[Cyborg]

After adjusting the basal rates for nighttime, there seems to be 3 other periods that need to be tested. From what I've been reading, the 3 periods are:

1) wake to lunch
2) lunch to late afternoon
3) later afternoon to bedtime

Is there a specific order in which these should be tested?

[JediSkipdogg]

Originally Posted by Cyborg

After adjusting the basal rates for nighttime, there seems to be 3 other periods that need to be tested. From what I've been reading, the 3 periods are:

1) wake to lunch
2) lunch to late afternoon
3) later afternoon to bedtime

Is there a specific order in which these should be tested?

Nope. I just like to do them in the order you are doing and have them listed. There really isn't any particular order, but it does help if you don't jump around too much, like do night then go to afternoon then breakfast then evening. You should try to have an overlap of a good basal rate set so you can know you are starting with something good for when you give your meal bolus to state the testing process.

[spike]

Originally Posted by Cyborg

After adjusting the basal rates for nighttime, there seems to be 3 other periods that need to be tested. From what I've been reading, the 3 periods are:

1) wake to lunch
2) lunch to late afternoon
3) later afternoon to bedtime

Is there a specific order in which these should be tested?

I found that ANY meal I could skip because my bg's were stable going into the period was useful for checking basal rates. Sometimes I'd be stable in the afternoon and so I'd skip supper and check out my evening basal rates. I kept meticulous logs to review the results from changes. I'd change by just .1/U up or down and then I'd need to skip the same meal another day to see if I hit my target bg range.

[Cyborg]

My trainer asked me to do the afternoon to bedtime basal test first. So today I eat a late dinner or no dinner at all, probably a late snack. I'll repeat the test for the next 2 days also. I did think it a little odd that my trainer didn't request them in the order listed though.

[Cyborg]

How far in advance of meal time do you adjust your basal rate if I find myself going high or low during one of the test periods (I'm using Novalog)?

[Cyborg]

Sorry to be such a pain in the @ss!

Do you start the test when you normally eat? So for my dinner testing if I normally eat dinner at 7:30, would I start the test then?

Thanks a bunch...

[spike]

Originally Posted by Cyborg

Sorry to be such a pain in the @ss!

Do you start the test when you normally eat? So for my dinner testing if I normally eat dinner at 7:30, would I start the test then?

Thanks a bunch...

No.


the following is a BRIEF overview of what a new pumper will be doing to get their basals, carb-insulin ratio, and insulin sensitivity adjusted. Do not just start in by following my BRIEF comments on the subject, please!

You need to get your basals correct for every hour of the day and night. You need to be testing around the clock to get your basals accurate. that means waking up to check at night. I have no problem doing that, as I never sleep a solid 8 hours anyway!

Anyway, getting back to your question, you need to have a basal rate that will keep you in your target range exclusive of eating and bolusing. So you don't START testing at 7:30. You test every hour or more and you'll need to retest another day to see the effect of any changes you've made. Keep detailed records so you can return to the previous setup if need be or to determine how much more to adjust it next time, if necessary. You must be methodical about this. If you are able to skip quite a few meals due to being in excellent control it shouldn't take more than a few weeks to refine the rates.

Once you've got the basals perfected to your satisfaction, then you can do the "insullin sensitivity" testing. You must have very stable bg's, somewhat above normal, and then you take ONE unit of insulin and check your bg's until you hit the 4-5 hour mark and see how far you've dropped. That becomes your guide for doing corrective boluses. My number goes way down in the middle of the night to 25 from my daytime number of 38, due to the dawn phenon.

You can also work on your carb to insulin ratios after the basals are accurate. Eat a known quantity of carbs and bolus and keep checking your bg's to see if you went too high or too low. At some point, you discover a "ratio" that works except for breakfast when many folks have a lower ratio, ie a unit of insulin covers LESS carbs than later in the day.

Before doing all this you should know the ballpark values! don't make wild guesses. talk to your doc before embarking on any changes to your insulin dosages. I have been given you an overview of the process, but you need to discuss all this with your doctor before attempting to make adjustments to your insulin therapy.


DISCLAIMER:
Don't just take my comments on "how to" as gospel. You should not just follow what I've written without checking with your doctor and/or your pumping books. I am NOT a medical professional! Keep your doctor informed as he/she has requested.

[Cyborg]

Thanks for the info Spike. I have read alot on the forum and the pumping insulin book and some good info from this site: http://www.insulin-pumpers.org/howto.shtml. I always feel rushed with the trainer and I only have an office number for her so I appreciate your input.

It sounds like setting the basal rates correctly is something that is required to prevent 2 things.

1) The obvious, avoid hypoglycemia.

2) Avoid hyperglycemia, which in a type 1 diabetic could lead to KDA because when you don't eat your body produces glucose that you need to offset with insluin.

If that's correct, then it's starting to make sense. (Where's the lightbulb icon?)

[spike]

Originally Posted by Cyborg

Thanks for the info Spike. I have read alot on the forum and the pumping insulin book and some good info from this site: http://www.insulin-pumpers.org/howto.shtml. I always feel rushed with the trainer and I only have an office number for her so I appreciate your input.

It sounds like setting the basal rates correctly is something that is required to prevent 2 things.

1) The obvious, avoid hypoglycemia.

2) Avoid hyperglycemia, which in a type 1 diabetic could lead to KDA because when you don't eat your body produces glucose that you need to offset with insluin.

If that's correct, then it's starting to make sense. (Where's the lightbulb icon?)

You need to know how to BOLUS properly to avoid hypos and hypers, as well as getting the BASALS right.


Yes, a T1 always need a basal insulin, because even when they are fasting, their body requires some insulin. That's why a failed infusion set CAN be dangerous, but only if one avoids regular bg testing.

