dog walks, and wouldn't want to as I have a shocking memory and would forget. Personally I think it would be much better if you have a routine of walking dogs at a certain time each day to get the basals right on a permanent basis.