[Mich]

After reading BarbaraC's and Subby's posts on Barbara's thread, I began to wonder how many of you have more than two basal rates and why.

I too, have been having ups, downs and absorbtion issues. I'm just taking Keflex for my fourth cellulitis. I seem to get them from something rubbing on my site, or maybe soap staying on it after a shower? I always use a sterile field when changing so it's a mystery to me (except for the one caused by Coastal Eddie the Cat biting my tubing.)

I also see lots of absorbtion issues. It takes a while for a site to "clear" and I tend to resist arms and legs also. Except for one notable time, just before I decided to pump two years ago, my A1C was better on MDI. Also, in two years, I've gained a lot of weight around my middle that seems to stay no matter what I do.

I've been seriously considering going back to MDI, but thought I would explore the "numerous basal rate" approach. I can't really decide what is enough of a difference in basal to set a new rate. Right now I have only two. Regular and inactive.

Who uses more. How do they look? I love my pump but I just wonder if it's right for me.

Mich

[xMenace]

I use one main set of rates: 16 rates per day. It keeps me flat without food. I make adjustments to that based on percentage. I'm pretty sedate right now, so I'll up it to as much as 140%. When I am active or super-bolusing or expecting to drop in the night (alcohol, activity) I'll drop it down to 50% or even lower. I did have two separate rates, but I found I never used the 2nd. I know some women fighting mentruel cycles have more than one rate.

[Subby]

One of these day's I'll write a short post. Sorry for such wordiness... ah well...

As those on the minimed will attest, inserting and editing basals can be a real pain. So after a while of really fiddling with "basal periods" I just sat down and put in a basal rate for each 2 hours. This make sit much easier as you refine them.

What got me to 2 hours? Once I generally ironed out my morning and got some consistent days courtesy of basal testing, (ie days I got to 12pm without hitting 10 mml/l / 180 mg/dl (which for me is extremely tricky w/o great basals), and about 3 or 4 rates), I discovered a picture of my common natural pattern in the arvo:

If 100% basal is what I got to at 12pm:

- From 12 on I climb steadily to say 200% over the next few hours
- then I get a sharp drop in basal reqs, as in back to 60% over 1 or 2 hours, sometime between 4 and 7.

When I started really trying to nail that down, I started to feel like I was getting somewhere when around those trouble times, I started really plotting a curve through the hours. Once I stuck in a framework of 2 hourly rates, I assumed many of them would just remain "repeats" but I found that tweaking at least every 2 hours has been of great benefit. Recently I tried, (again trying to tow the line for the doctor, foolishly) to re-generalise downwards, try and get it to a more "acceptable" number of rates, but found each one really did contribute. I may go to John's resolution at some stage, once I feel I've ironed out other issues and it's warranted.

What is fascinating (but obvious) is that when "blindly" tweaking my basals, it produces a very curvy, wavy effect through the day. It is a pattern, rather than a few levels. Some time I will graph it/scan it and upload it. So when my doctors/DE's looked at all these numbers and freaked out at something so outlandish and frighteningly over-the-top for them, I sat there thinking sadly "how blind are you guys?" - to me it made so much more sense that I was discovering the ebbs and tides of my body's basal requirements, and that a graduated basal rate if sensitively adjusted, will be much better at suiting basal reqs (if one has big variability like me, that is).

Yes, a pain in the backside to adjust over the phone in 40 seconds, which is what my dr's want. Yes, more complex than is desirable. Bugger them. Sad fact: the truth isn't always easy or convenient.

By the way, my HBA1c is currently still around the 6.5 - 7 mark, as is pretty usual for me (so, OK but not considered that great by "tight control" standards). This should improve next HBA1c, but my point is that you can get so much improvement without it reflected in HBA1c. My daily health is many times better, simply for having more even BG through the day and less spiking, most days. Like, life-changing better.

[Subby]

As far as the issue of changing needs on an event/day basis, (eg, active/inactive, sickness, just "happens" variablity etc)

I'm similar to John: I find temp basals are extremely versatile to use as a tool, and also like John I find that having just one set seems to be the way to go, even though multiple patterns sounds a good idea. Even though I do have very different days, using the one pattern and adjusting with temp basals is kind of like driving a car you know well, differently over different terrain, rather than trying to drive another vehicle that may be more suited to the terrain but that is less familiar to you, leading to less control from unfamiliarity.

I bet patterns are fantastic for some, though. People with very different structured days might benefit well from them. My days tend to have a lot of change, but not enough alternative structures to really suit getting to know another pattern.

[Mich]

Thank you both, John and Subby.

Having one daily basal pattern, fine-tuned, and varying by reducing percentage of basal makes perfect sense to me.

I just sat down and chopped my daily basal into two hour segments except for one spot (4-5-6 AM) where I know I need a 5 AM change. Now I will do basal testing and determine the fine points.

John, I also plan to pre-bolus more often when eating higher glycemic foods. I've been slacking on that and it shows.

Subby, you're correct. Our bodies are just not set up conveniently for the 5 minute phone consult.

Thank you both again, now I understand a structure for how to set up my variable basal rate.

Mich

[Gordonm]

I have 5 different rates in a day. I often will do a temp basal based on my activity. I drive quite a bit and if I know I'm in the car for 2 or more hours I will up it to 150% for that time. If I am very active that day I will lower it accordingly sometimes to as little as 40%. Nothing is exact. The pump is great but not perfect. My A1cs are in the 5.8 to 6.2 range with this.