A lack of insulin (like when your infusion set has a kinked cannula) can lead to DKA, which is a life threatening situtation, if allowed to persist. that doesn't mean you'll die 6 hours after a lack of basal insulin! It means that anyone on a pump needs to do regular bg checks. don't change sets before bedtime. If you engage in contact sports or or rigorous activites like crawling around on your belly under the house, make sure your set hasn't become dislodged. If you have several UNEXPLAINED high bg's consider changing your set. That doesn't mean that if you eat a meal that you aren't sure of the carb count, and you go higher than you'd hoped, that you'd change your set. That's an EXPECTED issue. I've had a few 400's over 10 years; less than a 1/2 dozen. I didn't stay there long. I changed my sets, and injected with a syringe to get it back in line. I've never gone over 8 hours without basal insulin. Once I had a set come out during the night because the tubing got tangled up. not bad for 10 years. I just throw my pump next to me while sleeping.

again, I don't want you changing your treatment based on my comments. I'm just relaying my experiences. Do your best to reach your doctor for any changes. Most of us pumpers are a self reliant lot, but we shouldn't be advocating that a new pumper "go it alone".

[BOZO]

Hello! I joined this group an hour ago; my first experience with this type of communication. I hope I don't mess it up! I might be in the wrong place, but bear with me til I figure out what I'm doing! I'm a type II, IDDM, Novlin N and Lantus of 6 years duration. I'm 3rd generation diabetic, but held on til I was much older than all my relatives. My interest as a type II diabetic was in the refrigeration aspect of insulin maintenance. Have been having problems when traveling recently.. when to keep cold..if to keep cold, etc., etc. til our vacations are always on edge when it comes to my insulin. On a recent trip, the hotel manager refused to help me when our room refrigerator didn't work, and I was concerned about keeping my insulin cold. (Again, the reason I visited your site...)He was totally insensitive to my needs, and told me to carry a cooler pack! What do any of you carry as far as a cooler pack is concerned when you travel. How do you keep it cold if your can't find a hotel that will freeze the pack for you? Thanks to all for your help.

[spike]

Originally Posted by BOZO

Hello! I joined this group an hour ago; my first experience with this type of communication. I hope I don't mess it up! I might be in the wrong place, but bear with me til I figure out what I'm doing! I'm a type II, IDDM, Novlin N and Lantus of 6 years duration. I'm 3rd generation diabetic, but held on til I was much older than all my relatives. My interest as a type II diabetic was in the refrigeration aspect of insulin maintenance. Have been having problems when traveling recently.. when to keep cold..if to keep cold, etc., etc. til our vacations are always on edge when it comes to my insulin. On a recent trip, the hotel manager refused to help me when our room refrigerator didn't work, and I was concerned about keeping my insulin cold. (Again, the reason I visited your site...)He was totally insensitive to my needs, and told me to carry a cooler pack! What do any of you carry as far as a cooler pack is concerned when you travel. How do you keep it cold if your can't find a hotel that will freeze the pack for you? Thanks to all for your help.

funny you should ask about cold and insulin. Your insulin will be ok for a few WEEKS at room temperature. Keep the "stash" in the fridge, but don't worry about the "working" bottle(s). of course, NEVER leave it in a parked car in warm/hot weather. and don't let it freeze.

the first time I went to tahoe I bugged the hotel to find a place for my insulin. I was new at DM and naive. Now I know the stuff isn't all that sensitive.

[Cyborg]

I would always take a soft cooler bag and some frozen blue ice or equivalent to get it there. I found that if you call the hotel ahead of time that it helps sometimes, but not always. Often you have to "remind" them when you get there and they will usually get you a small portable if you tell them its for medical supplies. The other day I found a link to a portable fridge/oven. It looked pretty cool, but I can't vouch for it. It was sold at Fry's. You could just stick with hotels that have fridges in the rooms, which is what I tried to do, but I know that's hard to do sometimes.

Maybe Spikes right, I don't know, but I'll be asking my endo his opinion in a week. You might want to do the same. I asked a question myself about pumping before I started 5 days ago. I asked if the pump kept the insulin cold and the answer is no it doesn't...

[spike]

Originally Posted by Cyborg

I would always take a soft cooler bag and some frozen blue ice or equivalent to get it there. I found that if you call the hotel ahead of time that it helps sometimes, but not always. Often you have to "remind" them when you get there and they will usually get you a small portable if you tell them its for medical supplies. The other day I found a link to a portable fridge/oven. It looked pretty cool, but I can't vouch for it. It was sold at Fry's. You could just stick with hotels that have fridges in the rooms, which is what I tried to do, but I know that's hard to do sometimes.

Maybe Spikes right, I don't know, but I'll be asking my endo his opinion in a week. You might want to do the same. I asked a question myself about pumping before I started 5 days ago. I asked if the pump kept the insulin cold and the answer is no it doesn't...

I've laid out most of the day in the Vegas sun with my pump and nary a problem with "weakend" insulin. I've spent entire days in 102+ heat and not had a problem. I get kinda peeved at people who swear it's going to self destruct in a short time (I'm back to the "if it works", don't tell me it won't ) I just know someone is going to jump into this discussion and talk about the dangers of warmed insulin going bad. I'm sure it does, but if I can stand the heat, my insulin has survived too. I would expect that repeated exposure to high heat will degrade the insulin markedly, but on a PRACTICAL basis I've not needed to resort to any special measure to "protect" my insulin pump, other than to not leave it laying flat in full sun if I'm reclining in a lounger for hours. I'll slip it under the chair, or place it inside my shorts/swim trunks (I use a belt clip on the pump). I also go swimming with it. YMMV!

[Cyborg]

I think my internal body temp is around 98.6 fahrenheit.