[solox316]

Without looking, I think I have 10-12 rates in one day. Much higher in the 5A-9Aish hours, due to insulin resistance... Very low during the afternoon, like half of the morning amounts... and somewhere in the middle come evening... the large number deal with the transition from morning to afternoon to evening... if that makes sense....

i used temps a lot, particually for excercise and "laziness", and sometimes for alcohol to avoid dropping low while sleeping...

[Chappo]

Since i've just started i'm one the one basal rate - 0.825u/hr (which will change once i see my endo this week).

I'm continually going down to sub 3's right on 11:15am. I will usually temp bolus -20% from 11pm-4am, and then that alleviates night-time hypos and stops just in time to stop DP. I've been waking up around 5.2

So for now i'm just temp bolusing each day with what i'm doing, it's a great tool!

[The_QUIET_one]

By rates do you mean how much insulin per hour? I find this is one of the most useful things about pumps, if you find that around 12am your always high for some inexplicable reason just change that part of your basal rate thats what I understood. I dont see why you would think MDI would improve it as that is one flat rate with lantus. Perhaps I misunderstood the question?

[Subby]

Quiet One, yep, rates as in basal rates / insulin per hour. Nope, I don't think the point was to argue Lantus vs pump rates, rather the question was what to try to make pump basals more effective.

Chappo, you've hit on a great way to troubleshoot and decide on new basals - when I find myself putting in a similar temp basal to deal with something a few times in a row, and it helps, I then know it's time to change my actual basal rates. (providing of course it was for a "routine" period). It's a good way to "try a rate on" and see how it goes, then change the underlying structure if you learn something.

[xMenace]

Originally Posted by Subby

As those on the minimed will attest, inserting and editing basals can be a real pain. So after a while of really fiddling with "basal periods" I just sat down and put in a basal rate for each 2 hours. This make sit much easier as you refine them.

I settled on 24 rates. I thought about 48 but not for long

They go something like this starting at midnight

1 .7
2 .7
3 .7
4 .7
5 1.3
6 1.85
7 1.85
8 1.85
9 1.85
10 1.15
11 .6
noon .45
1 .45
2 .45
3 .45
4 .9
5 1.3
6 1.4
7 1.4
8 1.3
9 1.15
10 .85
11 .75

[Chappo]

Subby, i pretty much decided if i need a basal rate at the same time more than 4 times in a row, in the pump it goes. Today i made my first change to my 0.825 regime, and dialed down my 9.30am - midday dosage to 0.7

For the past 3 days i was dipping just under 4, sometimes to around 3.3, and having to suspend/-30% to recover. So i'll see how it goes tomorrow as it's programmed in

[pegasus]

Originally Posted by Gordonm

I have 5 different rates in a day. I often will do a temp basal based on my activity. I drive quite a bit and if I know I'm in the car for 2 or more hours I will up it to 150% for that time. If I am very active that day I will lower it accordingly sometimes to as little as 40%. Nothing is exact.

My approach is similar to this. The following is pretty basic, but since I'm still fine-tuning after 4 mths, I remind myself of it when I'm thinking about changing. At the beginning, my trainer took my total (~28 u/day), divided by 2 (1/2 for basal, 1/2 for bolus), and then the 1/2 for basal by 24. Then looked at the basic basal testing info (a.m. fasting BS) and increased that (I'm not sure I have much dawn phenomena, but there's some); then at premeals and increased or decreased here and there. She fine-tuned a bit over the following couple of weeks, but since minimed paid badly for followup sessions, those ended. So I've been tweaking ever since. I'm at 6 rates now.

Yesterday I went bike riding for the first time since going on pump. I know I'm insulin sensitive, so I used a temp basal of 65% for 3 hours (to try and cover after ride as well). When I left I was at 145; when I returned I was at 63. I immediately dropped the temp to 55% for 2 hours and took a small amount of glucose (I don't find the 15-15-15 works for me). I monitored every 15-20 mins for the next couple of hours, and when I didn't increase enough, I dropped the temp to 45% for 2 hours. After that my BS stayed between 80 and 90 for a while. I think I hit over 100 once all evening, and woke up at 86.

So, the short of this long story, Mich, is that I'd guess you need more than 2 basal rates a day--it's just important for you to find your own.

I've ignored the idea of patterns so far--the basics have been too involving for me. My understanding is that they are for if your overall lifestyle has some distinct changes--if you work a desk job M-F and exercise/fix your house on weekends, sort of thing. But I think it's key to get the basic one straight before worrrying about patterns.

Good luck!

PS: John--why do you consider the same rates "new" ones? Why not .7 at 1, 1.3 at 5, 1.85 at 6, 1.15 at 10, etc.?

[Mich]

Wow. Thank you all so much for the insight. Good stuff.

John, I see why you have a rate for each small chunk of time. Then if you must edit it, you don't have to go back and change them all.

QuietOne, I brought up MDI because I am also having absorption problems or insulin going bad problems. I'm trying to figure that one out too.

I had wonderful control for my first year and a half of pump use. Now it seems it's all going south quickly.

Thank you all again for the good info. It will help me figure things out. Mich

PS My new avatar is Coastal Eddie the Cat, at about the age a year ago when he chewed through my tubing and gave me cellulitis. My first big pump surprise!

[Subby]

cute cat Aren't they little buggers sometimes.